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Volovat CC, Scripcariu DV, Boboc D, Volovat SR, Vasilache IA, Lupascu-Ursulescu C, Gheorghe L, Baean LM, Volovat C, Scripcariu V. Predicting the Feasibility of Curative Resection in Low Rectal Cancer: Insights from a Prospective Observational Study on Preoperative Magnetic Resonance Imaging Accuracy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:330. [PMID: 38399617 PMCID: PMC10890266 DOI: 10.3390/medicina60020330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: A positive pathological circumferential resection margin is a key prognostic factor in rectal cancer surgery. The point of this prospective study was to see how well different MRI parameters could predict a positive pathological circumferential resection margin (pCRM) in people who had been diagnosed with rectal adenocarcinoma, either on their own or when used together. Materials and Methods: Between November 2019 and February 2023, a total of 112 patients were enrolled in this prospective study and followed up for a 36-month period. MRI predictors such as circumferential resection margin (mCRM), presence of extramural venous invasion (mrEMVI), tumor location, and the distance between the tumor and anal verge, taken individually or combined, were evaluated with univariate and sensitivity analyses. Survival estimates in relation to a pCRM status were also determined using Kaplan-Meier analysis. Results: When individually evaluated, the best MRI predictor for the detection of a pCRM in the postsurgical histopathological examination is mrEMVI, which achieved a sensitivity (Se) of 77.78%, a specificity (Sp) of 87.38%, a negative predictive value (NPV) of 97.83%, and an accuracy of 86.61%. Also, the best predictive performance was achieved by a model that comprised all MRI predictors (mCRM+ mrEMVI+ anterior location+ < 4 cm from the anal verge), with an Se of 66.67%, an Sp of 88.46%, an NPV of 96.84%, and an accuracy of 86.73%. The survival rates were significantly higher in the pCRM-negative group (p < 0.001). Conclusions: The use of selective individual imaging predictors or combined models could be useful for the prediction of positive pCRM and risk stratification for local recurrence or distant metastasis.
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Affiliation(s)
- Cristian-Constantin Volovat
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.L.-U.); (L.G.)
| | - Dragos-Viorel Scripcariu
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Diana Boboc
- Department of Medical Oncology-Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.V.)
| | - Simona-Ruxandra Volovat
- Department of Medical Oncology-Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.V.)
| | - Ingrid-Andrada Vasilache
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Corina Lupascu-Ursulescu
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.L.-U.); (L.G.)
| | - Liliana Gheorghe
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.L.-U.); (L.G.)
| | - Luiza-Maria Baean
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.L.-U.); (L.G.)
| | - Constantin Volovat
- Department of Medical Oncology-Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (C.V.)
| | - Viorel Scripcariu
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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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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Olivia M, Allister S, Jeongyoon M, Marie D, Richard G, Carol-Ann V, Fateme R, Marylise B. An online educational and supportive care application for rectal cancer survivors with low anterior resection syndrome: A mixed methods pilot study. Colorectal Dis 2023; 25:1812-1820. [PMID: 37501348 DOI: 10.1111/codi.16665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/19/2023] [Accepted: 04/30/2023] [Indexed: 07/29/2023]
Abstract
AIM Restorative proctectomy is commonly associated with significant bowel dysfunction, known as low anterior resection syndrome (LARS), which has a negative impact on patients' quality of life. We developed an online patient-centred application on LARS (eLARS) for rectal cancer survivors. The primary objective of this study was to assess the feasibility of eLARS for rectal cancer survivors with LARS following restorative proctectomy. The secondary objective was to explore participants' experiences with LARS and the eLARS application. METHODS This was a mixed methods study, which included a feasibility and qualitative analysis. Participants were rectal cancer survivors who underwent restorative proctectomy for rectal cancer within 3 years, completed all adjuvant treatment, and suffered from bowel dysfunction postoperatively. Participants were given access to the application over a 2-month study period. Feasibility was defined as 75% of study participants using the application ≥4 times per month. Semi-structured interviews were conducted with participants after the study period and were analysed using thematic analysis. RESULTS Our sample included eight rectal cancer survivors, five women and three men. The median age was 58.5 years (56.5-64.5). Most participants (75%) were >1-year post-restorative proctectomy. 75% of study participants used the application ≥4 times per month for 2 months. Our thematic analysis revealed that participants felt that they lacked access to credible information and emotional support around the time of ileostomy closure, and found that eLARS addressed these challenges. CONCLUSION eLARS is a feasible educational and supportive care intervention for patients with LARS and has the potential to improve patients' quality of life.
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Affiliation(s)
- Monton Olivia
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Smith Allister
- Department of Emergency Medicine, Western University, London, Ontario, Canada
| | - Moon Jeongyoon
- Department of Surgery, Division of General Surgery, McGill University, Montreal, Quebec, Canada
| | - Demian Marie
- Department of Surgery, Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Garfinkle Richard
- Department of Surgery, Division of General Surgery, McGill University, Montreal, Quebec, Canada
| | - Vasilevsky Carol-Ann
- Department of Surgery, Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Rajabiyazdi Fateme
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Boutros Marylise
- Department of Surgery, Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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Bulkley JE, McMullen CK, Rawlings AM, Krouse RS, Francisco MC, Sterrett AT, Burnett-Hartman AN, Pawloski PA, Corley DA, Colwell JC, Feigelson HS. The association of bowel function, participation in life activities, and quality of life in rectal cancer survivors. Qual Life Res 2021; 31:487-495. [PMID: 34251589 DOI: 10.1007/s11136-021-02930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate whether limited participation in life activities is associated with quality of life (QOL) in rectal cancer survivors, and if so, whether this association is independent of bowel function difficulties. METHODS We surveyed rectal cancer survivors from four healthcare systems about their QOL, bowel function, and participation in life activities. Additional demographic and clinical variables were extracted from the electronic health record. We examined independent associations between bowel function, participation in life activities, and QOL, controlling for potential confounders. We also identified factors, including ostomy status, that correlate with participation in life activities. RESULTS Of the 527 respondents, 52% were male, 80% were non-Hispanic white, and the mean age was 63. In fully adjusted models for all rectal cancer survivors, participation in life activities was positively associated with QOL, while bowel function was not. Bowel function retained an independent association with QOL for those who previously had an ostomy and were therefore more likely to have a low rectal anastomosis. Lower participation in life activities was correlated with lower self-reported physical and cognitive function, younger age, financial difficulty, and being non-Hispanic white. CONCLUSIONS Rectal cancer survivors' participation in life activities was strongly associated with QOL, even when controlling for numerous confounders, including bowel function. Identifying ways to improve participation in life activities may be critical to developing rehabilitative and other supportive interventions that optimize QOL among rectal cancer survivors.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA.
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA
| | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA
| | - Robert S Krouse
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Melanie C Francisco
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA
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Verkuijl SJ, Jonker JE, Trzpis M, Burgerhof JGM, Broens PMA, Furnée EJB. Functional outcomes of surgery for colon cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 47:960-969. [PMID: 33277056 DOI: 10.1016/j.ejso.2020.11.136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION As survival rates of colon cancer increase, knowledge about functional outcomes is becoming ever more important. The primary aim of this systematic review and meta-analysis was to quantify functional outcomes after surgery for colon cancer. Secondly, we aimed to determine the effect of time to follow-up and type of colectomy on postoperative functional outcomes. MATERIALS AND METHODS A systematic literature search was performed to identify studies reporting bowel function following surgery for colon cancer. Outcome parameters were bowel function scores and/or prevalence of bowel symptoms. Additionally, the effect of time to follow-up and type of resection was analyzed. RESULTS In total 26 studies were included, describing bowel function between 3 to 178 months following right hemicolectomy (n = 4207), left hemicolectomy/sigmoid colon resection (n = 4211), and subtotal/total colectomy (n = 161). In 16 studies (61.5%) a bowel function score was used. Pooled prevalence for liquid and solid stool incontinence was 24.1% and 6.9%, respectively. The most prevalent constipation-associated symptoms were incomplete evacuation and obstructive, difficult emptying (33.3% and 31.4%, respectively). Major Low Anterior Resection Syndrome was present in 21.1%. No differences between time to follow-up or type of colectomy were found. CONCLUSION Bowel function problems following surgery for colon cancer are common, show no improvement over time and do not depend on the type of colectomy. Apart from fecal incontinence, constipation-associated symptoms are also highly prevalent. Therefore, more attention should be paid to all possible aspects of bowel dysfunction following surgery for colon cancer and targeted treatment should commence promptly.
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Affiliation(s)
- Sanne J Verkuijl
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Jara E Jonker
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Bao F, Shang J, Xiang C, Li G, Zhi X, Liu W, Wang D, Xian-Yu J, Deng Z. Gender aspects of survival after abdominoperineal resection for low rectal cancer: a retrospective study. Int J Colorectal Dis 2020; 35:2001-2010. [PMID: 32564125 DOI: 10.1007/s00384-020-03671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The difference in prognosis between genders after abdominoperineal resection (APR) for low rectal cancer (LRC) is unclear. This study aimed to compare survival outcomes between genders in patients with LRC who underwent curative APR. METHODS This retrospective cohort study used a database of consecutive colorectal resections. Patients who received curative APR with LRC were grouped according to their gender. Female patients were frequency-matched 1:1 on American Joint Committee on Cancer (AJCC) stage to male patients. Overall survival (OS), disease-free survival (DFS), and their independent risk factors were examined. RESULTS A total of 140 patients with APR for LRC were included after matching: 70 (50.0%) males and 70 (50.0%) females. No significant differences were found between the groups in terms of age, operation methods, AJCC stage, and adjuvant therapy (all P > 0.05). Median follow-up was 39 (range: 3-128) months. Male gender was independently associated with worse OS (adjusted hazard ratio [HR] = 2.755, 95% CI: 1.507-5.038, P = 0.001) and worse DFS (adjusted HR = 2.440, 95% CI: 1.254-4.746, P = 0.009). Subgroup analysis revealed that female patients with stage III disease had better OS (P = 0.001) and DFS (P < 0.001) than male patients. CONCLUSION Gender affects survival after a curative APR for LRC. Compared with females, male patients with LRC after curative APR had worse prognosis, especially for stage III disease.
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Affiliation(s)
- Feng Bao
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Jianying Shang
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Chunhua Xiang
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Guoqiang Li
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Xing Zhi
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Wen Liu
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Dong Wang
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Jianbo Xian-Yu
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Zhigang Deng
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China.
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Ma H, Zhang X, Li N, Lu X, Wei Y, Yuan N, Tian G, Li S. Glutamate receptor, ionotropic, N-methyl D-aspartate-associated protein 1, a potential target of miR-296, facilitates proliferation and migration of rectal cancer cells. Biosci Biotechnol Biochem 2020; 84:2077-2084. [PMID: 32657216 DOI: 10.1080/09168451.2020.1792267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of our article was to probe the influence of GRINA on rectal cancer and how GRINA is regulated in rectal cancer. Based on the public data, we found that GRINA was highly expressed in rectal cancer tissues and related to worse prognosis in rectal cancer patients. MiR-296 was predicted as an upstream regulatory miRNA of GRINA, which was further verified by dual-luciferase reporter assay. Moreover, we revealed that up-regulation/down-regulation of GRINA facilitated/suppressed SW1463/SW837 cell proliferation, migration, and invasion. Rescue assays indicated that the facilitating impact of GRINA on SW1463 cell proliferation and motility was abolished by miR-296 over-expression whilst the suppressing influence of GRINA on SW837 cell proliferation, migration, and invasion was reversed by miR-296 depletion. These consequences indicated that GRINA, which might be regulated by miR-296, acted stimulative important impact on rectal cancer cells, insinuating that GRINA might be a novel potential target for rectal cancer therapy.
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Affiliation(s)
- Huan Ma
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Xianyu Zhang
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Na Li
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Xiurong Lu
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Yulei Wei
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Na Yuan
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Guiying Tian
- Department of Radiotherapy, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
| | - Shuguang Li
- Department of Oncology, The First Affiliated Hospital of Hebei North University , Zhangjiakou, Hebei, P.R. China
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Garfinkle R, Loiselle CG, Park J, Fiore JF, Bordeianou LG, Liberman AS, Morin N, Faria J, Ghitulescu G, Vasilevsky CA, Bhatnagar SR, Boutros M. Development and evaluation of a patient-centred program for low anterior resection syndrome: protocol for a randomized controlled trial. BMJ Open 2020; 10:e035587. [PMID: 32474427 PMCID: PMC7264642 DOI: 10.1136/bmjopen-2019-035587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low anterior resection syndrome (LARS) is described as disordered bowel function after rectal resection that leads to a detriment in quality of life, and affects the majority of individuals following restorative proctectomy for rectal cancer. The management of LARS includes personalised troubleshooting and effective self-management behaviours. Thus, affected individuals need to be well informed and appropriately engaged in their own LARS management. This manuscript describes the development of a LARS patient-centred programme (LPCP) and the study protocol for its evaluation in a randomised controlled trial. METHODS AND ANALYSIS This will be a multicentre, randomised, assessor-blind, parallel-groups, pragmatic trial evaluating the impact of an LPCP, consisting of an informational booklet, patient diaries and nurse support, on patient-reported outcomes after restorative proctectomy for rectal cancer. The informational booklet was developed by a multidisciplinary LARS team, and was vetted in a focus group and semistructured interviews involving patients, caregivers, and healthcare professionals. The primary outcome will be global quality of life (QoL), as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30), at 6 months after surgery. The treatment effect on global QoL will be modelled using generalised estimating equations. Secondary outcomes include symptom change, patient activation, bowel function measures, emotional distress, knowledge about LARS and satisfaction with the LPCP. ETHICS AND DISSEMINATION The Research Ethics Committee (REC) at the Integrated Health and Social Services Network for West-Central Montreal (health network responsible for the Jewish General Hospital) is the overseeing REC for all Quebec sites. They have granted ethical approval (MP-05-2019-1628) for all Quebec hospitals (Jewish General Hospital, McGill University Health Center, CHU de Quebec) and have granted full authorisation to begin research at the Jewish General Hospital. Patient recruitment will not begin at the other Quebec sites until inter-institutional contracts are finalised and feasibility/authorisation for research is granted by their respective REC. The results of this study will be presented at national and international conferences, and a manuscript with results will be submitted for publication in a high-impact peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03828318; Pre-results.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Carmen G Loiselle
- Department of Oncology, McGill University, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Jason Park
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Liliana G Bordeianou
- Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Julio Faria
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Gabriela Ghitulescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sahir R Bhatnagar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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Goldstine J, van Hees R, van de Vorst D, Skountrianos G, Nichols T. Factors influencing health-related quality of life of those in the Netherlands living with an ostomy. ACTA ACUST UNITED AC 2019; 28:S10-S17. [DOI: 10.12968/bjon.2019.28.22.s10] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: this study examined the health-related quality of life (HRQoL) and wellbeing of people in the Netherlands who had undergone ostomy surgery. Aims: to assess how an ostomy population perceives their HRQoL and determine key stressors that influence HRQoL in this population. Methods: a cross-sectional survey, including the City of Hope National Medical Center Quality of Life Questionnaire for patients with an ostomy and a Visual Analogue Scale measuring HRQoL, was used to evaluate postsurgical patients. Findings: people with an ostomy in the Netherlands have a generally positive HRQoL, but this may be affected by peristomal skin irritation, experience of leakage on to the peristomal skin and whether their surgery was planned. Conclusions: access to specialist nurse support and products designed to prevent leakage and prevent skin irritation—two key drivers of HRQoL—may be able to maximise an individual's health status throughout their lifelong journey as a person with an ostomy.
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Katz M, Silverstein N, Coll P, Sullivan G, Mortensen EM, Sachs A, Gross JB, Girard E, Liang J, Ristau BT, Stevenson C, Smith PP, Shames BD, Millea R, Ali I, Poulos CM, Ramaraj AB, Otukoya AO, Nolan J, Wahla Z, Hardy C, Al-Naggar I, Bliss LA, McFadden DW. Surgical care of the geriatric patient. Curr Probl Surg 2019; 56:260-329. [DOI: 10.1067/j.cpsurg.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/13/2019] [Indexed: 12/15/2022]
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11
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Sun V, Wendel CS, Demark-Wahnefried W, Grant M, McMullen CK, Bulkley JE, Herrinton LJ, Hornbrook MC, Krouse RS. Diet and Behavior Modifications by Long-term Rectal Cancer Survivors to Manage Bowel Dysfunction-Associated Symptoms. Nutr Cancer 2018; 71:89-99. [PMID: 30572723 PMCID: PMC6456395 DOI: 10.1080/01635581.2018.1524017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/06/2018] [Accepted: 09/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Rectal cancer (RC) survivors experience significant bowel function issues after treatment. We aimed to describe self-reported dietary and behavioral modifications among long-term (≥5 yr) RC survivors to manage bowel dysfunction. METHODS RC survivors from Kaiser Permanente Northern California and Northwest regions completed surveys either via postage-paid return mail or telephone. Summary statistics on diet/behavioral modifications data were tabulated by proportion of responses. Modifications and frequency of bowel symptoms cited and were compared by ostomy status. RESULTS A total of 575 respondents were included (overall response rate = 60.5%). Fruits and vegetables were troublesome for symptoms, but was also helpful in mitigating constipation, obstruction, and frequency, as well as improving predictability. Many respondents attributed red meat (17.7%), fried foods (13.9%), spicy foods (13.1%), carbonated beverages (8.0%), and sweets (7.6%) to increased diarrhea, gas, and urgency. Common behavioral modifications included controlling meal portions (50.6%), timing regularity (25.3%), and refraining from late night eating (13.8%). Permanent ostomy survivors were more likely to report symptoms of obstruction, while anastomosis survivors were more likely to report urgency. CONCLUSION Multiple modifications were attempted by RC survivors to manage bowel symptoms. Identifying diet changes among RC survivors can improve symptom management and survivorship care.
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Affiliation(s)
- Virginia Sun
- a Department of Population Sciences , City of Hope , Duarte , California , USA
| | | | | | - Marcia Grant
- a Department of Population Sciences , City of Hope , Duarte , California , USA
| | - Carmit K McMullen
- d Center for Health Research, Kaiser Permanente Northwest , Portland , Oregon , USA
| | - Joanna E Bulkley
- d Center for Health Research, Kaiser Permanente Northwest , Portland , Oregon , USA
| | - Lisa J Herrinton
- e Kaiser Permanente Northern California Division of Research , Oakland , California , USA
| | - Mark C Hornbrook
- d Center for Health Research, Kaiser Permanente Northwest , Portland , Oregon , USA
| | - Robert S Krouse
- f Corporal Michael J. Crescenz Veterans Affairs Medical Center and Perelman School of Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
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12
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Chen XF, Chen J. Effect of continuity nursing on wound healing, complications, and self-care ability in patients after gastrointestinal surgery for colorectal cancer. Shijie Huaren Xiaohua Zazhi 2018; 26:945-950. [DOI: 10.11569/wcjd.v26.i15.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the influence of continuity nursing on self-care ability, complications, and wound healing in patients with colorectal stoma after gastrointestinal surgery.
METHODS We selected 120 patients who were diagnosed with colorectal cancer and underwent Miles surgery from May 2016 to May 2017 at Traditional Chinese Medicine Hospital of Zhuji City. These patients were randomly divided into an observation group and a control group, with 60 cases in each group. Both groups were given routine nursing care, and the observation group was additionally given continuity nursing care. The ESCA self-care scale was used to evaluate the self-care ability of patients in the two groups, the QLO-C30 life scale was used to score the daily life, and postoperative complications and stoma healing were also evaluated.
RESULTS The self-care ability scores were significantly better in male patients than in females (P < 0.05), and self-care ability did not correlate with living conditions (P > 0.05). The self-concept, self-care, responsibility, self-care skills, health knowledge, and ESCA score of the observation group were significantly better than those of the control group at 4.5 mo after the operation (P < 0.01). In the control group, the incidence of complications such as stoma edema, stoma stenosis, stoma loss, and dermatitis around the stoma was significantly higher in the control group than in the observation group (P < 0.05). The scores of cognitive function, role function, physical function, and social function of the observation group were significantly higher than those of the control group at 4.5 mo after the operation (P < 0.01).
CONCLUSION Continuity nursing care can effectively improve the self-care ability, reduce the incidence of postoperative complications, and improve quality of daily life in patients after Miles colostomy for colorectal cancer.
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Affiliation(s)
- Xiao-Fei Chen
- the Third Department of Surgery, Traditional Chinese Medicine Hospital of Zhuji City, Zhuji 311800, Zhejiang Province, China
| | - Jun Chen
- Department of Nephrology, the Second Hospital of Yinzhou District, Ningbo 315100, Zhejiang Province, China
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13
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Couwenberg AM, Burbach JPM, van Grevenstein WMU, Smits AB, Consten ECJ, Schiphorst AHW, Wijffels NAT, Heikens JT, Intven MPW, Verkooijen HM. Effect of Neoadjuvant Therapy and Rectal Surgery on Health-related Quality of Life in Patients With Rectal Cancer During the First 2 Years After Diagnosis. Clin Colorectal Cancer 2018; 17:e499-e512. [PMID: 29678514 DOI: 10.1016/j.clcc.2018.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Rectal cancer surgery with neoadjuvant therapy is associated with substantial morbidity. The present study describes the course of quality of life (QOL) in rectal cancer patients in the first 2 years after the start of treatment. PATIENTS AND METHODS We performed a prospective study within a colorectal cancer cohort including rectal cancer patients who were referred for neoadjuvant chemoradiation or short-course radiotherapy and underwent rectal surgery. QOL was assessed using the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30) and colorectal cancer questionnaire (EORTC QLQ-CR29) before treatment and after 3, 6, 12, 18, and 24 months. The outcomes were compared with the QOL scores from the Dutch general population and stratified by low anterior resection and abdominoperineal resection. Postoperative bowel dysfunction after low anterior resection was measured using the low anterior resection syndrome score. RESULTS Of the 324 patients, 272 (84%) responded to at least 2 questionnaires and were included in the present study. Compared with pretreatment levels, the strongest decline was observed in physical, role, and social functioning at 3 and 6 months after the start of treatment. Global health and cognitive functioning declined to a lesser extend, and emotional functioning gradually improved over the time. Within 24 months, the QOL scores had recovered toward the pretreatment levels in most patients. Compared with the general population, physical, role, social, and cognitive functioning and symptoms of fatigue and insomnia remained significantly worse in patients on longer-term. After low anterior resection, major bowel dysfunction was reported by 44% to 60% of the patients. Increasing urinary incontinence and severe complaints of impotence were observed in patients who had undergone abdominoperineal resection. CONCLUSION Rectal cancer treatment is associated with a significant decline in QOL during the first 6 months after the diagnosis. Within 2 years, most patients return toward pretreatment functioning but could still experience poorer functioning and treatment-related symptoms compared with the general population. These findings support shared decision-making and emphasize the need for postoperative supportive care and novel treatment approaches.
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Affiliation(s)
- Alice M Couwenberg
- Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Johannes P M Burbach
- Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Anke B Smits
- Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Niels A T Wijffels
- Department of Surgery, Zuwe Hofpoort Ziekenhuis, Woerden, The Netherlands
| | - Joost T Heikens
- Department of Surgery, Ziekenhuis Rivierenland, Tiel, The Netherlands
| | - Martijn P W Intven
- Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; University of Utrecht, Utrecht, The Netherlands
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14
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Sun V, Crane TE, Slack SD, Yung A, Wright S, Sentovich S, Melstrom K, Fakih M, Krouse RS, Thomson CA. Rationale, development, and design of the Altering Intake, Managing Symptoms (AIMS) dietary intervention for bowel dysfunction in rectal cancer survivors. Contemp Clin Trials 2018; 68:61-66. [PMID: 29567283 DOI: 10.1016/j.cct.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE Bowel dysfunction is a common, persistent long-term effect of treatment for rectal cancer survivors. Survivors often use dietary modifications to maintain bowel control. There are few evidence-based interventions to guide survivors on appropriate diet modifications for bowel symptom management. The purpose of this paper is to describe the development and design of the Altering Intake, Managing Symptoms (AIMS) intervention to support bowel dysfunction management in rectal cancer survivors. METHODS The AIMS intervention is a ten-session, telephone-based diet behavior change intervention delivered by trained health coaches. It uses dietary recall, participant-completed food and symptom diaries, and health coaching guided by motivational interviewing to promote bowel symptom management and improved diet quality. Based on the Chronic Care Self-Management Model (CCM), the AIMS Intervention is designed to improve self-efficacy and self-management of bowel symptoms by coaching survivors to appropriately modify their diets through goal setting, self-monitoring, and problem-solving. The intervention targets survivors with stage I-III rectosigmoid colon/rectum cancer who are 6 months post-treatment, 21 years and older, and English-speaking. CONCLUSIONS The design and development process described in this paper provides an overview and underscores the potential of the AIMS intervention to positively impact the quality of long-term survivorship for rectal cancer survivors. An ongoing pilot study will inform the design and development of future multi-site Phase II and III randomized trials.
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Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA, USA.
| | - Tracy E Crane
- College of Nursing, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA
| | - Samantha D Slack
- University of Arizona Cancer Center, Tucson, AZ, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Angela Yung
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Sarah Wright
- University of Arizona Cancer Center, Tucson, AZ, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Stephen Sentovich
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, CA, USA
| | - Kurt Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Robert S Krouse
- Surgical Services, Corporal Michael J. Crescenz Veterans Affairs Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, AZ, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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15
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Sun Myint A, Smith FM, Gollins SW, Wong H, Rao C, Whitmarsh K, Sripadam R, Rooney P, Hershman MJ, Fekete Z, Perkins K, Pritchard DM. Dose escalation using contact X-ray brachytherapy (Papillon) for rectal cancer: does it improve the chance of organ preservation? Br J Radiol 2017; 90:20170175. [PMID: 28937269 DOI: 10.1259/bjr.20170175] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE A watch and wait policy for patients with a clinical complete response (cCR) after external beam chemoradiotherapy (EBCRT) for rectal cancer is an attractive option. However, approximately one-third of tumours will regrow, which requires surgical salvage for cure. We assessed whether contact X-ray brachytherapy (CXB) can improve organ preservation by avoiding surgery for local regrowth. METHODS From our institutional database, we identified 200 of 573 patients treated by CXB from 2003 to 2012. Median age was 74 years (range 32-94), and 134 (67%) patients were males. Histology was confirmed in all patients and was staged using CT scan, MRI or endorectal ultrasound. All patients received combined CXB and EBCRT, except 17 (8.5%) who had CXB alone. RESULTS Initial cCR was achieved in 144/200 (72%) patients. 38/56 (68%) patients who had residual tumour received immediate salvage surgery. 16/144 (11%) patients developed local relapse after cCR, and 124/144 (86%) maintained cCR. At median follow up of 2.7 years, 161 (80.5%) patients were free of cancer. The main late toxicity was bleeding (28%). Organ preservation was achieved in 124/200 (62%) patients. CONCLUSION Our data suggest that CXB can reduce local regrowth to 11% compared with around 30% after EBCRT alone. Organ preservation of 62% achieved was higher than reported in most published watch and wait studies. Advances in knowledge: CXB is a promising treatment option to avoid salvage surgery for local regrowth, which can improve the chance of organ preservation in patients who are not suitable for or refuse surgery.
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Affiliation(s)
- Arthur Sun Myint
- 1 The Clatterbridge Cancer Centre , Liverpool , UK.,2 Institute of Translational Medicine , University of Liverpool , UK
| | - Fraser McLean Smith
- 3 The Royal Liverpool and Broadgreen University Hospital NHS Trust , Liverpool , UK
| | | | - Helen Wong
- 1 The Clatterbridge Cancer Centre , Liverpool , UK
| | - Christopher Rao
- 5 Department of Surgery , University Hospital, Lewisham, London , UK
| | | | - Raj Sripadam
- 1 The Clatterbridge Cancer Centre , Liverpool , UK
| | - Paul Rooney
- 3 The Royal Liverpool and Broadgreen University Hospital NHS Trust , Liverpool , UK
| | | | - Zsolt Fekete
- 7 Prof Dr Ion Chiricuţă Institute of Oncology , Cluj , Romania
| | - Kate Perkins
- 1 The Clatterbridge Cancer Centre , Liverpool , UK
| | - D Mark Pritchard
- 2 Institute of Translational Medicine , University of Liverpool , UK.,3 The Royal Liverpool and Broadgreen University Hospital NHS Trust , Liverpool , UK
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16
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Alavi M, Wendel CS, Krouse RS, Temple L, Hornbrook MC, Bulkley JE, McMullen CK, Grant M, Herrinton LJ. Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis. Ann Surg Oncol 2017; 24:3596-3603. [PMID: 28785900 PMCID: PMC5659930 DOI: 10.1245/s10434-017-6017-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics. METHODS The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer survivors with anastomosis. Bowel function was scored using the self-administered, 14-item Memorial Sloan-Kettering Cancer Center Bowel Function Index. Patient, cancer, and treatment variables were collected from the electronic medical chart. We used multiple regression to assess the relationship of patient- and treatment-related variables with the bowel function score. RESULTS The study included 381 anastomosis patients surveyed an average 12 years after their rectal cancer surgeries. The total bowel function score averaged 53 (standard deviation, 9; range, 31-70, higher scores represent better function). Independent factors associated with worse total bowel function score included receipt of radiation therapy (yes vs. no: 5.3-unit decrement, p < 0.0001), tumor distance from the anal verge (≤6 cm vs. >6 cm: 3.2-unit decrement, p < 0.01), and history of a temporary ostomy (yes vs. no: 4.0-unit decrement, p < 0.01). One factor measured at time of survey was also associated with worse total bowel function score: ever smoking (2.3-unit decrement, p < 0.05). The regression model explained 20% of the variation in the total bowel function score. CONCLUSIONS Low tumor location, radiation therapy, temporary ostomy during initial treatment, and history of smoking were linked with decreased long-term bowel function following an anastomosis. These results should improve decision-making about surgical options.
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Affiliation(s)
- Mubarika Alavi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | - Larissa Temple
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | - Marcia Grant
- City of Hope/Beckman Research Institute, Duarte, CA, USA
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
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17
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Physical activity, bowel function, and quality of life among rectal cancer survivors. Qual Life Res 2017; 26:3131-3142. [PMID: 28677077 DOI: 10.1007/s11136-017-1641-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Physical activity (PA) is positively associated with numerous health benefits among cancer survivors. This study examined insufficiently investigated relationships among PA, health-related quality of life (HRQOL), and bowel function (BF) in rectal cancer survivors. METHODS RC survivors (n = 1063) ≥5 years from diagnosis in two Kaiser permanente regions were mailed a multidimensional survey to assess HRQOL and BF. PA was assessed by a modified Godin Leisure-Time Exercise Questionnaire. PA minutes were categorized into weighted categories based on guidelines: (1) not active (zero PA minutes); (2) insufficiently active (1-149 PA minutes); (3) meeting guidelines (150-299 PA minutes); and (4) above guidelines (≥300 PA minutes). Relationships of PA with HRQOL and BF were evaluated using multiple linear regression, stratified by sex and ostomy status for BF. Types of PA identified as helpful for BF and symptoms addressed were summarized. RESULTS Response rate was 60.5%. Of 557 participants, 40% met or exceeded PA guidelines, 34% were not active, and 26% were insufficiently active. Aerobic activities, specifically walking and cycling, were most commonly reported to help BF. Higher PA was associated with better psychological wellbeing and multiple SF12 scales, worse BF scores in men with ostomies, and better BF scores in women. CONCLUSIONS Meeting or exceeding PA guidelines was associated with higher HRQOL. Although the BF findings are exploratory, they suggest women may benefit from increased PA, whereas men with ostomies may face challenges that require more study. Identifying PA strategies that will lead to improved patient compliance and benefit are needed.
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