Quality of life of older rectal cancer patients is not impaired by a permanent stoma

• Published in: European journal of surgical oncology Vol. 39; no. 2; pp. 164 - 170
• Main Authors: Orsini, R.G, Thong, M.S.Y, van de Poll-Franse, L.V, Slooter, G.D, Nieuwenhuijzen, G.A.P, Rutten, H.J.T, de Hingh, I.H.J.T
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2013
• Subjects: Age Factors; Aged; Aged, 80 and over; Anastomotic Leak - psychology; Case-Control Studies; Colo-anal anastomosis; Colostomy - adverse effects; Colostomy - psychology; Comorbidity; Elderly; Enterostomy - adverse effects; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Neoplasm Staging; Netherlands - epidemiology; Prevalence; Quality of Life; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectal Neoplasms - therapy; Registries; Risk Factors; Sexual Behavior; Sexual Dysfunction, Physiological - epidemiology; Sexual Dysfunction, Physiological - etiology; Sexual Dysfunctions, Psychological - epidemiology; Sexual Dysfunctions, Psychological - etiology; Sexual function; Stoma; Surgery; Surveys and Questionnaires; Netherlands; Stoma; Elderly; Sexual function; Colo-anal anastomosis; Quality of life
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2012.10.005

Abstract Background The current study was undertaken to investigate the impact of a stoma on the HRQL with a special focus on age. Materials and methods Using the Eindhoven Cancer Registry, rectal cancer patients diagnosed between 1998 and 2007 in 4 hospitals were identified. All patients underwent TME surgery. Survivors were approached to complete the SF-36 and EORTC QLQ-C38 questionnaires. HRQL scores of the four groups, stratified by stoma status (stoma/no stoma) and age at operation (<70 and ≥70), were compared. The SF-36 and the QLQ-CR38 sexuality subscale scores of the survivors were compared with an age- and sex-matched Dutch norm population. Results Median follow-up of 143 patients was 3.4 years. Elderly had significantly worse physical function ( p  = 0.0003) compared to younger patients. Elderly ( p  = 0.005) and patients without a stoma ( p  = 0.009) had worse sexual functioning compared to younger patients and patients with a stoma. Older males showed more sexual dysfunction ( p  = 0.01) when compared to younger males. In comparison with the normative population, elderly with a stoma had worse physical function ( p  < 0.01), but slightly better mental health ( p  < 0.05). Elderly without a stoma had better emotional role function ( p  < 0.01), and younger patients had worse sexual functioning and enjoyment (both p  < 0.0001). Conclusions Older patients with a stoma have comparable HRQL to older patients without a stoma or the normative population, indicating the feasibility of a permanent stoma for elderly patients with a low situated rectal carcinoma. The negative impact of treatment on sexual functioning as found in the current study calls for further attention to alleviate this problem in sexually active patients.