Rooney Michael K, Pasli Melisa, Chang George J, Das Prajnan, Koay Eugene J, Koong Albert C, Ludmir Ethan B, Minsky Bruce D, Noticewala Sonal S, Peacock Oliver, Smith Grace L, Holliday Emma B
Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA.
Cancers (Basel). 2023 Dec 28;16(1):153. doi: 10.3390/cancers16010153.
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.
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.
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, = 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, = 0.06 and median 17 vs. 5.5, = 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.
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.
尽管括约肌和/或器官保留治疗策略的应用日益增加，但许多低位直肠癌患者仍需要腹会阴联合切除术（APR），导致永久性造口。在此，我们旨在描述低位直肠癌患者的总体、与性和膀胱相关的患者报告生活质量（QOL）。我们还旨在探讨有和没有永久性造口的患者在患者报告结局方面的潜在差异。
我们分发了一份综合调查问卷，其中包括各种患者报告结局指标，包括FACT-G7调查问卷、ICIQ MLUTS/FLUTS、IIEF-5/FSFI以及一份针对造口患者的特定问卷。描述性统计和单变量比较用于比较有和没有永久性造口的患者的人口统计学、治疗情况和生活质量得分。
在联系的204名患者中，124名（60.8%）返回了完整的调查问卷；其中22名（18%）在调查完成时已有永久性造口。有25名低位直肠肿瘤（距肛缘≤5 cm）患者在调查完成时没有造口，其中13名（52%）采用非手术方法治疗。有造口的个体的FACTG7得分在数值上较低（中位数20.5对22，P = 0.12）。性功能指标IIEF和FSFI在有造口的个体中也较低（较差），但结果无显著差异。有造口的个体的MLUTS和FLUTS得分均较高（中位数分别为11对5，P = 0.06和中位数17对5.5，P = 0.01），表明排尿功能较差。患者报告的造口特定挑战包括可能影响社交活动和人际关系的胃肠道问题（如气体、气味、腹泻）。
尽管样本量有限，但本研究提供了以患者为中心、源自患者的数据，涉及低位直肠癌治疗后经过验证的长期生活质量。造口可能对生活质量产生多方面的负面影响，这些发现值得在前瞻性研究中继续探讨。这些结果可用于为低位直肠癌患者在器官保留和永久性造口两种情况下的共同决策提供参考。
