Quality of life in patients with a permanent stoma after rectal cancer surgery

Abstract

Aim: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

Methods: 711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

Results: 336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

Conclusion: Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

Keywords: HRQoL; Hernia; Parastomal; Rectal cancer; Stoma.

Fig. 1

Diagram showing patients receiving HRQoL forms and distribution of answers. Gender, age and follow-up time in eligible patients and patients replying to the forms are shown on the right

Fig. 2

SF-36 mean values in the group with permanent stoma and without permanent stoma. The line represents the healthy age-matched Swedish population (Ref pop). PF physical functioning, RP physical role functioning, BP bodily pain, GH general health, VT vitality, SF social functioning, RE emotional role functioning, MH mental health, pcs physical component summary, mcs mental component summary. High mean value represents good health or no disability

Fig. 3

EORTC QLQ-C30 mean values in the group with permanent stoma and the group without permanent stoma. The line represents the healthy Swedish population, adjusted for age and gender (Ref pop). Functional scales: PF physical function, RF role function, EF emotional function, CF cognitive function and SF social function. Symptom scales: FA fatigue, PA pain, NV nausea and vomiting. Single-item scales: DY dyspnea, SL insomnia, AP loss of appetite, CO constipation and FI financial impact. Global QoL global health status. High mean value in functional scales and global QoL represents high or healthy level of functioning and QoL. High mean value in symptom and single-item scales represents a high level of symptoms

Fig. 4

EORTC QLQ-CR38 mean values in the groups with and without permanent stoma. Function scales: BI body image, SX sexual functioning, SE sexual enjoyment, FU future perspective. Symptom scales: MI micturition problems, GI gastrointestinal symptoms, DF defecation problems (only for patients without stoma and intact sphincter), STO stoma-related problems (only for patients with stoma), MSX male sexual problems, FSX female sexual problems and WL weight loss. High mean value in function scales represents high or healthy level of functioning. High mean value in symptom scales represents high level of symptoms

Fig. 5

Patients with permanent stoma answering the question in CQ questionnaire: Do you have a bulge or a hernia around your stoma?