Sleep and quality of life in people with ileal conduit

Comparison of partial and total cystectomy for colorectal cancer with histologically confirmed bladder invasion

BACKGROUND

Although organs are preserved and quality of life is improved, insufficient evidence is available for the oncologic safety of partial cystectomy in patients with colorectal cancer with suspected bladder invasion. Therefore, we aimed to compare partial and total cystectomy outcomes in patients with pathologically confirmed or clinically suspected bladder invasion.

METHODS

Patients with colorectal cancer with suspected bladder invasion who underwent R0 resection from 2000 to 2020 were evaluated. Long-term outcomes were determined in patients with histologically confirmed bladder invasion.

RESULTS

Of the 151 consecutive patients, 96 (64.6%) had histologically confirmed bladder involvement, and 105 (69.5%) underwent partial cystectomy. Operative time, estimated blood loss, and reoperation rate in ≤30 days were significantly worse in the total cystectomy group than in the partial cystectomy group. The overall recurrence rate was significantly higher in the total cystectomy group than in the partial cystectomy group (39.1% vs 21.9%; P = .046). Five-year overall survival (75.8% vs 53.2%; P = .006) rates were higher in the partial cystectomy group than in the total cystectomy group; however, disease-free survival (60.8% vs 41.6%; P = .088) rates were similar in patients with suspected bladder invasion. In patients with histologically confirmed bladder invasion, 5-year overall survival rates (78.1% vs 52.1%; P = .017) were higher in the partial cystectomy group than in the total cystectomy group; however, disease-free survival rates (53.4% vs 41.2%; P = .220) did not differ significantly.

CONCLUSION

R0 resection is associated with favorable long-term outcomes in patients with locally advanced colorectal cancer. If R0 resection is possible, partial cystectomy is considered safe.

Effect of Laughter Yoga on Sleep and Quality of Life in Individuals With Fecal Ostomies: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the effect of laughter yoga on the quality of life and sleep quality in individuals with fecal ostomies.

DESIGN

This was randomized controlled trial.

SUBJECTS AND SETTING

The sample comprised 55 individuals with an ostomy who received care at Ankara University's I˙bni Sina Hospital Stoma Therapy Unit in Ankara, Turkey. Data were collected over a 2-month period (January and February 2020).

METHODS

Participants were allocated into an intervention group (n = 27) who received a yoga therapy intervention and a control group (n = 28) who received no intervention via simple randomization. Demographic and pertinent clinical variables were obtained during a baseline visit in both groups, along with the Pittsburgh Sleep Quality Index (PSQI) and Stoma-Quality of Life (Stoma-QOL) instruments. The intervention group received laughter yoga weekly over a period of 8 weeks.

RESULTS

Mean scores on the PSQI and the Stoma-QOL at baseline were compared. Participants in the intervention had a significant decline in mean PSQI scores (6.85 vs 5.48, P = .044) indicating improvement in sleep quality following the intervention. Analysis revealed no significant difference in mean Stoma-QOL scores (P = .077). Control group participants had no significant difference in either mean PSQI or Stoma-QOL scores following data collection at the end of 8 weeks.

CONCLUSIONS

Laughter yoga had a positive effect on the sleep quality in individuals with fecal ostomies. Further research is recommended to evaluate the effect of the number of laughter yoga sessions on the sleep quality and quality of life in individuals with ostomies.

Quality of life following formation of an ileal conduit due to urinary bladder neoplasm: A systematic review

AIM

To present the findings of a systematic review on reported quality of life following the formation of a urinary diversion as a result of cystectomy due to urinary bladder neoplasm.

BACKGROUND

Bladder cancer is the most commonly occurring cancer of the urological system. Treatment often involves undergoing a radical cystectomy with an ileal conduit formation. Quality of life issues associated with this surgery are complex and varied.

DESIGN

A systematic review using thematic synthesis.

DATA SOURCES

A comprehensive search, using The Cochrane Library, CINAHL, PubMed and PsycInfo databases, focusing on the years from 2007 to 2020.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was the chosen checklist used. Studies were critically appraised using the Crowe Critical Appraisal Tool.

RESULTS

The formation of an ileal conduit negatively affects respondent's quality of life particularly regarding body image, social distress, reduced sexual activity and employment. Poor research focus on the impact of ileal conduit formation on sexual well-being postoperatively was apparent.

CONCLUSIONS

Further research using qualitative methodologies is needed to gain a deeper understanding of how this life-changing procedure impacts quality of life.

[How do patients manage their urostomy in everyday life? A questionnaire survey]

INTRODUCTION

The complications of stoma and peristomal are encountered by nearly 80% of patients within two years of surgery. The objective of this study was to evaluate the practical modalities of daily management of stoma and possible skin complications in a series of patients with non-continent urinary stoma.

METHODS

Monocentric study by questionnaires including all patients with non-continent urinary stoma between 2007 and 2019 in a French university center. The STOMA-QOL and a self-report questionnaire with 15 specific questions were used.

RESULTS

Among the 87 patients included in the analysis whose median age was 71 years, 57.5% used a 2-piece system, 69% used leg or thigh pockets, 74.7% were self-sufficient in emptying their stoma pockets. Autonomy on cutaneous support change was 38%. 62.1% of patients reported a peristomal skin event and 74.7% reported leaking stoma. In multivariate analysis, BMI>30, the presence of leaks and physical activity were significantly associated with the onset of peristomal skin events.

CONCLUSION

This study sheds light on the practical modalities of management of urinary stoma and the occurrence of skin complications related to stoma in terms of frequency and predisposing factors. The results obtained are likely to guide practitioners in the information of future operations and in the management of complications of urinary stoma.

LEVEL OF EVIDENCE

III.

Advanced colonic cancer with clinically suspected bladder invasion: Outcomes and prognosis from a multicentric study of 117 patients from the FRENCH research group

BACKGROUND

Bladder invasion by colon cancer is rare; however, its management is still controversial. Our objective was to report outcomes and identify risk factors for local recurrence in colon cancer with clinically suspected bladder invasion.

METHODS

We conducted a retrospective study in 23 centers in France. All patients who underwent colon surgery with bladder resection (2010-2017) were included. Metastatic and recurrent colon cancers were excluded.

RESULTS

One hundred and seventeen patients (men = 73) were included. Partial cystectomy occurred in 108 patients (92.3%), with a total cystectomy occurring in 9 patients (7.7%). Neoadjuvant treatment was given to 31 patients (26.5%). Major morbidity was 20.5%. R0 resection rates were 87.2%. Histologically confirmed bladder invasion was present in 47%. Thirty-four patients were pN+, while 60 patients (51.3%) received adjuvant chemotherapy. Mean follow-up was 33.8 months. Three-year overall survival and disease-free survival were 82.9% and 59.5%. Rates of local recurrence and distant recurrence were 14.5% and 18.8%, respectively; the local recurrences (11/17; 65%) were in the bladder, while 4 of these patients had a bladder recurrence despite not having histologically confirmed bladder invasion at the index surgery. The rate of bladder recurrence after histologic bladder invasion was 13% (7/55), while the rate of bladder recurrence without primary bladder invasion was 7% (4/62) (P = .343). Neoadjuvant therapy, type of cystectomy, and adjuvant therapy did not influence local recurrence (P > .445 each). R1 bladder resections, when compared with a R0 bladder resections, were associated with an increased rate of local recurrence (63% vs 10%; P < .0001).

CONCLUSION

Clinically suspected bladder invasion increases local recurrence even in the absence of histologically confirmed bladder invasion. Only complete resections with R0 margins decrease local recurrence. Careful, detailed postoperative surveillance is required, even without pathologic bladder invasion.

Health-Related Quality of Life and Sleep Disorders in Patients With a Urostomy: Is There a Relationship?

PURPOSE

The purpose of this study was to evaluate the relationship between health-related quality of life (HRQOL) and sleep disorders in persons living with a urostomy.

DESIGN

A cross-sectional descriptive study.

SUBJECTS AND SETTINGS

Eighty-six adults with a urostomy who were cared for in a stoma outpatient clinic of a hospital in Osaka, Japan, for at least 1 month before data collection, and who were attending support group meetings comprised the sample. The majority of participants (n= 68; 79.1%) were diagnosed with bladder cancer; the median time since ostomy surgery was 3.7 years.

METHODS

Participants were queried about demographic and pertinent clinical data; they also completed 2 instruments that measured HRQOL and sleep quality. All data were collected via interview. HRQOL was assessed using a Japanese language version of the World Health Organization Quality of Life (WHOQOL). Sleep quality was evaluated using a Japanese language version of the Pittsburgh Sleep Quality Index (PSQI-J). Demographic and clinical data were collected via a questionnaire designed for this study.

RESULTS

WHOQOL scores among persons living with a urostomy were significantly (P < .001) lower than scores among the general population in Japan. Forty-six participants (53.5%) had scores that were higher than 5.5, the cut-off point on the PSQI-J indicating reduced sleep quality. Scores on the PSQI-J were significantly negatively associated with the cumulative scores for WHOQOL scores (standardized partial regression coefficient -0.504, P < .001) even after adjustment based on all other variables.

CONCLUSIONS

Study findings suggest that persons with a urostomy have lower HRQOL and sleep quality than adults in the general population.