The Quality of Life of Patients with Colorectal Cancer and a Stoma in China: A Quantitative Cross-sectional Study

Stoma-related complications and quality-of-life assessment: A cross-sectional study with patients from Ethiopia and Sweden

BACKGROUND

The situation for patients with ostomy can be challenging, probably more in a resource-constrained environment. Our objective was to evaluate quality of life (QoL) (using EQ5D-5L) and stoma-specific QoL (using Stoma QoL) in a high- and low-income setting.

METHODS

In this cross-sectional study from the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, and South General Hospital (SGH), Stockholm, patients with a permanent or temporary ostomy at TASH (EthioPerm), (EthioTemp), and patients with ostomy at SGH (SweSto) were included in October 2022-January 2023.

RESULTS

Patients N = 66 were included in groups: EthioPerm N = 28, EthioTemp N = 17, and SweSto N = 21. In EthioTemp, 88% used homemade stoma bags. Although morbidity related to the nipple itself was similar in the groups, the overall score from Stoma QoL was significantly lower in EthioPerm, 48/100 than in SweSto, 74/100. Scores were significantly lower for pouch-related problems and social interactions in Ethiopian patients. In EthioPerm, 71% of the patients worried that they were a burden to the people close to them compared to 14% in SweSto (p < 0.001). Leakage was over four times more common in EthioPerm than in SweSto. Mean overall EQ5D-5L score was 18 percentage points lower than the national mean score in EthioPerm and 2 percentage points lower in SweSto.

CONCLUSION

QoL was more affected in the Ethiopian study participants than in the Swedish, even when commercial stoma bags were available. The largest problems were leakage, embarrassment with social interactions, and pouch-related problems.

TRIAL REGISTRATION

NCT05970458 Clinicaltrials.gov, https://clinicaltrials.gov/study/NCT05970458?locStr=Ethiopia&country=Ethiopia&distance=50&cond=Stoma%20Ileostomy&rank=1.

Validity of the Health Personality Assessment among rectal cancer survivors in Serbia

Understanding health personality traits in rectal cancer survivors could help to optimize recovery and coping mechanisms. The objective of this study was to evaluate psychometric properties of the Health Personality Assessment in Serbian language among rectal cancer survivors. A cross-sectional study was carried out from June to December 2022. The study sample consisted of 76 people who underwent the open lower anterior resection for rectal carcinoma at the Clinic for Digestive Surgery and the Clinic for Emergency Surgery, University of Clinical Center of Serbia (Belgrade, Serbia) and whose ileostomy was closed. Study participants were interviewed over the telephone using the Serbian version of the HPA which was translated according to the internationally accepted methodology for translation and adaptation of questionnaires. The confirmatory factor analysis suggested that the fit indices for 5-factor structure of the HPA were acceptable-to-good: Goodness of fit index = 0.939; Tucker Lewis fit index = 0.989; Comparative fit index = 0.992; Root Mean Square Error of Approximation = 0.019. Cronbach's alpha coefficients for Health Neuroticism, Health Extraversion and Health Agreeableness were>0.7 and for Health Openness and Health Conscientiousness were >0.4. Predictive validity testing suggested that not having complications with the ileostomy and a longer time since ileostomy closure were associated with stronger Health Agreeableness. Also, a longer time since ileostomy closure was associated with stronger Health Conscientiousness. The Serbian version of the HPA showed good construct validity and acceptable internal consistency. This is an important tool in further research of personality and health outcomes among rectal cancer survivors.

Comparison of adjustment to a temporary or permanent ostomy using the OAI-23

AIM

The aim of this work was to compare adjustment between those with a new temporary or permanent ostomy in a cohort of Australian adults.

METHOD

This is a multicentre, longitudinal observational study. Ostomy adjustment was measured using the Ostomy Adjustment Inventory (OAI-23) at six possible time points ending at 9 months postsurgery or at the time of ostomy closure in those with a temporary stoma. The OAI-23 includes four domains: anger, acceptance, anxious preoccupation and social engagement.

RESULTS

Eligibility criteria were met by 1230 patients, with 849 (69%) recruited and consented. Of these, 108 were excluded as their surgery did not result in the formation of an ostomy and a further 41 were excluded due to there being no data on ostomy type (temporary or permanent). This left a study population of 700, of whom 397 had a temporary and 303 a permanent ostomy. Only small differences were observed between the temporary and permanent ostomy groups at most time points within the four OAI-23 domains. There were no statistically significant differences found beyond 2 weeks postdischarge and the differences were of small size. While no difference was found between the groups in the domain of anxious preoccupation, both groups demonstrated an increase in anxious preoccupation over time. Neither group regained their presurgery confidence to attend social engagements.

CONCLUSION

We found only minor differences in adjustment in those with a new temporary ostomy compared with a new permanent ostomy. Both groups demonstrated increasing anxious preoccupation and problems with social engagement. This suggests that access to education, training and support should be equitable between these two groups in clinical practice, and needs to incorporate a focus on psychological as well as physical outcomes.

Survivorship in Early-Stage Rectal Cancer Patients Who Have Received Combined Modality Therapy

Survival rates in early-stage rectal cancer patients have increased over the past few decades. Societies such as the National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and European Society of Medical Oncology (ESMO) have proposed guidelines related to cancer survivorship care including formal recommendations to address the needs in early-stage rectal cancer survivors. These guidelines, in addition to new clinical research findings in survivorship will be reviewed, specifically looking at physical, psychosocial, and financial concerns in rectal cancer survivorship.

Robot-assisted fluorescent sentinel lymph node identification in early-stage colon cancer

BACKGROUND

Patients with cT1-2 colon cancer (CC) have a 10-20% risk of lymph node metastases. Sentinel lymph node identification (SLNi) could improve staging and reduce morbidity in future organ-preserving CC surgery. This pilot study aimed to assess safety and feasibility of robot-assisted fluorescence-guided SLNi using submucosally injected indocyanine green (ICG) in patients with cT1-2N0M0 CC.

METHODS

Ten consecutive patients with cT1-2N0M0 CC were included in this prospective feasibility study. Intraoperative submucosal, peritumoral injection of ICG was performed during a colonoscopy. Subsequently, the near-infrared fluorescence 'Firefly' mode of the da Vinci Xi robotic surgical system was used for SLNi. SLNs were marked with a suture, after which a segmental colectomy was performed. The SLN was postoperatively ultrastaged using serial slicing and immunohistochemistry, in addition to the standard pathological examination of the specimen. Colonoscopy time, detection time (time from ICG injection to first SLNi), and total SLNi time were measured (time from the start of colonoscopy to start of segmental resection). Intraoperative, postoperative, and pathological outcomes were registered.

RESULTS

In all patients, at least one SLN was identified (mean 2.3 SLNs, SLN diameter range 1-13 mm). No tracer-related adverse events were noted. Median colonoscopy time was 12 min, detection time was 6 min, and total SLNi time was 30.5 min. Two patients had lymph node metastases present in the SLN, and there were no patients with false negative SLNs. No patient was upstaged due to ultrastaging of the SLN after an initial negative standard pathological examination. Half of the patients unexpectedly had pT3 tumours.

CONCLUSIONS

Robot-assisted fluorescence-guided SLNi using submucosally injected ICG in ten patients with cT1-2N0M0 CC was safe and feasible. SLNi was performed in an acceptable timespan and SLNs down to 1 mm were detected. All lymph node metastases would have been detected if SLN biopsy had been performed.

Sleep Problems in Individuals With Intestinal Stomas and Determining the Quality of Sleep: A Multicenter Study

PURPOSE

The aim of this study was to determine sleep problems and the sleep quality of individuals with intestinal stomas.

DESIGN

Descriptive quantitative design was used.

SUBJECTS AND SETTING

The research was carried out from September 2018 to September 2019 at 3 university hospitals with stoma units located in Ankara, Turkey. The study sample comprised 222 individuals with intestinal ostomies who were being monitored in these 3 centers. Approximately half (N = 113, 50.9%) had an ileostomy and 68.5% (N = 152) had a temporary stoma. More than half of the participants (N = 116, 52.3%) reported current sleep problems, 59.5% (N = 132) reported that their stoma affected their sleep, and 64% (N = 142) had problems at night due to their stomas, reporting that they woke up frequently during their main sleep period due to ostomy-related problems.

METHODS

Three instruments were used to measure study outcomes: the researcher-designed instrument determining the descriptive characteristics of individuals with intestinal stomas, the Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale.

RESULTS

The mean Pittsburgh Sleep Quality Index score was found to be above 5 (13.42, SD: 3.01) indicating poor sleep quality. The mean Epworth Sleepiness Scale score was 7.54 (SD: 6.37) indicating that participants had daytime sleepiness. The mean Pittsburgh Sleep Quality Index scores of participants with ileostomies ( P = .002) and those with temporary stomas ( P = .009) were found to be significantly higher.

CONCLUSIONS

Study findings indicate that individuals with intestinal stomas have poor sleep quality and problems with daytime sleepiness; those with ileostomies and temporary stomas had the worst quality of sleep.

Open versus laparoscopic Hartmann's procedure: a systematic review and meta-analysis

PURPOSE

Hartmann's procedure is traditionally performed in emergency situations where single-step procedures with immediate anastomosis may be unsafe. However, it can be associated with significant morbidity and low colostomy reversal rate. Whilst randomised controlled trials and a Cochrane review have reported strong evidence of laparoscopic over open colectomies, no such reviews have been performed for Hartmann's procedure. Hence, this paper aims to summarise the existing evidence to determine the efficacy of laparoscopic Hartmann's procedure over its open counterpart.

METHODS

Embase, Medline and Cochrane databases were searched from inception to 15 November 2020 for keywords relating to 'laparoscopy' and 'Hartmann' using strict inclusion and exclusion criteria. Odds ratio was estimated for dichotomous outcomes and weighted mean difference was estimated for continuous outcomes.

RESULTS

From the 836 articles yielded from the search strategy, 12 articles were selected for meta-analysis. Pooled analysis revealed that laparoscopic Hartmann's procedure (LHP) allows for a shorter length of stay, and a lower risk of overall surgical site infections and superficial surgical site infections. There was no significant difference in other outcomes. Single-arm analysis of LHP also showed an unprecedented high colostomy reversal rate of over 80%.

CONCLUSION

In clinically suitable patients, laparoscopic Hartmann's procedure has benefits over open Hartmann's procedure. Despite the selection bias of single-arm studies, LHP has reported a high stoma reversal rate of over 80%. Future well-controlled studies should be done to affirm the findings.