Abstract
Background
Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis.
Methods
This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction.
Results
CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use.
Conclusions
CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.
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References
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.
Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104–7.
Johnston CF, Tomlinson G, Temple LK, Baxter NN. The management of patients with T1 adenocarcinoma of the low rectum: a decision analysis. Dis Colon Rectum. 2013;56(4):400–7.
Vironen JH, Kairaluoma M, Aalto AM, Kellokumpu IH. Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum. 2006;49(5):568–78.
Pucciarelli S, Del Bianco P, Efficace F, et al. Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery. Support Care Cancer. 2010;18(5):601–8.
Emmertsen KJ, Laurberg S, Rectal Cancer Function Study G. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg. 2013;100(10):1377–87.
Pittman J, Rawl SM, Schmidt CM, et al. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J Wound Ostomy Continence Nursing. 2008;35(5):493–503.
McMullen CK, Hornbrook MC, Grant M, et al. The greatest challenges reported by long-term colorectal cancer survivors with stomas. J Supportive Oncol. 2008;6(4):175–82.
Krouse RS, Grant M, Wendel CS, et al. A mixed-methods evaluation of health-related quality of life for male veterans with and without intestinal stomas. Dis Colon Rectum. 2007;50(12):2054–66.
Krouse R, Grant M, Ferrell B, Dean G, Nelson R, Chu D. Quality of life outcomes in 599 cancer and non-cancer patients with colostomies. J Surg Res. 2007;138(1):79-87.
Sun V, Grant M, McMullen CK, et al. Surviving colorectal cancer: long-term, persistent ostomy-specific concerns and adaptations. J Wound Ostomy Continence Nurs. 2013;40(1):61–72.
Horner DJ, Wendel CS, Skeps R, et al. Positive correlation of employment and psychological well-being for veterans with major abdominal surgery. Am J Surg. 2010;200(5):585–90.
Knowles G, Haigh R, McLean C, Phillips HA, Dunlop MG, Din FV. Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life. Eur J Oncol Nurs. 2013;17(5):570–7.
Landers M, Savage E, McCarthy G, Fitzpatrick JJ. Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer. Clin J Oncol Nurs. 2011;15(6):E105–13.
Lai X, Wong FK, Ching SS. Review of bowel dysfunction of rectal cancer patients during the first five years after sphincter-preserving surgery: a population in need of nursing attention. Eur J Oncol Nurs. 2013;17(5):681–92.
Thaysen HV, Jess P, Laurberg S. Health-related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer: a review. Colorectal Dis. 2012;14(7):797–803.
Taylor C, Morgan L. Quality of life following reversal of temporary stoma after rectal cancer treatment. Eur J Oncol Nurs. 2011;15(1):59–66.
Hida J, Yoshifuji T, Tokoro T, et al. Long-term functional outcome of low anterior resection with colonic J-pouch reconstruction for rectal cancer in the elderly. Dis Colon Rectum. 2004;47(9):1448–54.
Ramirez M, McMullen C, Grant M, Altschuler A, Hornbrook MC, Krouse RS. Figuring out sex in a reconfigured body: experiences of female colorectal cancer survivors with ostomies. Women Health. 2009;49(8):608–24.
Mohler MJ, Coons SJ, Hornbrook MC, et al. The health-related quality of life in long-term colorectal cancer survivors study: objectives, methods and patient sample. Curr Med Res Opin. 2008;24(7):2059–70.
Krouse RS, Mohler MJ, Wendel CS, et al. The VA ostomy health-related quality of life study: objectives, methods, and patient sample. Curr Med Res Opin. 2006;22(4):781–91.
McHorney CA, Ware JE Jr, Rogers W, Raczek AE, Lu JF. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care. 1992;30(5 Suppl):MS253–65.
Grant M, Ferrell B, Dean G, Uman G, Chu D, Krouse R. Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire. Qual Life Res. 2004;13(8):1445–57.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.
Liu L, Herrinton LJ, Hornbrook MC, Wendel CS, Grant M, Krouse RS. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. Dis Colon Rectum. 2010;53(2):200–12.
Krouse RS, Herrinton LJ, Grant M, et al. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol. 2009;27(28):4664–70.
Krouse RS, Grant M, Rawl SM, et al. Coping and acceptance: the greatest challenge for veterans with intestinal stomas. J Psychosom Res. 2009;66(3):227–33.
Grant M, McMullen CK, Altschuler A, et al. Gender differences in quality of life among long-term colorectal cancer survivors with ostomies. Oncol Nurs Forum. 2011;38(5):587–96.
Sun V, Borneman T, Koczywas M, et al. Quality of life and barriers to symptom management in colon cancer. Eur J Oncol Nurs. 2012;16(3):276–80.
Acknowledgment
This research was supported by VA HSR&D grant IIR-02-221, R01 CA106912, CA106912-02S1, Sun Capital Partners Foundation, and Arizona Cancer Center Support Grant CA023074. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or the NIH, or any other funders.
Disclosure
Dr. Herrinton: Research funding support from Centocor, P & G, Genentech, and Medimmune. The other authors have no financial disclosures to report.
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Sun, V., Grant, M., Wendel, C.S. et al. Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors. Ann Surg Oncol 22, 4317–4324 (2015). https://doi.org/10.1245/s10434-015-4731-9
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DOI: https://doi.org/10.1245/s10434-015-4731-9