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GebreLibanos H, Taye G, Wondimagegnehu A, Feyisa JD, Afework T, Gebreegziabher E, Gufue ZH. The quality of life of colorectal cancer patients attending the cancer center in addis Ababa, Ethiopia. BMC Cancer 2025; 25:754. [PMID: 40263993 PMCID: PMC12012933 DOI: 10.1186/s12885-025-14122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 04/08/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND Globally, colorectal cancer (CRC) is the third most common type of cancer and the second most deadly. CRC significantly impairs patients' overall and health-related quality of life, as well as their psychological and physical function. However, in Ethiopia, there is insufficient local evidence about the quality of life of patients with colorectal cancer. Hence, this study aimed to assess the quality of life of adult colorectal cancer patients who have follow-ups at the cancer center in Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. METHODS An institutional-based cross-sectional study was conducted among 159 colorectal cancer patients attending the Tikur Anbessa Specialized Hospital Cancer Center from February to April 2019. The validated Amharic version of the European Organisation for Research and Treatment of Cancer Core 30 questionnaire (EORTC QLQ C-30) and the disease-specific colorectal cancer questionnaire (EORTC QLQ CR-29) were used. A binary logistic regression model was used to identify the factors associated with quality of life. The adjusted measure of effect (AOR) with a 95% CI was presented and P < 0.05 was used to declare statistical significance. RESULTS There were 159 colorectal cancer patients, 89 of whom were male, and the median time from diagnosis was 12.5 months. The patients had a low global health status score with a mean (± SD) of 52.88 ± 21.02. Being employed (AOR = 3.41; 95% CI 1.15, 10.17), early-stage clinical diagnosis (AOR = 4.98; 95% CI 1.51, 16.4), physical functioning (AOR = 1.04, 95% CI 1.01, 1.06), and social functioning (AOR = 1.02; 95% CI 1.01, 1.04) were associated with good quality of life. Whereas, being female (AOR = 0.16; 95% CI 0.05, 0.52), having financial difficulty (AOR = 0.98; 95% CI 0.96, 0.99), and having blood and mucus in the stool (AOR = 0.94; 95% CI 0.91, 0.96) were associated with poor quality of life. CONCLUSION In our study, half of our study participants had poor quality of life. The responsible stakeholders should identify and address the patients' respective symptoms. Female patients, those in severe clinical stages, unemployed patients, those experiencing financial difficulties, and those with blood and mucus in their stool should receive due attention.
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Affiliation(s)
- Helen GebreLibanos
- Department of Epidemiology, School of Public Health, Debre Birhan University, Debre Birhan, Ethiopia.
| | - Girma Taye
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abigiya Wondimagegnehu
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jilicha Diribi Feyisa
- Department of Radiation Oncology and Applied Sciences, Dartmouth Cancer Center, Lebanon, NH, USA
| | - Tsion Afework
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Sociology Department, School of Social and Political Science, University of Glasgow, Glasgow, UK
| | | | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
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Yazd SMM, Shahriarirad R, Almasi S, Naddaffard D, Sheikhi S, Mosayebi I, Goudarzi K, Tafti SMA, Behboudi B, Kazemeini A, Keramati MR. Analyzing quality of life after low anterior resection for rectal cancer. Ir J Med Sci 2024; 193:2643-2652. [PMID: 39098985 DOI: 10.1007/s11845-024-03757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/11/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Rectal cancer is one of the most common cancers worldwide that imposes high costs on patients and the healthcare system while also having a significant impact on the patient's quality of life (QoL). AIM We aimed to assess the QoL of rectal cancer patients undergoing lower anterior resection (LAR) and evaluate potential confounding factors. METHODS In this cross-sectional study, we included patients undergoing neo-adjuvant chemotherapy followed by LAR, diverting ileostomy, and adjuvant chemotherapy. Six months after stoma reversal, QoL was assessed using a cancer-specific core questionnaire EORTC QLQ-C30 and also a colorectal cancer module EORTC QLQ-CR29. Linear and quantile regression models were used to examine associations of QoL and patients' demographical and clinical features. RESULTS The study population comprised 210 patients with an average age of 61.9 ± 11.0 (range: 37-85) and 112 (53.3%) male patients. The higher tumor stage increases the QoL of patients by reducing diarrhea, loss of appetite, defecation problems, and stool frequency. Based on the linear regression analysis, a farther distance of the anastomosis from the anal verge (AV) was correlated with lower symptom scores and higher QoL. Also, at the 75th percentile cut-off of the QLQ-CR29 scores, a higher N stage of the tumor was correlated with higher QoL based on functional subscale (coefficient = 3.032, P = 0.016). CONCLUSIONS QoL of patients after LAR for rectal cancer is significantly associated with the distance of the anastomosis site from the AV.
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Affiliation(s)
- Seyed Mostafa Meshkati Yazd
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shayan Almasi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saman Sheikhi
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran
| | - Imana Mosayebi
- Department of Biotechnology, Amol University of Special Modern Technologies, Mazandaran, Iran
| | - Kimia Goudarzi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Ahmadi Tafti
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Behboudi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Kazemeini
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Keramati
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
- Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Ivatury SJ, Suwanabol PA, Roo ACD. Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients. Clin Colon Rectal Surg 2024; 37:256-265. [PMID: 38882940 PMCID: PMC11178388 DOI: 10.1055/s-0043-1770720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better inform patients deliberating treatment options for rectal cancer.
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Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Ana C. De Roo
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, Missouri
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Seow-En I, Chok AY, Matchar DB, Yoon S, Chong DQ, Tan EKW. Long-term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort. Colorectal Dis 2021; 23:2348-2360. [PMID: 34097342 DOI: 10.1111/codi.15768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/15/2021] [Accepted: 05/31/2021] [Indexed: 01/22/2023]
Abstract
AIM As populations age and cancer management improves, long-term survivorship and quality-of-life (QOL) outcomes are becoming equally important as oncological results. Data from Asian populations are scarce. We aimed to evaluate the sexual health, gastrointestinal function and QOL amongst colorectal cancer survivors in a tertiary referral centre in Singapore. METHOD Adults who had undergone elective curative surgery for non-metastatic colorectal cancer at least 2 years prior were included. Exclusion criteria were cognitive disease, serious postoperative complications or recurrent cancer. Participants were invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires EORTC-QLQ-C30 and QLQ-CR29. Using multiple bivariate analysis, r scores were used to examine relationship trends between QOL domains and survivor sociodemographic and disease-specific characteristics. RESULTS From February 2017 to July 2019, 400 responses were recorded. Median age and follow-up duration were 64 years (range 32-90) and 78 months (interquartile range 49-113) respectively. Patients who had Stage III cancer had better overall QOL scores compared to Stage I/II. Rectal (vs. colon) cancer negatively influenced sexual health and gastrointestinal function, but did not appear to affect overall QOL. Amongst our cohort, 57% (n = 129) of men and 43% (n = 75) of women were sexually active. Markers of socioeconomic status, including employment, education and housing type, were found to significantly impact perception of various aspects of QOL. CONCLUSION Knowledge of factors which influence well-being can identify individuals who may benefit from tailored management strategies. Regular patient-doctor contact may play a role in building and maintaining positive perspectives of cancer survivors. Normative data should be obtained from local populations to facilitate future comparative research.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - David Bruce Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore.,Department of Medicine, Duke University Medical School, Durham, NC, USA
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore
| | - Dawn Qingqing Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore City, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
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Ssewanyana Y, Ssekitooleko B, Suuna B, Bua E, Wadeya J, Makumbi TK, Ocen W, Omona K. Quality of life of adult individuals with intestinal stomas in Uganda: a cross sectional study. Afr Health Sci 2021; 21:427-436. [PMID: 34394325 PMCID: PMC8356576 DOI: 10.4314/ahs.v21i1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Intestinal stomas remain important life-saving surgical options in a wide range of gastrointestinal pathologies globally. Living with a stoma has potential to impair the patient's quality of life, often with associated negative psychological effects. OBJECTIVE To evaluate the quality of life among intestinal stoma patients under Mulago National Referral Hospital (MNRH), with emphasis on psychological effects and effects on family-social interactions. METHODOLOGY A cross-sectional study carried out at surgical outpatient clinics of MNRH between January and June 2018. Data was collected using Stoma-QOL questionnaire, PHQ-9 and GAD-7 from 51 participants who had lived with intestinal stomas for at least a month. RESULTS Of the 51 participants, male: female ratio was 4:1 and aged 18-84 years (mean age 44.04+18.47 years). 76.5% had colostomy; 23.5% had ileostomy. Majority (88.2%) had temporary stomas. The overall mean Stoma-QOL score was 55.12+ 17.04. Only about a quarter (24%) of participants had Stoma-QOL scores >70 (best). Most patients exhibited negative psychological effects (anxiety-100%, concerns about changed body image - 96.1% and depression - 88.4%). CONCLUSION Most participants had low levels of stoma-related quality of life, suffered negative psychological effects and exhibited limited social interactions. This calls for efforts to support Stoma patients adapt beter life.
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Affiliation(s)
- Yasin Ssewanyana
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda. Tel; +256774988991
| | - Badru Ssekitooleko
- Department of Surgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Bashir Suuna
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda. Tel; +256774988991
| | - Emmanuel Bua
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda. Tel; +256774988991
| | - Joseph Wadeya
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda. Tel; +256774988991
| | - Timothy K Makumbi
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda. Tel; +256774988991
- Department of Surgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - William Ocen
- Department of Surgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University. , Tel: +256706464873
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Liu M, Sun W, Cai YY, Wu HZ. Validation of Quality of Life Instruments for Cancer Patients - Colorectal Cancer (QLICP-CR) in patients with colorectal cancer in Northeast China. BMC Cancer 2018; 18:1228. [PMID: 30526549 PMCID: PMC6286537 DOI: 10.1186/s12885-018-5135-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Measuring quality of life is important for cancer patients, but there are regional differences in age-standardized colorectal cancer incidence and mortality rates which may affect measurement. This study aimed to evaluate the reliability, validity and responsiveness of Quality of Life Instruments for Cancer Patients - Colorectal Cancer (QLICP-CR) in colorectal cancer patients in Northeast China, and assess its usefulness for evaluation of quality of life in these patients. METHODS From November 2016 to January 2017, 152 patients with colorectal cancer from Liaoning Cancer Hospital & Institute were surveyed three times using QLICP-CR and the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) to measure their quality of life (on admission, 2-3 days later and at discharge). Reliability was evaluated by internal consistency and test-retest reliability. Validity was examined by item-domain correlation, criterion-related validity and factor construct validity analysis. Responsiveness was assessed using paired Student's t tests and calculating standardized response mean. RESULTS Cronbach's α coefficient for QLICP-CR ranged from 0.62 to 0.93. Pearson correlation and intra-class correlation coefficients for QLICP-GM, the five domains and the total scale of QLICP-CR ranged from 0.74 to 0.91 and 0.74 to 0.90. The item-domain correlation analysis showed good convergent validity and discriminant validity. Correlation analysis of domain scores between FACT-C and QLICP-CR showed good criterion-related validity. Exploratory factor analysis revealed that nine and three principal components were extracted from items in the two modules of QLICP-CR, and the contribution rate of cumulative variance was 70.21 and 72.26%. There were significant differences in quality of life between the first and the third measurements, with standardized response mean values ranging from 0.30 to 0.81. CONCLUSIONS The QLICP-CR was a reliable, valid and sensitive instrument to measure quality of life in colorectal cancer patients in Northeast China.
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Affiliation(s)
- Min Liu
- Department of Teaching and Student Affairs, Cancer Hospital of China Medical University, Shenyang, 110042, Liaoning, China.,Department of Teaching and Student Affairs, Liaoning Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China
| | - Wei Sun
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yuan-Yi Cai
- Department of Health Service Administration, School of Humanities and Social Science, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Hua-Zhang Wu
- Department of Health Service Administration, School of Humanities and Social Science, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China.
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Shen MH, Chen LP, Ho TF, Shih YY, Huang CS, Chie WC, Huang CC. Validation of the Taiwan Chinese version of the EORTC QLQ-CR29 to assess quality of life in colorectal cancer patients. BMC Cancer 2018; 18:353. [PMID: 29606101 PMCID: PMC5880067 DOI: 10.1186/s12885-018-4312-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/26/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The increasing incidence of colorectal cancer in Taiwan has generated a need for a disease-specific quality-of-life measuring instrument. We aimed to validate the Taiwan Chinese version of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29. METHODS A total of 108 patients were interviewed. Convergent and discriminant validity, Cronbach's alpha coefficient, test-retest reliability, and known-groups comparisons were used to examine the reliability and validity. RESULTS We found good internal consistency reliability for multi-item scales of the QLQ-C30 and QLQ-CR29, except for the cognitive function and pain scale of the QLQ-C30. Patients in the active treatment group reported compromised functional scale scores (global health status/quality of life, QLQ-C30) and worse symptoms (blood and mucus in stool, QLQ-CR29) than those in the follow-up group. Similar results were found in comparisons based on Eastern Cooperative Oncology Group (ECOG) Performance Status and Bristol Stool Scale: higher physical function/sexual interest, less fatigue/urine frequency symptoms for patients with the lowest ECOG Performance Status (Grade 0), and borderline worse stool frequency scores from Types 5 and 6 patients on the Bristol Stool Scale. CONCLUSION The study validated the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-CR29. The clinical applicability warrants further studies with greater number of participants.
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Affiliation(s)
- Ming-Hung Shen
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, No.280, Jen-I Rd. Sec.4, Daan Dist., Taipei City, 106, Taiwan.,Division of General Surgery, Department of Surgery, Fu-Jen Catholic University Hospital, No.69; Gui-Zi Rd., Taishan Dist., New Taipei City, 243, Taiwan
| | - Ling-Ping Chen
- Division of Hematology and Oncology, Department of Medicine, Cathay General Hospital, No.280, Jen-I Rd. Sec.4, Daan Dist., Taipei City, 106, Taiwan
| | - Thien-Fiew Ho
- Department of Surgery, Cathay General Hospital Sijhih, No.2, Lane 59, Jian-Cheng Rd., Sijhih Dist., New Taipei City, 221, Taiwan
| | - Ying-Yih Shih
- Department of Medicine, Cathay General Hospital Sijhih, No.2, Lane 59, Jian-Cheng Rd., Sijhih Dist., New Taipei City, 221, Taiwan
| | - Ching-Shui Huang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, No.280, Jen-I Rd. Sec.4, Daan Dist., Taipei City, 106, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu-Xing St., Xinyi Dist., Taipei City, 110, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Chi-Cheng Huang
- Division of General Surgery, Department of Surgery, Fu-Jen Catholic University Hospital, No.69; Gui-Zi Rd., Taishan Dist., New Taipei City, 243, Taiwan. .,Division of General Surgery, Department of Surgery, Cathay General Hospital, No.280, Jen-I Rd. Sec.4, Daan Dist., Taipei City, 106, Taiwan. .,School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu-Xing St., Xinyi Dist., Taipei City, 110, Taiwan. .,School of Medicine, College of Medicine, Fu-Jen Catholic University, No.510, Zhong-Zheng Rd., Xinzhuang Dist., New Taipei City, 242, Taiwan.
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Lin KY, Denehy L, Frawley HC, Wilson L, Granger CL. Pelvic floor symptoms, physical, and psychological outcomes of patients following surgery for colorectal cancer. Physiother Theory Pract 2018; 34:442-452. [PMID: 29308963 DOI: 10.1080/09593985.2017.1422165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little has been published regarding general and pelvic floor-related health status in patients who have undergone surgery for colorectal cancer (CRC). OBJECTIVE The objective of the study was to assess changes in pelvic floor symptoms, physical activity levels, psychological status, and health-related quality of life (HRQoL) in patients with CRC from pre- to 6 months postoperatively. METHODS Pelvic floor symptoms, physical activity levels, anxiety and depression, and HRQoL of 30 participants who were undergoing surgery for stages I-III CRC were evaluated pre- and 6 months postoperatively. RESULTS Six months postoperatively, there were no significant changes in severity of pelvic floor symptoms, or other secondary outcomes (physical activity levels, depression, global HRQoL) compared to preoperative levels (p > 0.05). However, fecal incontinence (p = 0.03) and hair loss (p = 0.003) measured with the HRQoL instrument were significantly worse. Participants were engaged in low levels of physical activity before (42.3%) and after surgery (47.4%). CONCLUSION The findings of a high percentage of participants with persistent low physical activity levels and worse bowel symptoms after CRC surgery compared to preoperative levels suggest the need for health-care professionals to provide information about the benefits of physical activity and bowel management at postoperative follow-ups. Further investigation in larger studies is warranted.
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Affiliation(s)
- Kuan-Yin Lin
- a Department of Physiotherapy, School of Health Sciences , University of Melbourne , Melbourne , Australia.,b Department of Physiotherapy , Royal Melbourne Hospital , Melbourne , Australia.,c Centre for Allied Health Research and Education, Cabrini Health , Melbourne , Australia
| | - Linda Denehy
- a Department of Physiotherapy, School of Health Sciences , University of Melbourne , Melbourne , Australia.,e Institute for Breathing and Sleep , Melbourne , Victoria , Australia
| | - Helena C Frawley
- c Centre for Allied Health Research and Education, Cabrini Health , Melbourne , Australia.,d Physiotherapy, School of Allied Health , La Trobe University , Melbourne , Australia
| | - Lisa Wilson
- f Department of General Surgery , The Royal Melbourne Hospital , Melbourne , Victoria , Australia
| | - Catherine L Granger
- a Department of Physiotherapy, School of Health Sciences , University of Melbourne , Melbourne , Australia.,b Department of Physiotherapy , Royal Melbourne Hospital , Melbourne , Australia.,e Institute for Breathing and Sleep , Melbourne , Victoria , Australia
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Wani RA, Bhat IUA, Parray FQ, Chowdri NA. Quality of Life After "Total Mesorectal Excision (TME)" for Rectal Carcinoma: a Study from a Tertiary Care Hospital in Northern India. Indian J Surg Oncol 2017; 8:499-505. [PMID: 29203980 DOI: 10.1007/s13193-017-0698-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/17/2017] [Indexed: 01/20/2023] Open
Abstract
Quality of life (QoL) is a key element in rectal cancer (RC) patients. There is not much data regarding this from North India. This study assesses QoL following low anterior resection (LAR) and abdominoperineal resection (APR), operated for low rectal tumors at a high-volume center in northern India. One-hundred-thirty patients of rectal carcinoma were prospectively assessed for quality of life using the European Organization for Cancer QLQ-30 and CR29 questionnaires and compared with reference data population. There was no significant difference in the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 functional or symptom score between the study group and reference data population. Specific functional and symptom QoL scores of the study group were comparable to that of reference data population. There was no significant difference in the EORTC QLQ-C30 functional or symptom score between APR and LAR groups, except for the symptom of nausea and vomiting which was reported significantly more by the LAR group patients than APR group (p = 0.001). LAR patients had significantly higher scores with regard to nausea and vomiting than patients with an APR (p < 0.05). APR patients had significantly higher scores with regards to urinary frequency (p = 0.0001), abdominal pain (p = 0.0001), and embarrassment (p = 0.0001) than LAR patients. Quality of life after APR and LAR for rectal carcinoma was found to be comparable to the reference data population, and the QoL after APR was similar to that after LAR barring a few symptoms.
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Affiliation(s)
- Rauf Ahmad Wani
- Colorectal Division, Gen and Minimal Invasive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190010 India
| | - Ikhlaq-Ul-Aziz Bhat
- Colorectal Division, Gen and Minimal Invasive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190010 India
| | - Fazl Qadir Parray
- Colorectal Division, Gen and Minimal Invasive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190010 India
| | - Nisar Ahmad Chowdri
- Colorectal Division, Gen and Minimal Invasive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190010 India
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Questionnaire to assess quality of life in patients with breast cancer – Validation of the Chinese version of the EORTC QLQ-BR 53. Breast 2017; 32:87-92. [DOI: 10.1016/j.breast.2016.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/18/2016] [Accepted: 12/26/2016] [Indexed: 11/24/2022] Open
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Lin JB, Zhang L, Wu DW, Xi ZH, Wang XJ, Lin YS, Fujiwara W, Tian JR, Wang M, Peng P, Guo A, Yang Z, Luo L, Jiang LY, Li QQ, Zhang XY, Zhang YF, Xu HW, Yang B, Li XL, Lei YX. Validation of the chinese version of the EORTC QLQ-CR29 in patients with colorectal cancer. World J Gastroenterol 2017; 23:1891-1898. [PMID: 28348496 PMCID: PMC5352931 DOI: 10.3748/wjg.v23.i10.1891] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To assess the validity and reliability of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer 29 (EORTC QLQ-CR29) in Chinese patients with colorectal cancer (CRC).
METHODS From March 2014 to January 2015, 356 patients with CRC from four different hospitals in China were enrolled in the study, and all patients self-administered the EORTC QLQ-CR29 and the quality of life core questionnaire (EORTC QLQ-C30). Evaluation of the scores was based on the Karnofsky Performance Scale (KPS). The reliability and validity of the questionnaires were assessed by Cronbach’s α coefficient, the Spearman correlation test and Wilcoxon rank sum test.
RESULTS The EORTC QLQ-CR29 showed satisfactory reliability (α > 0.7), although the urinary frequency and blood and mucus in stool dimensions had only moderate reliability (α = 0.608). The multitrait scaling analyses showed good convergent (r > 0.4) and discriminant validity. Significant differences were obtained for each item in the different KPS subgroups (KPS ≤ 80; KPS > 80). Body image and most single-item dimensions showed statistically significant differences in patients with a stoma compared with the rest of the patients.
CONCLUSION The EORTC QLQ-CR29 exhibits high validity and reliability in Chinese patients with CRC, and can therefore be recommended as a valuable tool for the assessment of quality of life in these patients.
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Mrabti H, Amziren M, ElGhissassi I, Bensouda Y, Berrada N, Abahssain H, Boutayeb S, El Fakir S, Nejjari C, Benider A, Mellas N, El Mesbahi O, Bennani M, Bekkali R, Zidouh A, Errihani H. Quality of life of early stage colorectal cancer patients in Morocco. BMC Gastroenterol 2016; 16:131. [PMID: 27733117 PMCID: PMC5062841 DOI: 10.1186/s12876-016-0538-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 06/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21–88). The male–female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.
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Affiliation(s)
- Hind Mrabti
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco.
| | - Mounia Amziren
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
| | - Ibrahim ElGhissassi
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
| | - Youssef Bensouda
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
| | - Narjiss Berrada
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
| | - Halima Abahssain
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
| | - Saber Boutayeb
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
| | - Samira El Fakir
- Department of Epidemiology and Public health, Faculty of Medicine, Fez, Morocco
| | - Chakib Nejjari
- Department of Epidemiology and Public health, Faculty of Medicine, Fez, Morocco
| | - Abdellatif Benider
- Department of Radiotherapy, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Nawfel Mellas
- Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco
| | - Omar El Mesbahi
- Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco
| | - Maria Bennani
- Lalla Salma Foundation-Prevention and Treatment of Cancers, Rabat, Morocco
| | - Rachid Bekkali
- Lalla Salma Foundation-Prevention and Treatment of Cancers, Rabat, Morocco
| | - Ahmed Zidouh
- Lalla Salma Foundation-Prevention and Treatment of Cancers, Rabat, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, University Hospital, Rabat, Morocco
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Herrinton LJ, Altschuler A, McMullen CK, Bulkley JE, Hornbrook MC, Sun V, Wendel CS, Grant M, Baldwin CM, Demark-Wahnefried W, Temple LKF, Krouse RS. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery. CA Cancer J Clin 2016; 66:387-97. [PMID: 26999757 PMCID: PMC5618707 DOI: 10.3322/caac.21345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/13/2016] [Accepted: 02/09/2016] [Indexed: 12/14/2022] Open
Abstract
For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.
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Affiliation(s)
- Lisa J Herrinton
- Senior Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Senior Consultant, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Carmit K McMullen
- Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Joanna E Bulkley
- Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Mark C Hornbrook
- Chief Scientist, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Virginia Sun
- Assistant Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Christopher S Wendel
- Research Instructor, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Marcia Grant
- Distinguished Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Carol M Baldwin
- Professor Emerita and Southwest Borderlands Scholar, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Wendy Demark-Wahnefried
- Professor and Webb Endowed Chair of Nutrition Sciences, Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Larissa K F Temple
- Colorectal Surgical Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert S Krouse
- Staff General and Oncologic Surgeon, Professor of Surgery, Southern Arizona Veterans Affairs Health Care System and University of Arizona College of Medicine, Tucson, AZ
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Kwoun HJ, Shin YH. Impact of Bowel Function, Anxiety and Depression on Quality of Life in Patients with Sphincter-preserving Resection for Rectal Cancer. J Korean Acad Nurs 2015; 45:733-41. [DOI: 10.4040/jkan.2015.45.5.733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/05/2015] [Accepted: 07/06/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yun Hee Shin
- Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea
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Lim SH, Chan SWC, Lai JH, He HG. A randomized controlled trial examining the effectiveness of a STOMA psychosocial intervention programme on the outcomes of colorectal patients with a stoma: study protocol. J Adv Nurs 2014; 71:1310-23. [PMID: 25494719 DOI: 10.1111/jan.12595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Abstract
AIMS To report a study protocol that evaluates the effects of a psychosocial intervention on patients with a newly formed stoma. BACKGROUND With the loss of a significant body function and distorted body image, stoma patients experience physical, psychological and social challenges. Nurses have an important role in helping patients' make a smooth transition to living with their stoma. Limited studies have examined the effects of psychosocial interventions on improving stoma-related health outcomes. DESIGN A randomized controlled trial is planned. METHODS Eighty-four patients with newly formed stoma in a tertiary hospital in Singapore (Research Ethics Committee approval obtained in January 2013) will be recruited. Participants will be randomly assigned to either a control group who receive routine care or an intervention group who receive STOMA psychosocial intervention besides routine care. Outcome variables include stoma care self-efficacy, days to stoma proficiency, length of hospital stay, acceptance of stoma, anxiety and depression and quality of life. Data will be collected at four time points: before randomization and intervention (baseline), on the day of discharge (mid-intervention), at 4 weeks after discharge (postintervention 1) and at 4 months after discharge (postintervention 2). DISCUSSION This study will develop a psychosocial intervention programme, which may improve patients' stoma-related outcomes. The findings will provide direction to health professionals about education and the type of support that could be offered to patients concerning stoma care in the hospital setting, which will eventually improve their quality of life.
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Affiliation(s)
- Siew Hoon Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Nursing, Singapore General Hospital, Singapore
| | - Sally Wai-Chi Chan
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New Castle, Australia
| | - Jiunn Herng Lai
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
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Abu-Helalah MA, Alshraideh HA, Al-Hanaqta MM, Arqoub KH. Quality of Life and Psychological Well-Being of Colorectal Cancer Survivors in Jordan. Asian Pac J Cancer Prev 2014; 15:7653-64. [DOI: 10.7314/apjcp.2014.15.18.7653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Li X, Song X, Chen Z, Li M, Lu L, Xu Y, Zhan W, He Y, Xu K. Quality of life in rectal cancer patients after radical surgery: a survey of Chinese patients. World J Surg Oncol 2014; 12:161. [PMID: 24886668 PMCID: PMC4059026 DOI: 10.1186/1477-7819-12-161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 04/20/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aimed to investigate the impact of sociodemographic and clinical characteristics on health-related quality of life (HRQoL) in disease-free survivors after radical surgery for rectal cancer in a Chinese mainland population. METHODS We performed a cross-sectional survey from August 2002 to February 2011 by use of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires of 438 patients who underwent curative surgery for rectal cancer. Patients who were followed up for a minimum of 6 months, had no relevant major comorbidities and whose disease had not recurred were asked to complete both questionnaires. The impact of sociodemographic and clinical characteristics on HRQoL were compared by univariate and multivariate regression analyses. RESULTS In total, 285 patients responded to the survey (response rate, 65.1%). Psychological-related HRQoL variables such as emotional function (P = 0.021) and future perspectives (P = 0.044) were poorer for younger patients than for older patients; and physiological-related HRQoL was reflected by physical function (P = 0.039), which was poorer for older patients than for younger patients. In terms of physiologic function and symptoms concerning HRQoL, such as pain (P = 0.002) and insomnia (P = 0.018), females had lower values than males. Low education and unemployment were associated with a worse HRQoL. HRQoL was worse for patients with stomas compared to those without, especially in psychosocial areas such as role function (P = 0.025), social function (P <0.001) and body image (P = 0.004). Financial HRQoL was worse for younger patients and patients with stoma. CONCLUSIONS HRQoL aspects and degrees to which they were impaired after curative surgery for rectal cancer were different when compared by many sociodemographic and clinical factors in Chinese mainland patients.
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Affiliation(s)
| | - Xinming Song
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No, 58 Zhongshan Er Road, Guangzhou 510080, China.
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Gavaruzzi T, Lotto L, Giandomenico F, Perin A, Pucciarelli S. Patient-reported outcomes after neoadjuvant therapy for rectal cancer: a systematic review. Expert Rev Anticancer Ther 2014; 14:901-18. [PMID: 24745308 DOI: 10.1586/14737140.2014.911090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoadjuvant therapy followed by total mesorectal excision is standard of care for locally advanced rectal cancer. However, this approach has been previously shown to be associated with high rate of morbidity and it may have a negative effect on patients' reported outcomes (PROs). In order to summarize findings on the effect of the neoadjuvant approach on PROs, we systematically reviewed articles published in the last five years. Thirty-five articles met the inclusion criteria. Ten articles compared the effect of surgery with and without neoadjuvant therapy, six articles compared different neoadjuvant therapies, ten articles reported on patients who were all treated with neoadjuvant therapy, and nine articles examined the effect of neoadjuvant therapy in the analyses. The results are summarized by function investigated and critically commented.
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Affiliation(s)
- Teresa Gavaruzzi
- Clinica Chirurgica I, Policlinico Universitario, via Giustiniani, 2, 35128 Padova, Italy
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Abstract
BACKGROUND AND OBJECTIVES This review focuses on health-related quality-of-life (HRQoL) assessment questionnaires and the influence of various parameters on HRQoL at distinct time points after laparoscopic colectomy for cancer. METHODS A PubMed electronic database literature search was conducted. RESULTS Twenty studies (7 prospective randomized, 5 nonrandomized, 2 retrospective, 1 matched, and 3 observational studies) used the following HRQoL tools: European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 (8 studies), EORTC QLQ-CR38 (6 studies), EORTC QLQ-CR29 (1 study), Short Form 36 (8 studies), Gastrointestinal Quality Life Index (2 studies), EuroQoL-5D (1 study), Symptoms Distress Scale (2 studies), Quality of Life Index (2 studies), and global quality of life (1 study). Long-term beneficial effects on patient HRQoL after laparoscopic colectomy for cancer have not been clearly shown compared with "open" resections. A physical function deterioration and emotional function improvement are observed during the first month. Most patients have recovered at 12 months. Distinct HRQoL domains may be affected in older, female, and chemotherapy-treated patients. HRQoL-related parameters of pain and cosmesis have been assessed in few of the current studies on hand-assisted and single-incision laparoscopic colectomy. CONCLUSION Studies' heterogeneity in terms of assessment tools and time points remains as the main obstacle to establish robust conclusions. The addition of more patients and extension of the follow-up period will improve our knowledge on HRQoL changes after laparoscopic colectomy for cancer.
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Affiliation(s)
- George E Theodoropoulos
- Colorectal Unit, First Department of Propaedeutic Surgery, Athens Medical School, 7 Semitelou Street, GR-11528 Athens, Greece.
| | - Theodoros Karantanos
- Colorectal Unit, First Department of Propaedeutic Surgery, Athens Medical School, Athens, Greece
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Marinatou A, Theodoropoulos GE, Karanika S, Karantanos T, Siakavellas S, Spyropoulos BG, Toutouzas K, Zografos G. Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched study. Dis Colon Rectum 2014; 57:158-166. [PMID: 24401876 DOI: 10.1097/dcr.0000000000000040] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anastomotic leaks after colorectal resections for cancer are a leading cause of postoperative morbidity, mortality, and long hospital stay. Few data exist on the potentially deleterious effect of the anastomotic leaks after proctectomy for cancer on patient health-related quality of life. OBJECTIVE The aim of this study was to explore the effect of clinically evident anastomotic leaks on health-related quality of life after rectal cancer excision. DESIGN This is a case-matched study. SETTINGS This study was conducted in a Greek academic surgical department. PATIENTS Included were 25 patients undergoing low anterior resection complicated by an anastomotic leak (Clavien classification II, n = 14, and III, n = 11) and 50 patients undergoing low anterior resection with an uncomplicated course. MAIN OUTCOME MEASURES Health-related quality-of-life data were prospectively collected at fixed assessment time points (baseline, 3, 6, and 12 months postoperatively) by the use of validated questionnaires (Medical Outcomes Study Short Form 36, Gastrointestinal Quality of Life Index, European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30, and European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-CR29). RESULTS "Leak" patients required a longer hospitalization. Although the numbers of initially constructed defunctioning loop ileostomies were not significantly different between cases and controls, "leak" patients were required to remain with a stoma significantly more often at all postoperative assessment time points. No differences were observed in the baseline scores between the 2 groups. Physical function of "leak" patients was significantly worse at all postoperative assessment time points. At 6 and 12 months, their emotional and social function and overall quality-of-life scores were significantly decreased in comparison with the patients with an uncomplicated course. "Leak" patients experienced significantly more "stoma-related problems" and "sore skin" around the stoma site. LIMITATIONS Limited number of patients, restriction of follow-up to the end of the first year, and heterogeneity in terms of the presentation, severity, and management of anastomotic leaks were the limitations of this study. CONCLUSIONS Anastomotic leaks have an adverse effect on postoperative health-related quality of life.
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Affiliation(s)
- Annezo Marinatou
- Colorectal Unit, First Department of Propaedeutic Surgery, Athens Medical School, Athens, Greece
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Gavaruzzi T, Giandomenico F, Del Bianco P, Lotto L, Perin A, Pucciarelli S. Quality of life after surgery for rectal cancer. Recent Results Cancer Res 2014; 203:117-149. [PMID: 25103003 DOI: 10.1007/978-3-319-08060-4_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients' health-related quality of life (HRQoL) is now considered a relevant clinical outcome. This study systematically reviewed articles published in the last 5 years, focusing on the impact of rectal cancer treatment on patients' HRQoL. Of the 477 articles retrieved, 56 met the inclusion criteria. The most frequently reported comparisons were between surgical procedures (21 articles), especially between sphincter-preserving and non-sphincter preserving surgery or between stoma and stoma-free patients (13 articles), and between multimodality therapies (11 articles). Additionally, twelve articles compared patients' and healthy controls' HRQoL as primary or secondary aim. The majority of the studies were observational (84 %), controlled (66 %), cross-sectional (54 %), prospective (100 %), with a sample of more than 100 patients (59 %), and with more than 60 % of patients treated with neoadjuvant therapy (50 %). The most frequently used instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), its colorectal cancer specific module QLQ-CR38, and the Medical Outcomes Study Short-Form 36 items questionnaire. Findings from the included articles are summarised and commented, with a special focus on the comparison between surgical treatments, between irradiated and not-irradiated patients, and between patients and the general population.
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Affiliation(s)
- Teresa Gavaruzzi
- Department of Surgical Oncological and Gastroenterological Sciences-First Surgical Clinic, University of Padova, Padua, Italy,
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Theodoropoulos GE, Papanikolaou IG, Karantanos T, Zografos G. Post-colectomy assessment of gastrointestinal function: a prospective study on colorectal cancer patients. Tech Coloproctol 2013; 17:525-536. [PMID: 23605189 DOI: 10.1007/s10151-013-1008-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 03/25/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anatomical changes after intestinal resection and the effects of adjuvant treatment for colorectal cancer may lead to gastrointestinal disturbances. The aim of our study was to assess gastrointestinal function using validated health-related quality of life (HRQoL) questionnaires that are able to reliably quantify patients' symptoms. METHODS Two hundred and eighty-nine colorectal cancer patients underwent HRQoL assessment preoperatively and at 3,6 and 12 months postoperatively. They were evaluated with the Gastrointestinal Quality of Life Index (GIQLI) ["global" and "symptoms" scales and questions 3 ("bloating"), 4 ("excessive gas"), 6 ("gurgling noises"), 7 ("frequent bowel movements (BMs)"), 30 ("urgent BMs"), 31 ("diarrhea"), 32 ("constipation"), 36 ("uncontrolled stools")] and the European Organization for Research and Treatment of Cancer (EORTC) modules QLQ-C30 (symptom scales: "constipation" and "diarrhea") and QLQ-CR29 (symptom scales: "defecation problems," "incontinence," and "bloating"). RESULTS GIQLI "global" and "symptom" indices and the majority of single-item scores and the EORTC QLQ-C30 "constipation" and "diarrhea" subscales showed significant postoperative improvement (p < 0.05). Females and younger age (<70 years) patients appeared to have worse postoperative gastrointestinal function. Rectal cancer patients had more "urgent BMs," "uncontrolled stools" and worse "global" and "symptom" scores at 3 months and more "diarrhea" at 3 and 6 months than colon cancer patients (p < 0.03). Right colectomy patients had less "excessive passage of gas," "constipation," and "uncontrolled stools" than left colectomy patients (3 months, p < 0.01). Anterior resection patients faced more gastrointestinal difficulties, especially in the first 6 months after surgery. Adverse effects related to stage and adjuvant treatment were predominant only at baseline (p < 0.05). GIQLI "diarrhea" and "constipation" scores were correlated with the respective EORTC QLQ-C30 domains (p = 0.0001). CONCLUSIONS Overall, gastrointestinal function is improved after colorectal cancer surgery. However, women and younger patients are at higher risk of postoperative gastrointestinal dysfunction.
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Affiliation(s)
- G E Theodoropoulos
- Colorectal Unit, 1st Department of Propaedeutic Surgery, Hippocration Hospital, University of Athens Medical School, 7 Semitelou Street, 11528, Athens, Greece,
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Long-term quality-of-life after neoadjuvant short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer. Radiother Oncol 2013; 108:326-30. [DOI: 10.1016/j.radonc.2013.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/18/2013] [Accepted: 08/12/2013] [Indexed: 01/11/2023]
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Pita-Fernández S, Pértega-Díaz S, López-Calviño B, Seoane-Pillado T, Gago-García E, Seijo-Bestilleiro R, González-Santamaría P, Pazos-Sierra A. Diagnostic and treatment delay, quality of life and satisfaction with care in colorectal cancer patients: a study protocol. Health Qual Life Outcomes 2013; 11:117. [PMID: 23845102 PMCID: PMC3710493 DOI: 10.1186/1477-7525-11-117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/09/2013] [Indexed: 01/12/2023] Open
Abstract
Background Due to recent improvements in colorectal cancer survival, patient-reported outcomes, including health-related quality of life and satisfaction with care, have become well-established endpoints to determine the impact of the disease on the lives of patients. The aim of this study is to determine prospectively, in a cohort of colorectal cancer incident cases: a) health-related quality of life, b) satisfaction with hospital-based care, and c) functional status. A secondary objective is to determine whether diagnostic/therapeutic delay influence quality of life or patients’ satisfaction levels. Methods/design Single-centre prospective follow-up study of colorectal cancer patients diagnosed during the period 2011–2012 (n = 375). This project was approved by the corresponding ethics review board, and informed consent is obtained from each patient. After diagnosis, patients are interviewed by a trained nurse, obtaining information on sociodemographic characteristics, family history of cancer, first symptoms, symptom perception and reaction to early symptoms. Quality of life is assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires, and patients’ satisfaction with care is determined using the EORTC IN-PATSAT32. Functional status is measured with the Karnofsky Performance Status Scale. Clinical records are also reviewed to collect information on comorbidity, tumour characteristics, treatment, hospital consultations and exploratory procedures. Symptoms-to-diagnosis interval is defined as the time from the date of first symptoms until the cytohistological confirmation of cancer. Treatment delay is defined as the time between diagnosis and surgical treatment. All the patients will be followed-up for a maximum of 2 years. For survivors, assessments will be re-evaluated at one and two years after the diagnosis. Multiple linear/logistic regression models will be used to identify variables associated with the patients’ functional status, quality of life and satisfaction with care score. Changes in quality of life over time will be analysed with linear mixed-effects regression models. Discussion The results will provide a deeper understanding of the impact of colorectal cancer from a more patient-centred approach, allowing us to identify groups of patients in need of additional attention, as well as areas for improvement. Special attention will be given to the relationship between diagnostic/therapeutic delay and patients’ quality of life and satisfaction with the care received.
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Affiliation(s)
- Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario A Coruña, Universidade de A Coruña, Hotel de Pacientes 7a Planta, As Xubias 84, A Coruña, Spain.
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Quality of Life and Functions After Chemoradiation for Rectal Cancer: A Review of Recent Publications. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0161-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Theodoropoulos GE, Karantanos T, Stamopoulos P, Zografos G. Prospective evaluation of health-related quality of life after laparoscopic colectomy for cancer. Tech Coloproctol 2013; 17:27-38. [DOI: 10.1007/s10151-012-0869-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/24/2012] [Indexed: 12/14/2022]
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Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2012; 12:CD004323. [PMID: 23235607 PMCID: PMC7197443 DOI: 10.1002/14651858.cd004323.pub4] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND For almost one hundred years abdominoperineal excision has been the standard treatment of choice for rectal cancer. With advances in the techniques for rectal resection and anastomosis, anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, except for those cancers very close to the anal sphincter. The main reason for this has been the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincter-preserving technique. However, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma-patients. OBJECTIVES To compare the quality of life in rectal cancer patients with or without permanent colostomy. SEARCH METHODS We searched PUBMED, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Colorectal Cancer Group's specialised register. Abstract books from major gastroenterological and colorectal congresses were searched. Reference lists of the selected articles were scrutinized. SELECTION CRITERIA All controlled clinical trials and observational studies in which quality of life was measured in patients with rectal cancer having either abdominoperineal excision/Hartmann's operation or low anterior resection, using a validated quality of life instrument, were considered. DATA COLLECTION AND ANALYSIS One reviewer (JP) checked the titles and abstracts identified from the databases and hand search. Full text copies of all studies of possible relevance were obtained. The reviewer decided which studies met the inclusion criteria. Both reviewers independently extracted data. If information was insufficient the original author was contacted to obtain missing data. Extracted data were cross-checked and discrepancies resolved by consensus. MAIN RESULTS Sixty-nine potential studies were identified. Thirty-five of these, all non-randomised and representing 5127 participants met the inclusion criteria. Fourteen trials found that people undergoing abdominoperineal excision/Hartmann's operation did not have poorer quality of life measures than patients undergoing anterior resection. The rest of the studies found some difference, but not always in favour of non-stoma patients. Due to clinical heterogeneity and the fact that all studies were observational trials, meta-analysis of the included studies was not possible. AUTHORS' CONCLUSIONS The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/Hartmann's operation. The included studies challenges the assumption that anterior resection patients fare better. Larger, better designed and executed prospective studies are needed to answer this question.
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Affiliation(s)
- Jørn Pachler
- Gastroenterology Unit, Hvidovre Hospital, Hvidovre, Denmark.
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Magaji BA, Moy FM, Roslani AC, Sagap I, Zakaria J, Blazeby JM, Law CW. Health-related quality of life among colorectal cancer patients in Malaysia: a study protocol. BMC Cancer 2012; 12:384. [PMID: 22937765 PMCID: PMC3443003 DOI: 10.1186/1471-2407-12-384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 08/27/2012] [Indexed: 12/12/2022] Open
Abstract
Background Colorectal cancer is a major public health problem in Malaysia. However, it is also one of the most treatable cancers, resulting in significant numbers of survivors. Therefore, the impact of surviving treatment for colorectal cancer on health related quality of life is important for the patients, clinicians and policy makers, and may differ in different cultures and populations. The aim of this study was to validate the Malaysian versions of the European Organization for Research and Treatment of Cancer quality of life instruments among colorectal cancers patients. Methods/design This is a cross sectional multi centre study. Three hospitals were included, the University of Malaya Medical Centre, the Universiti Kebangsaan Malaysia Medical Centre and Hospital Tuanku Jaafar Seremban. Malaysian citizens and permanent residence were studied and demographic and clinical information obtained from hospital records. The European Organization for Research and Treatment of Cancer Quality of life Core 30, colorectal cancer CR29, and the colorectal cancer liver metastasis LMC 21 were used and an observer assessment of performance obtained with the Karnofsky Performance Scale. Questionnaires were translated into three most commonly spoken languages in Malaysia (Bahasa Malaysia, Chinese and Tamil), then administered, scored and analyzed following the developers’ guidelines. Ethical approval was obtained from the participating centres. Tests of reliability and validity were performed to examine the validity of these instruments. Conclusion The result of pilot testing shows that the use of the Malaysian versions of EORTC QLQ C30, CR29 instruments is feasible in our sample of colorectal cancer patients. Instructions for completion as well as questions were well understood except the questions on the overall quality of life, overall health status and sexual activity. Thus we anticipate obtaining good psychometric properties for the instruments at the end of the study.
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Affiliation(s)
- Bello Arkilla Magaji
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Sjödahl R, Schulz C, Myrelid P, Andersson P. Long-term quality of life in patients with permanent sigmoid colostomy. Colorectal Dis 2012; 14:e335-8. [PMID: 22251418 DOI: 10.1111/j.1463-1318.2012.02941.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The study aimed to assess quality of life (QoL) in patients with a sigmoid colostomy using a simple general and disease-specific instrument. A subgroup not doing well was identified and examined further. METHOD The Short Health Scale (SHS) is a four-item instrument exploring severity of symptoms, function in daily life, worry, and general well-being, using visual analogue scales ranging from 0 to 100 where 100 is the worst possible situation. The SHS was delivered to 206 patients with a sigmoid colostomy. It was returned by 181 (87.9%) patients [88 men; median age 73 (33-91) years]. Follow-up was 61 (10-484) months for 178 (86.4%) patients returning usable questionnaires. A subgroup of 16 patients scoring more than 50 in all four items of the SHS was further examined with StomaQOL where 100 is best possible. RESULTS The median score for severity of symptoms was 18 (2-95), function in daily life 21 (0-95), worry 17 (3-98) and general well-being 22 (0-99). A score of < 50 in the SHS was recorded in 84.9%, 82.1%, 79.9% and 70.5% respectively. In the group scoring more than 50 in all four items patients diagnosed with irritable bowel syndrome constituted 43.8% to compare with 5.6% in the entire study group (P < 0.001). Median score for StomaQOL was 37 (22-62) in this group. CONCLUSION Most patients with a permanent sigmoid colostomy have a good QoL consistent with previous findings. However, this is reduced in a subgroup of patients diagnosed with irritable bowel syndrome.
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Affiliation(s)
- R Sjödahl
- Faculty of Health Sciences, Division of Surgery, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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