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Goodman W, Downing A, Allsop M, Munro J, Hubbard G, Beeken RJ. Understanding the associations between receipt of, and interest in, advice from a healthcare professional and quality of life in individuals with a stoma from colorectal cancer: a latent profile analysis. Support Care Cancer 2024; 32:463. [PMID: 38922504 PMCID: PMC11208265 DOI: 10.1007/s00520-024-08657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 06/13/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To explore whether profiles derived from self-reported quality of life were associated with receipt of, and interest in, advice from a healthcare professional in people with a stoma. METHODS Secondary analysis of cross-sectional national survey data from England of 4487 people with a stoma from colorectal cancer. The survey assessed quality of life using various scales, receipt and interest in various forms of advice, and physical activity. A three-step latent profile analysis was conducted to determine the optimum number of profiles. Multinomial regression explored factors associated with profile membership. A series of logistic regression models examined whether profile membership was associated with interest in advice. RESULTS Five profiles were identified; 'consistently good quality of life', 'functional issues', 'functional and financial issues', 'low quality of life' and 'supported but struggling'. Individuals in the 'functional and financial issues' and 'low quality of life' profiles were more likely to have received financial advice compared to the 'consistently good quality of life' profile. When compared to the 'consistently good quality of life' profile, all other profiles were more likely to report wanting advice across a range of areas, with the strongest associations in the 'low quality of life' profile. CONCLUSION Findings indicate that people with a stoma are not a homogenous group in terms of quality of life. Participants in profiles with quality of life concerns report wanting more advice across various categories but findings suggest there is scope to explore how this can be tailored or adapted to specific groups.
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Affiliation(s)
| | - Amy Downing
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Gill Hubbard
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Rebecca J Beeken
- School of Medicine, University of Leeds, Leeds, UK.
- Research Department of Behavioural Science and Health, University College London, London, UK.
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Houqiong J, Yuli Y, Yahang L, Tao L, Yang L, Yaxiong L, Dongning L, Taiyuan L. LASSO-based nomogram predicts the risk factors of low anterior resection syndrome for middle and low rectal cancer underwent robotic surgery. Surg Endosc 2024; 38:3378-3387. [PMID: 38714570 DOI: 10.1007/s00464-024-10863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/14/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND This study aims to analyze the influencing factors of postoperative Low Anterior Resection Syndrome (LARS) in patients with middle and low rectal cancer who underwent robotic surgery. It also seeks to predict the probability of LARS through a visual, quantitative, and graphical nomogram. This approach is expected to lower the risk of postoperative LARS in these patients and improve their quality of life through effective prevention and early intervention. PATIENTS AND METHODS This research involved patients with middle and low rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to October 2022. A series of intestinal dysfunction symptoms arising from postoperative rectal cancer were diagnosed and graded using LARS scoring criteria. After the initial screening of all variables related to LARS with Lasso regression, they were included in logistic regression for further univariate and multivariate analysis to identify independent risk factors for LARS. A prediction model was then constructed. RESULTS The study included 358 patients. The parameters identified by Lasso regression included obstruction, BMI, tumor localization, maximum tumor diameter, AJCC stage, stoma, neoadjuvant therapy (NAT), and postoperative adjuvant therapy (AT). Univariate and multivariate analyses indicated that a higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and postoperative adjuvant therapy were independent risk factors for total LARS. The AUC of the prediction nomogram was 0.834, with a sensitivity of 0.825 and specificity of 0.741. The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve fit the diagonal well. CONCLUSION Higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and adjuvant therapy were identified as independent risk factors for total LARS. A new predictive nomogram for postoperative LARS in patients with middle and low rectal cancer undergoing robotic surgery was developed, proving to be stable and reliable. This tool will assist clinicians in managing the postoperative treatment of these patients, facilitating better clinical decision-making and maximizing patient benefits.
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Affiliation(s)
- Ju Houqiong
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Yuan Yuli
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Liang Yahang
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Li Tao
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Liu Yang
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Liu Yaxiong
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Liu Dongning
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China.
| | - Li Taiyuan
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China.
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Zamaray B, Veld JV, Brohet R, Consten EC, Tanis PJ, van Westreenen HL. Timing of restoration of bowel continuity after decompressing stoma, in left-sided obstructive colon cancer: a nationwide retrospective cohort. Int J Surg 2024; 110:864-872. [PMID: 37916947 PMCID: PMC10871576 DOI: 10.1097/js9.0000000000000872] [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: 06/16/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND With the increasing use of decompressing stoma as a bridge to surgery for left-sided obstructive colon cancer (LSOCC), the timing of restoration of bowel continuity (ROBC) is a subject of debate. There is a lack of data on immediate ROBC during elective resection as an alternative for a 3-stage procedure. This study analysed if immediate ROBC during tumour resection is safe and of any benefit for patients who underwent decompressing stoma for LSOCC. METHODS In a Dutch nationwide collaborative research project, 3153 patients who underwent resection for LSOCC in 75 hospitals (2009-2016) were identified. Extensive data on disease and procedural characteristics, and outcomes was collected by local collaborators. For this analysis, 332 patients who underwent decompressing stoma followed by curative resection were selected. Immediate ROBC during tumour resection was compared to two no immediate ROBC groups, (1) tumour resection with primary anastomosis (PA) with leaving the decompressing stoma in situ, and (2) tumour resection without PA. RESULTS Immediate ROBC was performed in 113 patients (34.0%) and no immediate ROBC in 219 patients [168 with PA (50.6%) and 51 patients without PA (15.4%)]. No differences at baseline between the groups were found for age, ASA score, cT, and cM. Major surgical complications (8.8% immediate ROBC vs. 4.8% PA with decompressing stoma and 7.8% no PA; P =0.37) and mortality (2.7% vs. 2.4% and 0%, respectively; P =0.52) were similar. Immediate ROBC resulted in a shorter time with a stoma (mean 41 vs. 240 and 314 days, respectively; P <0.001), and fewer permanent stomas (7% vs. 21% and 80%, respectively; P <0.001) as compared to PA with a decompressing stoma or no PA. CONCLUSION After a decompressing stoma for LSOCC, immediate ROBC during elective resection appears safe, reduces the total time with a stoma and the risk of a permanent stoma.
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Affiliation(s)
- Bobby Zamaray
- Department of Surgery, Isala Hospital, Zwolle
- Department of Surgery, University Medical Centre Groningen, Groningen
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Centre Amsterdam
| | - Joyce V. Veld
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Centre Amsterdam
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam
| | | | - Esther C.J. Consten
- Department of Surgery, University Medical Centre Groningen, Groningen
- Department of Surgery, Meander hospital, Amersfoort
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Centre Amsterdam
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Halms T, Strasser M, Hasan A, Rüther T, Trepel M, Raab S, Gertzen M. Smoking and quality of life in lung cancer patients: systematic review. BMJ Support Palliat Care 2024; 13:e686-e694. [PMID: 37607808 DOI: 10.1136/spcare-2023-004256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Lung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor in the treatment of patients with LC, the impact of smoking status on QoL remains unclear. This systematic review aims to provide a comprehensive overview of available evidence on the relationship between smoking status and QoL among patients with LC. METHODS A systematic search of Embase, Medline and Web of Science was conducted. Studies reporting the impact of smoking status on QoL among patients with LC were eligible for inclusion. Two reviewers independently assessed the eligibility of studies, extracted data and evaluated the risk of bias using the Critical Appraisal Skills Programme appraisal tool for cohort studies. A descriptive synthesis was performed due to the heterogeneity of the studies. RESULTS A total of 23 studies met the inclusion criteria (17 studies providing cross-sectional and 6 longitudinal data). The studies included a total of 10 251 participants. The results suggested a tendency towards lower QoL among smokers compared with non-smokers. The effect of smoking cessation on QoL was insufficiently investigated in the included studies and therefore remains inconclusive. CONCLUSIONS The findings of this review suggest that current smokers may experience worse QoL than former and never smokers. The results of this systematic review should, however, be viewed in the context of the difficulty of data collection in this patient group given the low survival rates and low performance status, among other factors and in light of the large variety of different QoL measures used. Future research requires uniform QoL measures, a holistic representation of all patients with LC as well as a comprehensive consideration of all potential determinants of QoL. The potential benefits of smoking cessation on QoL among patients with LC require investigation.
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Affiliation(s)
- Theresa Halms
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Martina Strasser
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig‑Maximilians University Munich, Munich, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- Comprehensive Cancer Center Augsburg (CCCA), Augsburg, Germany
| | - Stephan Raab
- Department of Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Marcus Gertzen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
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Li YC, Hsu HH, Yang SP, Hu GC, Wang HM, Huang WC, Wang TJ. Healthy Lifestyle and Quality of Life in Post-Operative Colorectal Cancer Patients: A Five-Month Observational Study. Nutrients 2023; 16:68. [PMID: 38201897 PMCID: PMC10781141 DOI: 10.3390/nu16010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Health-related quality of life (HRQOL) is an important indicator of treatment effectiveness. An unhealthy lifestyle can have a negative impact on quality of life. This study aimed to investigate changes in health-related lifestyle over time after surgery for colorectal cancer and their impact on HRQOL. Healthy lifestyle habits examined in this study included physical activity, smoking, alcohol consumption, fruit and vegetable intake, sleep, and obesity levels. An observational study design was used. A total of 75 post-operative colorectal cancer patients were recruited from two medical centers in Taiwan. Data were collected through structured questionnaires. Mean HRQOL scores at 1, 3, and 5 months after discharge were 102.5 (SD = 18.8), 102.9 (SD = 20.1), and 103.0 (SD = 18.9), respectively. A generalized estimating equation analysis showed that alcohol consumption (p = 0.009), fruit and vegetable intake (p = 0.020), physical activity (p = 0.023), sleep quality (p < 0.001), and obesity (p = 0.035) were important predictors of post-operative quality of life in patients with colorectal cancer. The impact of smoking on HRQOL did not reach statistical significance. Colorectal cancer patients tend to have better HRQOL after surgery if they stay physically active, eat enough fruits and vegetables, and sleep well.
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Affiliation(s)
- Yi-Chiu Li
- Division of Colorectal, Department of Surgery, MacKay Memorial Hospital, Taipei City 10449, Taiwan; (Y.-C.L.); (H.-H.H.)
| | - Hsi-Hsien Hsu
- Division of Colorectal, Department of Surgery, MacKay Memorial Hospital, Taipei City 10449, Taiwan; (Y.-C.L.); (H.-H.H.)
- MacKay Junior College of Medicine Nursing and Management, Taipei City 11260, Taiwan
| | - Shu-Ping Yang
- Department of Nursing, Cathay General Hospital, Taipei City 10630, Taiwan; (S.-P.Y.); (H.-M.W.)
| | - Gwo-Chi Hu
- Department of Rehabilitation, MacKay Memorial Hospital, Taipei City 10449, Taiwan;
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Hui-Mei Wang
- Department of Nursing, Cathay General Hospital, Taipei City 10630, Taiwan; (S.-P.Y.); (H.-M.W.)
| | - Wen-Chien Huang
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei City 10449, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 11219, Taiwan
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Neuberger L, Braude P, Weeks K, Braude P, Halliday R, McCarthy K, Carter B. A new stoma for an older person-An association with quality of life and physical function: A systematic review. J Am Geriatr Soc 2022; 70:2415-2425. [PMID: 35506939 DOI: 10.1111/jgs.17803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/22/2022] [Accepted: 03/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Older people are more likely to have a stoma postabdominal surgery than younger people. Few studies have examined the effect of a stoma on older people. The aim of this review was to explore the effect of a stoma on functional independence of an older person. We explored secondary outcomes of poststoma formation length of hospital stay, quality of life and factors affecting stroma independence. METHODS An exploratory systematic review was developed by our multidisciplinary group including an expert patient, colorectal surgeon, stoma nurse, physiotherapist, geriatrician, and methodologist. Four databases were searched including studies with participants 60 years old or older, who had undergone abdominal surgery for any pathology resulting in an abdominal stoma. RESULTS We identified 857 studies, of which we included 25 in the final review incorporating 6972 participants (average age 67.4 years). There was a strong association between presence of stoma and (1) worse physical function (standardized MD = 0.7; 95% CI 0.21-1.19; I2 = 95) and (2) worse quality of life (standardized MD = 1.61; 95% CI 0.5-2.72, I2 = 98). The same effect was seen in fecal ostomy and urinary diversion. Few studies measured stoma independence and only one examined factors affecting this. No studies examined length of stay. CONCLUSIONS Stoma have a negative association with the physical function and quality of life of older people. Future studies should focus on identifying modifiable factors that may affect physical function, quality of life, and stoma independence.
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Affiliation(s)
- Lydia Neuberger
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Philip Braude
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Kayleigh Weeks
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Peter Braude
- Division of Women's Health, King's College London, London, UK
| | - Ruth Halliday
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Kathryn McCarthy
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Ben Carter
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK.,Biostatistics and Health informatics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Cochrane Skin Group, Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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In vivo antitumor activity of Euphorbia lathyris ethanol extract in colon cancer models. Biomed Pharmacother 2022; 149:112883. [PMID: 35692123 DOI: 10.1016/j.biopha.2022.112883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Euphorbia lathyris seeds have been used to treat various medical conditions. We previously reported that ethanolic extract from the defatted seed of Euphorbia lathyris (EE) (variety S3201) possesses a potent in vitro antitumor activity against colon cancer (CRC) cell lines. However, the effects of EE on CRC in vivo models and its possible preventive activity have not been elucidated. The aim of this study is to develop an in vivo study to corroborate its efficacy. For this purpose, two tumor induction models have been developed. In orthotopic xenograft model, it has been shown that EE reduces tumor size without hematological toxicity. The ethanolic extract induced an intense apoptosis in tumors mediated by caspase 3. Using the Azoxymethane/Dextran Sulfate Sodium model, a reduction of dysplastic polyps has been demonstrated, showing its preventive power. Furthermore, EE promoted the presence of an eubiotic microbiotal environment in the mucosa of the colon and induced an increase in antioxidant enzyme activity. This fact was accompanied by a modulation of cytokine expression that could be related to its protective mechanism. Therefore, although further experiments will be necessary to determine its applicability in the treatment of CRC, ES could be a new prevention strategy as well as treatment for this type of tumor, being a powerful candidate for future clinical trials.
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