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Joshua TG, Robitaille S, Paradis T, Maalouf MF, Feldman LS, Fiore JF, Liberman S, Lee L. Decision-making preferences and regret in rectal cancer patients undergoing restorative proctectomy: A prospective cohort study. Surgery 2024; 176:1065-1071. [PMID: 38997862 DOI: 10.1016/j.surg.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND How patients make treatment choices in rectal cancer is poorly understood and may affect long-term regret and satisfaction. The objective of this study is to characterize decision-making preferences and their effect on decisional regret in patients undergoing restorative proctectomy for rectal cancer. METHODS A prospective cohort study was conducted in a single academic specialist rectal cancer center from October 2018 to June 2022. Adult patients who underwent restorative proctectomy at least one year prior were recruited. Health literacy was assessed using the BRIEF instrument. Decision-making preferences regarding cancer treatment were assessed using the Control Preferences Scale. Decisional regret regarding their choice of restorative proctectomy was assessed using the Decision Regret Score. Bowel dysfunction was measured using the low anterior resection syndrome score. RESULTS Overall, 123 patients were included. Health literacy was categorized as adequate in 63%, marginal in 25%, and limited in 12%. Patients with adequate health literacy were more likely to prefer a collaborative decision-making role compared with those with low health literacy (86% vs 65%, P = .016). Patients with incongruence between preferred and actual decision-making roles were more likely to report high regret (56% vs 25%, P = .003). Patients with major low anterior resection syndrome were also more likely to experience high regret compared with patients with no/minor low anterior resection syndrome (44% vs 25%, P = .036). CONCLUSION A significant proportion of patients with rectal cancer undergoing restorative proctectomy do not have a decision-making role that is congruent with their preferences, and these patients experience a high degree of regret.
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Affiliation(s)
- Temitope G Joshua
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/temitopegjoshua
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/sarobitaille
| | - Tiffany Paradis
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/tiffparadis
| | - Michael F Maalouf
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/michaelmaalouf_
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/lianefeldman
| | - Julio F Fiore
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/juliofiorejr
| | - Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/senderliberman
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada.
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Hilty Chu BK, Loria A, Dhimal T, Li Y, Colugnati F, Yousefi Nooraie R, Cupertino P, Aquina CT, Ramsdale EE, Fleming FJ. The Rise of Patients Declining Rectal Cancer Surgery in the Era of Total Neoadjuvant Therapy. Ann Surg Oncol 2024:10.1245/s10434-024-16037-7. [PMID: 39148007 DOI: 10.1245/s10434-024-16037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND The treatment landscape for rectal cancer is rapidly evolving, particularly with the increasing use of neoadjuvant therapies. Still, up to 50% of patients with stage II-III disease require surgical resection post-neoadjuvant therapy to achieve the best oncologic outcomes. Many patients, however, hope to avoid surgery. This study aimed to assess trends and factors associated with declining recommended oncologic resection after systemic therapy nationally and in our institution. PATIENTS AND METHODS This is a retrospective analysis using the National Cancer Database from 2009 to 2021 and an institutional cohort at an academic center between 2009 and 2022 including adults with stage I-III rectal adenocarcinoma who underwent neoadjuvant therapy and were suitable for surgery. RESULTS Of 96,997 patients nationally, the rate of declining surgery increased from 2.3% in 2009 to 6.3% in 2021, a trend mirrored in our institutional cohort of 365 patients (0% in 2009/2010 to approximately 6-12% in 2021/2022). Locally, patients who declined surgery had higher rates of tobacco use, temporary loss to follow-up during therapy, and a more robust, albeit incomplete, tumor response to neoadjuvant therapy compared with controls who underwent surgery. Despite a stoma being the most cited reason for declining surgery, 30.4% of patients who declined oncologic resection died with a stoma. CONCLUSIONS Our findings underscore a notable trend of patients declining oncologic resections following neoadjuvant therapy for rectal cancer. By shedding light on the outcomes of patients who opt against surgery, we address a critical gap in the literature essential for informing patients about potential risks.
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Affiliation(s)
- Bailey K Hilty Chu
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Anthony Loria
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Totadri Dhimal
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Yue Li
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Fernando Colugnati
- School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Paula Cupertino
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher T Aquina
- Departments of Colorectal Surgery and Surgical Oncology, Advent Health Orlando, Orlando, FL, USA
| | - Erika E Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Quan H, Wang H, Yang Y, Yu H. The Safety and Effectiveness of Telemedicine for Cancer-Related Colostomy Care in the Early Stage of Discharge: A Prospective, Randomized, Single-Center Study. TELEMEDICINE REPORTS 2024; 5:212-218. [PMID: 39081454 PMCID: PMC11285997 DOI: 10.1089/tmr.2024.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 08/02/2024]
Abstract
Background There has been an exponential growth in the use of telemedicine services to provide clinical care. However, the safety and effectiveness of telemedicine in cancer-related colostomy care during the early stages of discharge remain unclear. This study aimed to support that the safety and effectiveness of telemedicine in cancer-related colostomy care were not inferior to those of outpatient care. Methods This was a prospective randomized noninferiority study. A total of 76 consecutive patients who underwent cancer-related colostomy stoma were enrolled and randomly divided into a telemedicine group or an outpatient group with an equal allocation ratio (1:1). The outpatient group was provided in-person interview mode colostomy care, whereas the telemedicine group was provided video interview mode colostomy care. The stoma-related complications, self-care ability, and quality of life reflected the safety and effectiveness of colostomy care in the early stages of discharge. Results The incidence of stoma-related complications within two weeks and one month after discharge was not significantly different between the two groups (p 2-weeks = 0.772 and p 1-month = 0.760). The mean NCI-CTCAE score for stoma-related complications was less than level 2. The ESCA and C-COH-QOL-OQ scores were not significantly different between the telemedicine and outpatient groups at two weeks and one month after discharge (all p > 0.05). Conclusion The results revealed that the safety and effectiveness of telemedicine for cancer-related colostomies in the early stages of discharge were not inferior to those of outpatient care alone.
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Affiliation(s)
- Haizhou Quan
- Division of General Surgery, Zhoushan Hospital of Wenzhou Medical University, Zhoushan City, China
| | - Hongqiang Wang
- Division of General Surgery, Zhoushan Hospital of Wenzhou Medical University, Zhoushan City, China
| | - Yu’e Yang
- Outpatient Department, The First Affiliated Hospital of Haerbin Medical University, Harbin, China
| | - Hongwei Yu
- Division of General Surgery, Zhoushan Hospital of Wenzhou Medical University, Zhoushan City, China
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Rooney MK, Pasli M, Chang GJ, Das P, Koay EJ, Koong AC, Ludmir EB, Minsky BD, Noticewala SS, Peacock O, Smith GL, Holliday EB. Patient-Reported Sexual Function, Bladder Function and Quality of Life for Patients with Low Rectal Cancers with or without a Permanent Ostomy. Cancers (Basel) 2023; 16:153. [PMID: 38201580 PMCID: PMC10778006 DOI: 10.3390/cancers16010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Despite the increasing utilization of sphincter and/or organ-preservation treatment strategies, many patients with low-lying rectal cancers require abdominoperineal resection (APR), leading to permanent ostomy. Here, we aimed to characterize overall, sexual-, and bladder-related patient-reported quality of life (QOL) for individuals with low rectal cancers. We additionally aimed to explore potential differences in patient-reported outcomes between patients with and without a permanent ostomy. METHODS We distributed a comprehensive survey consisting of various patient-reported outcome measures, including the FACT-G7 survey, ICIQ MLUTS/FLUTS, IIEF-5/FSFI, and a specific questionnaire for ostomy patients. Descriptive statistics and univariate comparisons were used to compared demographics, treatments, and QOL scores between patients with and without a permanent ostomy. RESULTS Of the 204 patients contacted, 124 (60.8%) returned completed surveys; 22 (18%) of these had a permanent ostomy at the time of survey completion. There were 25 patients with low rectal tumors (≤5 cm from the anal verge) who did not have an ostomy at the time of survey completion, of whom 13 (52%) were managed with a non-operative approach. FACTG7 scores were numerically lower (median 20.5 vs. 22, p = 0.12) for individuals with an ostomy. Sexual function measures IIEF and FSFI were also lower (worse) for individuals with ostomies, but the results were not significantly different. MLUTS and FLUTS scores were both higher in individuals with ostomies (median 11 vs. 5, p = 0.06 and median 17 vs. 5.5, p = 0.01, respectively), suggesting worse urinary function. Patient-reported ostomy-specific challenges included gastrointestinal concerns (e.g., gas, odor, diarrhea) that may affect social activities and personal relationships. CONCLUSIONS Despite a limited sample size, this study provides patient-centered, patient-derived data regarding long-term QOL in validated measures following treatment of low rectal cancers. Ostomies may have multidimensional negative impacts on QOL, and these findings warrant continued investigation in a prospective setting. These results may be used to inform shared decision making for individuals with low rectal cancers in both the settings of organ preservation and permanent ostomy.
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Affiliation(s)
- Michael K. Rooney
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Melisa Pasli
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - George J. Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Prajnan Das
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Eugene J. Koay
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Albert C. Koong
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Ethan B. Ludmir
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Bruce D. Minsky
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Sonal S. Noticewala
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Oliver Peacock
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Grace L. Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Emma B. Holliday
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
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