Quality of life and need for care in patients with an ostomy: a survey of 2647 patients of the Berlin OStomy-Study (BOSS)

Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries

BACKGROUND

Colorectal cancer management may require an ostomy formation; however, a stoma may negatively impact health-related quality of life (HRQoL). This study aimed to compare generic and stoma-specific HRQoL in patients with a permanent colostomy after rectal cancer across different countries.

METHOD

A cross-sectional cohorts of patients with a colostomy after rectal cancer in Denmark, Sweden, Spain, the Netherlands, China, Portugal, Australia, Lithuania, Egypt, and Israel were invited to complete questionnaires regarding demographic and socioeconomic factors along with the Colostomy Impact (CI) score, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and five anchor questions assessing colostomy impact on HRQoL. The background characteristics of the cohorts from each country were compared and generic HRQoL was measured with the EORTC QLQ-C30 presented for the total cohort. Results were compared with normative data of reference European populations. The predictors of reduced HRQoL were investigated by multivariable logistic regression, including demographic and socioeconomic factors and stoma-related problems.

RESULTS

A total of 2557 patients were included. Response rates varied between 51-93 per cent. Mean time from stoma creation was 2.5-6.2 (range 1.1-39.2) years. A total of 25.8 per cent of patients reported that their colostomy impairs their HRQoL 'some'/'a lot'. This group had significantly unfavourable scores across all EORTC subscales compared with patients reporting 'no'/'a little' impaired HRQoL. Generic HRQoL differed significantly between countries, but resembled the HRQoL of reference populations. Multivariable logistic regression showed that stoma dysfunction, including high CI score (OR 3.32), financial burden from the stoma (OR 1.98), unemployment (OR 2.74), being single/widowed (OR 1.35) and young age (OR 1.01 per year) predicted reduced stoma-related HRQoL.

CONCLUSION

Overall HRQoL is preserved in patients with a colostomy after rectal cancer, but a quarter of the patients interviewed reported impaired HRQoL. Differences among several countries were reported and socioeconomic factors correlated with reduced quality of life.

[Advance of digitalization for specialized care?]

For years the influence of progressive digitalization has become noticeable in the work areas of care experts in ostomy, continence and wounds (PSKW). A few years ago the feasibility of tele-healthcare and the resulting quality of care for ostomates in the out of hospital area were also tested in international studies. The driving forces included the insurance companies in the healthcare system who wanted to build a cost-effective supply structure for the insured people using digital aids. Even before the corona crisis a health insurance service contract included the requirement that service providers also offer stoma care for ostomates via online access. For the first time, the option of remote care for people with an ostomy by service providers in the outpatient area was defined as part of the contract. In this article the possibility of telecare stomatherapy as a supplement to face to face care of ostomates by SKW care experts is presented and the situation under the current corona pandemic is considered.

Quality of Life (QoL) Among Ostomized Patients – a cross-sectional study using Stoma-care QoL questionnaire about the influence of some clinical and demographic data on patients’ QoL

Introduction In Portugal around 20,000 individuals are ostomized, with all the associated changes in patients’ everyday life that can compromise their Quality of Life (QoL).

Objectives Assess and compare QoL of a group of ostomized patients according to sex, age group, type of surgery, primary disease, stoma duration and stoma type.

Material and methods Ostomized patients observed in Stomatherapy department in between January 1st and May 30th 2017 was enrolled. QoL was assessed using the questionnaire Stoma Care QoL Questionnaire). Four domains were evaluated: Self-esteem and Self-image – SeSi Score; relation with Family and Friends – FF Score; relation with Sleep and Fatigue – SF score and ostomy Device Functioning insecurities – DeF score.

Results Urostomy patients had significantly higher Total Scores, SeSi and FF scores than colostomy and ileostomy patients. Regarding SeSi Score, patients aged 70 years old or more and malignant diseases presented significantly higher scores than their younger counterparts and benign causes, respectively. FF Score document that patients with malignant diseases have significantly higher scores than patients with benign diseases.

Conclusions Ileostomy and colostomy patients have a significantly lower QoL than urostomy patients mostly because of its impact on social relations and self-esteem and self-image.

Coping Processes of Patients with Ostomies in South Korea: A Focus Group Study

Despite the adverse effects of negative coping after receiving a stoma, there is a lack of information on how patients cope with ostomies and on their families' experiences throughout the coping process. We aimed to explore the coping experiences of individuals with ostomies throughout their illness, applying the Corbin and Strauss Chronic Illness Trajectory Framework, using exploratory qualitative methods involving focus group interviews. Purposive sampling was utilized to recruit 19 participants (split across three groups) through an ostomy association in South Korea. Two focus group interviews were separately conducted from March through to May 2017 until data saturation was achieved. Using qualitative content analysis, we analyzed the transcribed interviews and identified words and themes to interpret the results. The coping experiences of patients with ostomies were expressed through three interrelated themes: struggling and suffering, learning how to live with ostomy, and living with ostomy. We found gender differences in spousal support and a struggle among older patients regarding social coping. The themes identified suggest that gender should be considered when designing interventions to help patients cope with ostomies.

Validation of the colostomy impact score in patients ostomized for a benign condition

AIM

The colostomy impact (CI) score is a patient-reported outcome measure assessing reduction in health-related quality of life (HRQL) due to a stoma. The score was originally developed and validated in a cohort of rectal cancer survivors with a permanent colostomy. For the CI score to be applied to patients with a colostomy after surgery for a benign condition it must be validated in this patient group. The aim of this study was to assess construct validity and known groups validity of the CI score in patients with a colostomy after surgery for a benign condition.

METHOD

In a cross-sectional survey among ostomates in the Capital Region of Denmark, patients completed the CI score and the SF-36 v2 questionnaires. Construct validity was assessed by Pearson's correlation coefficients and known groups validity was assessed by t-test when dividing patients into groups of minor or major CI.

RESULTS

The CI score showed a moderate negative correlation with the Physical Component Summary (PCS) of -0.41 and a weak negative correlation with the Mental Component Summary (MCS) of -0.39. The strength of the correlation depended on the underlying condition leading to stoma formation. Differences were significant between the minor and major CI groups in mean PSC and MCS with t-values of 5.32 and 3.86, respectively.

CONCLUSION

The CI score is a valid instrument for assessing stoma-related impact on HRQL regardless of the underlying condition leading to stoma formation, and the CI score discriminates meaningfully between groups with known differences in stoma-related reduced HRQL.

Quality of life in postostomy surgery patients: A cross-sectional survey

Background and Aim

Ostomy is a radical treatment that is sometimes required due to severe inflammatory bowel disease (IBD), colorectal cancer (CRC), and so on. Around 8000 people in New Zealand live with stoma bags. We studied factors associated with poor quality of life (QoL) in ostomy patients to improve patient care.

Methods

Eligible adult patients identified through the Southern District Health Board database were invited to participate. The survey consisted of the general stoma QoL, IBD, CRC QoL, and dietary and lifestyle questionnaires.

Results

Response rate was 54.5% (n = 241/448). Study participants were a mean (SD) 70.9 (14.2) years old, 60.6% were male, and 89.5% were New Zealand European; 52.5% of the study participants had a colostomy, and 56.4 and 22.4% received their stoma due to CRC and IBD, respectively. Median (first-third interquartile range) duration since ostomy for overall study sample was 6.9 (3.3-15.1) years. Mean (SD) Stoma-QoL score for all the patients was 60.3 (10.8) points (scale 20-80). Stoma-underlying disease (P = 0.28) and type of stoma (P = 0.60) were not associated with Stoma-QoL scores. Older adults had higher Stoma-QoL, IBD questionnaire and QLQ-C30 quality-of-life scores; 73.1% received dietary recommendations for the stoma, And 56.4% changed their diet, 51.4% found it easy to adhere to dietary recommendations, and 9.2% found it quite/very difficult.

Conclusion

This study found high-quality life scores in postostomy patients and no significant association between the underlying disease, time since ostomy, level of comorbidities, and how the appliance worked, which highlight the multifactorial nature of the quality of life concept and difficulties measuring it.

Is platelet-rich plasma improves the anastomotic healing in hyperthermic intraperitoneal chemotherapy with oxaliplatin: an experimental rat study

Purpose

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a novel treatment option for peritoneal surface malignancies. Due to cytotoxic effects of chemotherapeutic agents, anastomosis healing can be impaired and lead to leakage rates higher than conventional intestinal surgery. In this experimental study, we aimed to investigate the effects of platelet-rich plasma (PRP) on colonic anastomosis in rats that received HIPEC with oxaliplatin.

Methods

Thirty rats were divided into 3 groups. Group 1 was determined as control group and hyperthermic saline perfusion was performed after colon anastomosis. In group 2, colon anastomosis then hyperthermic oxaliplatin perfusion was performed. In the last group, the colonic anastomosis was enhanced by PRP gel and then hyperthermic oxaliplatin perfusion was performed. All the rats were reoperated on postoperative day 7 and anastomotic bursting pressure values were recorded. Tissue samples were taken for hydroxyproline assay and histopathological examination.

Results

Control group had higher anastomotic bursting pressure value than group 2 and group 3 (P < 0.001). There were significant differences in anastomotic bursting pressure between groups 2 and 3 (P < 0.001). Group 2 had significantly lower hydroxyproline levels than group 3 and control group (P < 0.001). Histopathological examination revealed that PRP application reduced inflammatory response.

Conclusion

PRP application on colonic anastomosis improves anastomotic healing and can reduce anastomosis related complications and stoma creation; though further clinical studies are needed.

Improving Self-Care Outcomes in Ostomy Patients via Education and Standardized Discharge Criteria

Adjusting to life with a new ostomy is a daunting prospect for many patients. Without proper education, complications can occur, some requiring hospital readmission. Many home healthcare nurses also face the challenge of training new ostomy patients in self-care. The purpose of this quality improvement pilot study was to improve outcomes in a sample of new ostomy patients by implementing an intervention consisting of nurse and patient education. The study was conducted at a Southern California home healthcare agency with an average patient census of 270. The participants were 30 home healthcare nurses (6 licensed vocational nurses and 24 registered nurses). We followed the outcomes of four home healthcare patients with new ostomies. The nurse ostomy education session included both didactic and hands-on components to promote practice change. Patient education was guided by the use of an evidence-based ostomy skills checklist adapted from the Wound, Ostomy, and Continence Nurses Society's ostomy discharge criteria. Nurse's skills and competence were measured and compared via results from a 10-question pre- and postintervention nurse self-assessment survey. Patient outcomes were measured and compared via pre- and postintervention chart reviews examining three factors: number of weeks on service, number of visits to reach independence, and number of unscheduled visits. Statistical analysis of survey data showed a significant change in the scores for all questions, indicating the nurses felt more confident managing ostomies after the education session. After the intervention, the number of weeks patients were on service for a new ostomy diagnosis decreased by an average of 1.5 weeks; patients required 50% fewer visits to reach independence; and unscheduled visits decreased by 500%.

Impact of a Parastomal Bulge on Quality of Life - A Cross-sectional Study of Patients From the Danish Stoma Database

OBJECTIVE

To investigate stoma specific and generic HRQoL in patients with and without a parastomal bulge.

BACKGROUND

Most patients have to live with their stoma complicated by a parastomal bulge. How this affects quality of life remains unclear.

METHODS

Patients in the Danish Stoma Database completed the Short-form 36 health survey and the stoma-QOL questionnaire. Linear regression analysis, adjusted for potential confounding factors, provided mean and mean score differences and 95% confidence intervals for each HRQoL scale and item. Cohens d provided estimates of effect size.

RESULTS

A total of 1265 patients (65%) completed the questionnaire 4.4 (interquartile range 3.1-6.0) years after stoma surgery. Of these, 693 (55%) patients with a parastomal bulge had significantly impaired (P < 0.01) HRQoL across all stoma specific and generic health domains compared to patients without a parastomal bulge. In patients with a benign diagnosis or an ileostomy, a parastomal bulge impacted significantly on Social Functioning and Mental Health resulting in a worse Mental Component Summary. A large bulge >10 cm impaired HRQoL (P < 0.01) across all stoma specific and generic domains. The impact on HRQoL was independent of time with the bulge.

CONCLUSIONS

A novel finding in this large, unselected sample from high-quality regional registries was that parastomal bulging was associated with substantial and sustained impairment of HRQoL.

Systematic review of the impact of demographic and socioeconomic factors on quality of life in ostomized colorectal cancer survivors

Background: Formation of a fecal stoma may be necessary to ensure radical resection in colorectal cancer (CRC) patients but will substantially impact the health-related quality of life (HRQoL) in about 20% of cases. Little is known about patient-related risk factors for reduced HRQoL in patients with a permanent stoma. We, therefore, reviewed the current literature on how demographic and socioeconomic factors affect HRQoL in CRC survivors with a stoma. Material and methods: The databases Pubmed, Embase, CINAHL, and PsycINFO were systematically searched. Two independent reviewers extracted and quality-assessed eligible publications. Studies assessing HRQoL using a validated questionnaire at least 6 months after surgery for CRC were included if data on the impact of demographic and/or socioeconomic, factors on HRQoL were analyzed and presented. Results: Eligible studies predominantly presented small cross-sectional cohorts. Age showed equivocal results; hence, some studies found younger patients had inferior HRQoL compared with older patients, and others found no difference. Subdivision into age groups differed widely. Several studies found that both generic and stoma-specific HRQoL was lower in females compared with males. Most studies found that socioeconomic factors did not affect HRQoL while one study found lower education correlated to reduced HRQoL. Categorization of these factors also varied widely. Conclusions: This is to our knowledge the first systematic review on the impact of patient-related factors on HRQoL in long-term CRC survivors. We found that a stoma had more impact in younger ostomates than older and that HRQoL in females was reduced more than in males. Conclusions regarding other factors were difficult due to few studies and contradictory results. Further research in this subject is much needed in order to target preventive measures when planning surgery in patients in high risk of reduced HRQoL.

Safety of extraperitoneal rectal resection and ileo- or colorectal anastomosis without loop ileostomy in patients with peritoneal metastases treated with CRS and HIPEC

AIM

Extraperitoneal rectal resection combined with complete peritonectomy of the pelvis in patients with peritoneal metastases is associated with a high rate of morbidity and mortality due to anastomotic leakage (AL). Therefore, many centers tend to perform loop ileostomy to reduce the clinical impact of AL. The aim of this study was to analyze the need for protective stoma creation in this patient group to avoid major complications and mortality in the case of AL.

METHOD

We analyzed 53 patients who underwent extraperitoneal rectal resection from 409 consecutive patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) at our department between January 1997 and December 2016.

RESULTS

Mean age of the patients was 56.7 (SD 12.2) years and the mean Peritoneal Cancer Index was 24.6 (SD 12.0). Complete cytoreduction was achieved in 33 patients (62.3%). Six patients received an ileostomy or a colostomy, 5 of 6 with permanent intention. One patient (2.1%) developed AL postoperatively. Overall, 21 patients (39.6%) developed surgical complications, while 41 (77.3%) developed medical complications. The mortality rate was 7.5% (n = 4). In total, 26 patients (49.1%) developed Clavien-Dindo class-III/IV complications.

CONCLUSIONS

These results demonstrate the safety of colorectal anastomosis in combination with HIPEC in the absence of loop ileostomy. Loop ileostomy may be omitted for patients with low risk for AL in experienced centers with adequate post-operative care, possibilities for post-operative assessment and radiological intervention to avoid stoma related complications and increase the quality of life of patients with peritoneal metastases. This article is protected by copyright. All rights reserved.

Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial

AIM

Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost.

METHOD

Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care.

RESULTS

The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P < 0.001). In the SP more patients required extra care at home for their ostomy than in the NP (60.6% vs 33.7%, respectively; risk difference 26.9%, 95% CI: 13.5-40.4%). Stoma revision was done more often in the SP (n = 11) than in the NP (n = 2). Total costs in the SP did not differ significantly from the NP.

CONCLUSION

The NP did not reduce the number of stoma-related complications but did lead to improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended.