1
|
Maalouf MF, Robitaille S, Penta R, Wang A, Liberman S, Fiore JF, Feldman LS, Lee L. How well do we measure the impact of bowel dysfunction on health-related quality of life after rectal cancer surgery? Surgery 2024; 176:303-309. [PMID: 38839434 DOI: 10.1016/j.surg.2024.04.038] [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: 12/18/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Rectal cancer surgery risks causing bowel dysfunction, which has an important impact on health-related quality of life. The validity of generic tools used to measure health-related quality of life after bowel dysfunction is unclear. This study aimed to determine the content validity of health-related quality-of-life measurement tools in rectal cancer. METHODS This was a qualitative single-center study in which adult patients who underwent rectal cancer surgery with sphincter preservation from July 2017 to October 2020 were recruited. Patients were excluded if they developed local metastasis, required a permanent stoma, or had surgery <1 year since recruitment. Telephone-based semi-structured interviews were conducted. Bowel dysfunction was measured using the Low Anterior Resection Syndrome score. Content analysis was achieved using the International Classification of Functioning framework. RESULTS Recurrent bowel dysfunction-related concepts included "Mental functions," "Defecation functions," "Emotional functions," "Recreation and leisure," "Intimate relationships," and "Remunerative employment." A mean of 7.5 recurrent bowel dysfunction-related concepts were identified within the health-related quality of life instruments analyzed. The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (n = 11) and the 36-Item Short Form Health Survey (n = 9) covered the greatest number of recurrent bowel dysfunction-related concepts. Concepts such as "Mental functions," "Urination functions," "Sexual functions," "Driving," and "Mobility" were not covered by any instrument. CONCLUSION The content of traditional health-related quality-of-life instruments is missing important areas that represent the impact of bowel dysfunction after rectal cancer surgery on health-related quality of life. These findings could help improve patient-centered care in rectal cancer surgery.
Collapse
Affiliation(s)
- Michael F Maalouf
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. https://twitter.com/MichaelMaalouf_
| | - Stephan Robitaille
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Ruxandra Penta
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Anna Wang
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Sender Liberman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
2
|
Al Rashid F, Liberman AS, Charlebois P, Stein B, Feldman LS, Fiore JF, Lee L. The impact of bowel dysfunction on health-related quality of life after rectal cancer surgery: a systematic review. Tech Coloproctol 2022; 26:515-527. [PMID: 35239096 DOI: 10.1007/s10151-022-02594-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Symptoms of bowel dysfunction after sphincter-preserving rectal cancer surgery have an important impact on health-related quality of life (HRQOL), but that relationship is complex. A better understanding of this relationship allows for better informed shared decision-making about surgery. Our objective was to perform a systematic review to determine which HRQOL domains are most affected by postoperative bowel dysfunction. METHODS A systematic review of the CINAHL, Cochrane Library, Embase, Medline, PsycInfo, PubMed, Web of Science, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies that evaluated bowel function after sphincter-preserving rectal cancer surgery and assessed HRQOL using a validated instrument. The quality of HRQOL analysis was assessed using an 11-item checklist. The main outcome was the impact bowel dysfunction had on global and domain specific quality-of-life indices. The impact was evaluated for clinical relevance using the Minimum Clinical Important Difference (MCID) for each specific HRQOL instrument. RESULTS Out of 952 unique citations, 103 studies were full-text reviews. Eighteen studies met the inclusion criteria (4 prospective cohorts and 9 cross-sectional studies). Of the 15 studies with long-term follow-up, the time to assessment after surgery ranged from 1.2 to 14.6 years. The low anterior resection syndrome score and European Organization for Research and Treatment core quality-of-life questionnaire (EORTC QLQ-C30) were the most commonly used instruments. Medium and large magnitudes in MCID were seen for global health, social functioning, emotional functioning, fatigue, diarrhea, and financial difficulties. Among included studies, the most consistently reported functional domains affected by bowel function were social functioning and emotional functioning. CONCLUSIONS Following sphincter-preserving rectal cancer surgery, poor bowel function mainly affects the social and emotional functional domains of HRQOL, which in turn impact global scores. This finding can help inform patients about expected changes in HRQOL after rectal cancer surgery and facilitate individualized treatment decisions.
Collapse
Affiliation(s)
- F Al Rashid
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada.
| | - A S Liberman
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - P Charlebois
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - B Stein
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - J F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - L Lee
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
3
|
Fleming CA, Cullinane C, Lynch N, Killeen S, Coffey JC, Peirce CB. Urogenital function following robotic and laparoscopic rectal cancer surgery: meta-analysis. Br J Surg 2021; 108:128-137. [PMID: 33711141 DOI: 10.1093/bjs/znaa067] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mixed results are reported on clinical and cancer outcomes in laparoscopic rectal cancer surgery (LRCS) compared with robotic rectal cancer surgery (RRCS). However, more favourable functional outcomes are reported following RRCS. This study compared urinary and sexual function following RRCS and LRCS in male and female patients. METHODS A systematic review and meta-analysis of urinary and sexual function after RRCS and LRCS was performed following PRISMA and MOOSE guidelines, and registered prospectively with PROSPERO (ID:CRD42020164285). The functional outcome reporting tools most commonly included: the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI). Mean scores and changes in mean scores from baseline were analysed using RevMan version 5.3. RESULTS Ten studies were included reporting on 1286 patients. Some 672 patients underwent LRCS, of whom 380 (56.5 per cent) were men and 116 (17.3 per cent) were women (gender not specified in 176 patients, 26.2 per cent). A total of 614 patients underwent RRCS, of whom 356 (58.0 per cent) were men and 83 (13.5 per cent) were women (gender not specified in 175 patients, 28.5 per cent). Regarding urinary function in men at 6 months after surgery, IPSS scores were significantly better in the RRCS group than in the LRCS group (mean difference (MD) -1.36, 95 per cent c.i. -2.31 to -0.40; P = 0.005), a trend that persisted at 12 months (MD -1.08, -1.85 to -0.30; P = 0.007). ΔIIEF scores significantly favoured RRCS at 6 months [MD -3.11 (95%CI -5.77, -0.44) P <0.021] and 12 months [MD -2.76 (95%CI -3.63, -1.88) P <0.001] post-operatively. Mixed urinary and sexual function outcomes were reported for women. CONCLUSION This meta-analysis identified more favourable urinary and erectile function in men who undergo robotic compared with conventional laparoscopic surgery for rectal cancer. Outcomes in women did not identify a consistently more favourable outcome in either group. As robotic rectal cancer surgery may offer more favourable functional outcomes it should be considered and discussed with patients.
Collapse
Affiliation(s)
- C A Fleming
- Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - C Cullinane
- Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland
| | - N Lynch
- Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland
| | - S Killeen
- Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland
| | - J C Coffey
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick, Ireland
| | - C B Peirce
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|
4
|
Challenges, evidence, ethics and surgeons: Lessons learned from the recent evolution of colorectal surgery. Cir Esp 2019; 97:549-550. [PMID: 31027835 DOI: 10.1016/j.ciresp.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/20/2022]
|
5
|
Besson A, Deftereos I, Chan S, Faragher IG, Kinsella R, Yeung JM. Understanding patient-reported outcome measures in colorectal cancer. Future Oncol 2019; 15:1135-1146. [PMID: 30880455 DOI: 10.2217/fon-2018-0723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Quality of life has become increasingly regarded as a key outcome measurement for cancer patients. Patient-reported outcome measures (PROMs) represent the tools used to ascertain self-reported quality of life. This review provides a summary of the literature regarding the use of PROMs in colorectal cancer and evaluates the advantages and limitations of generic and disease specific questionnaires that can be utilized in clinical practice. Factors that influence PROMs are outlined, including cancer characteristics, patient factors and treatment methods. Finally, future directions for the use of PROMs in colorectal cancer to inform healthcare delivery at an individual- and systems-based level are discussed.
Collapse
Affiliation(s)
- Alex Besson
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition, Western Health, Footscray, Victoria, Australia
| | - Steven Chan
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
| | - Rita Kinsella
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Mc Yeung
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
| |
Collapse
|