Systematic review of the impact of demographic and socioeconomic factors on quality of life in ostomized colorectal cancer survivors

Abstract

Background: Formation of a fecal stoma may be necessary to ensure radical resection in colorectal cancer (CRC) patients but will substantially impact the health-related quality of life (HRQoL) in about 20% of cases. Little is known about patient-related risk factors for reduced HRQoL in patients with a permanent stoma. We, therefore, reviewed the current literature on how demographic and socioeconomic factors affect HRQoL in CRC survivors with a stoma. Material and methods: The databases Pubmed, Embase, CINAHL, and PsycINFO were systematically searched. Two independent reviewers extracted and quality-assessed eligible publications. Studies assessing HRQoL using a validated questionnaire at least 6 months after surgery for CRC were included if data on the impact of demographic and/or socioeconomic, factors on HRQoL were analyzed and presented. Results: Eligible studies predominantly presented small cross-sectional cohorts. Age showed equivocal results; hence, some studies found younger patients had inferior HRQoL compared with older patients, and others found no difference. Subdivision into age groups differed widely. Several studies found that both generic and stoma-specific HRQoL was lower in females compared with males. Most studies found that socioeconomic factors did not affect HRQoL while one study found lower education correlated to reduced HRQoL. Categorization of these factors also varied widely. Conclusions: This is to our knowledge the first systematic review on the impact of patient-related factors on HRQoL in long-term CRC survivors. We found that a stoma had more impact in younger ostomates than older and that HRQoL in females was reduced more than in males. Conclusions regarding other factors were difficult due to few studies and contradictory results. Further research in this subject is much needed in order to target preventive measures when planning surgery in patients in high risk of reduced HRQoL.

Health professionals’ perceptions of colorectal cancer patients’ treatment burden and their supportive work to ameliorate the burden – a qualitative study

“…Treatment varies depending on the cancer stage at the time of diagnosis, but most patients receive surgical treatment. For some of the patients, the diagnosis of low, rectal cancer or surgical complications of anastomotic leakage results in the formation of a stoma, affecting the patients’ quality of life [ 12 ]. Patients with stage II or stage III are offered rectal cancer preoperative chemo-radiation as standard treatment [ 2 ], whereas patients diagnosed with CRC stage II or stage III often need adjuvant chemotherapy treatment post-surgery [ 13 ].…”

The Quality of Life of Patients with Surgically Treated Colorectal Cancer: A Narrative Review

“…The type of surgical procedure influences the QoL of CRC patients [ 58 , 59 ]. Surprisingly it is still unclear whether socioeconomic status affects the QoL of CRC patients with a stoma who survived or did not [ 60 ]. A group of frail patients has been shown to improve in emotional functioning at 3 months after the surgery [ 25 ].…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

“…Beyond the typical short-term metrics captured in standard databases, the morbidity of ostomy surgery may also be measured in terms of the stoma-related negative effects on the quality of life and other long-term morbidities related to having an ostomy. [3][4][5][6][7][8] Many patients have ostomies that are considered "problematic" and present with management problems like skin irritation and pouching difficulties that require prolonged and specialized care and result in increased utilization of health care resources and increased costs. [9][10][11][12][13][14][15] The incidence and impact of short-and long-term stoma-related complications can be mitigated by perioperative education and marking, proper surgical technique, and attention to postoperative care pathways.…”