Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer

Psychobiotics Ameliorate Depression and Anxiety Status in Surgical Oncology Patients: Results from the ProDeCa Study

Background: Psychological disorders are prevalent in patients having undergone gastrointestinal cancer surgery, and their emotional status may further deteriorate during subsequent chemotherapy. Psychobiotics are specific probiotics that have the unique characteristics of producing neuroactive substances that are thought to act on the brain-gut axis. The aim of the present study was to evaluate the benefits of a psychobiotic formula on depression and anxiety status, as well as on perceived stress, versus a placebo in patients on a chemotherapy course following gastrointestinal surgery for cancer. Patients: The enrolled patients, allocated to the psychobiotic and placebo groups, were assessed by means of these psychometric tests: Beck's Depression Inventory and the Hamilton Depression Rating 17-item Scale for depression; the General Anxiety Disorder-7 for anxiety; and the Perceived Stress Scale-14 Item for perceived stress at three time-points: upon allocation [T1], after one month of treatment [T2], and two months thereafter [T3]. Results: In total, 266 patients were included. One month of psychobiotic treatment improved [i] depression status by 60.4% [48 depressed patients at T1, reduced to 16 at T3]; [ii] anxiety by 57.0% [72 patients at T1, 26 at T3]; and [iii] stress by 60.4% [42 at T1, 14 at T3]. The placebo-treated patients experienced a deterioration in all parameters studied, i.e., depression increased by 62.9%, anxiety by 39.7%, and stress by 142.5%. Conclusions: Based on these findings, it can be recognized that psychobiotic treatment has great potential for every patient at risk of suffering from depression, anxiety, or stress during the course of surgery/chemotherapy for gastrointestinal cancer.

Body image as a mediator between bowel dysfunction symptoms and psychological outcomes among patients with colorectal cancer

BACKGROUND

Colorectal cancer (CRC) survivors commonly experience bowel dysfunction symptoms because of treatment, leading to psychological distress. While previous studies have focused on managing physical symptoms and the impact of a stoma on psychological outcomes, CRC patients without a stoma may also suffer from psychological distress, including body image distress due to their bowel dysfunction symptoms. Body image distress may mediate the relationship between bowel dysfunction symptoms and psychological outcomes in CRC patients.

OBJECTIVES

This study aims to (1) identify bowel dysfunction symptoms, body image distress, and psychological outcomes in CRC survivors and (2) examine the mediating role of body image in the relationship between bowel dysfunction symptoms and psychological outcomes.

METHODS

A cross-sectional and correlational design was employed, and CRC survivors completed the Low Anterior Resection Syndrome (LARS) Score, Body Image Scale (BIS), and Hospital Anxiety and Depression Scale (HADS) questionnaires. The mediated role of body image was examined using Hayes' PROCESS macro.

RESULTS

A total of 193 CRC patients provided data, with 65.8% reporting experiencing bowel dysfunction symptoms, 44.6% reporting body image distress, and 40.4% experiencing anxiety and depression. Body image was found to partially mediate the effect of bowel dysfunction symptoms on both anxiety (β = 0.0446, 95% CI = 0.0061, 0.0968) and depression (β = 0.0411, 95% CI = 0.0034, 0.0941).

CONCLUSION AND IMPLICATIONS

The significant mediating role of body image underscores the importance of addressing both bowel dysfunction symptoms and body image distress. Healthcare professionals should integrate both physical and psychological aspects to promote psychological well-being.

Body image and quality of life undergoing totally robotic versus robotic-assisted distal gastrectomy: a retrospective propensity score matched cohort study

BACKGROUND

With the improvement of anastomotic techniques and the iteration of anastomotic instruments, robotic intracorporeal suturing has become increasingly proficient. The era of fully intracorporeal anastomosis in robotic gastric cancer resection is emerging. This study aims to explore the impact of totally robotic distal gastrectomy (TRDG) and robotic-assisted distal gastrectomy (RADG) on patients' quality of life.

PATIENTS AND METHODS

This study is a comparative retrospective study of propensity score matching. This study included 306 patients who underwent robotic distal gastrectomy for gastric cancer between June 2016 and December 2023 at our center. Covariates used in the propensity score included sex, age, BMI, ASA score, maximum tumour diameter, degree of histological differentiation, Pathological TNM stage, Pathological T stage, Pathological N stage, and Lauren classification. Outcome measures included operative time, intraoperative bleeding, time to first venting, time to first fluid intake, postoperative hospital stay, total hospitalization cost, total length of abdominal incision, postoperative complications, inflammatory response, body image, and quality of life.

RESULTS

According to the results of the study, compared with the RADG group, the TRDG group had a faster recovery time for gastrointestinal function (P = 0.025), shorter length of abdominal incision (P < 0.001), fewer days in the hospital (P = 0.006) less pain (P < 0.001), less need for additional analgesia (P = 0.013), and a postoperative white blood cell count (P < 0.001) and C-reactive protein content indexes were lower (P<0.001). In addition, the TRDG group had significantly better body imagery and cosmetic scores (P = 0.015), physical function (P = 0.039), role function (P = 0.046), and global function (P = 0.021) than the RARS group. Meanwhile, the TRDG group had milder symptoms of fatigue (P = 0.037) and pain (P < 0.001). The PASQ Total Subscale Score (P < 0.001) and Global Subscale Score (P < 0.001) were significantly lower in the TRDG group than in the RADG group at postoperative 3 months.

CONCLUSION

Totally robotic distal gastrectomy has a smaller incision, faster gastrointestinal recovery time, fewer days of postoperative hospitalization, and lower inflammatory markers than robotic-assisted distal gastrectomy. At the same time, postoperative cosmetic and quality of life outcomes were satisfactory. Clinically, these benefits translate to enhanced patient recovery, reduced surgical trauma, and better postoperative outcomes. These findings could guide surgeons in selecting more effective surgical approaches for patients undergoing gastrectomy, leading to better overall patient satisfaction and outcomes.

Factors associated with anxiety in colorectal cancer survivors: a scoping review

PURPOSE

Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety.

METHODS

Using Arksey and O'Malley's (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included.

RESULTS

We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used.

CONCLUSIONS

This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods.

IMPLICATIONS FOR CANCER SURVIVORS

This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.

"To be myself again": Perceived benefits of group-based exercise for colorectal cancer patients

PURPOSE

To explore the perceived benefits of a group-based exercise program for patients with colorectal cancer (CRC) undergoing chemotherapy treatment.

METHODS

In-depth semi-structured interviews were conducted with all participants (n = 27) at the end of the exercise program (patients, relatives and healthcare professionals). The exercise instructor in charge of the exercise program with CRC patients also collected observational field notes throughout a research diary.

RESULTS

Three main themes related to exercise as a coping strategy were obtained: (a) physical recovery; (b) psychosocial well-being, and (c) reconnection with their embodied selves and normal lives. Physical recovery included a perceived increase in fitness and a reduction in physical side-effects. Psychosocial well-being included perceived benefits in self-confidence, sense of control, reduced fear, feeling of being useful, sense of achievement, positive thinking and avoiding depression. All the physical and psychosocial benefits helped patients reconnect with their embodied selves, engage in activities practised before the diagnoses, improve their body image, avoid stigma, and increase their social life beyond cancer diagnoses. In this sense, some patients held on to their past selves, trying to keep or recover normality in their lives, while others acknowledged that they might not be the same person anymore, with exercise being part of this new identity.

CONCLUSIONS

This study shows that exercise is a coping strategy that benefitted CRC patients in several ways related to their physical and psychosocial quality of life.

Body Image Issues in Patients With Colorectal Cancer: A Scoping Review

BACKGROUND

Stomas in colorectal cancer (CRC) survivors lead to body image problems. Advances in treatment help reduce the rate of stoma formation, but body image distress is still frequently experienced in CRC survivors.

OBJECTIVES

This review is aimed toward mapping and describing the state of knowledge regarding body image in patients with CRC.

METHODS

A systematic literature search complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Screening and data extraction were performed by 2 reviewers independently for all potentially eligible studies.

RESULTS

A total of 56 eligible articles were selected. The majority of these studies were quantitative studies (85%). The eligible studies were classified into 4 broad categories: instruments used to assess body image, prevalence of body image distress, factors related to body image, and impact of body image distress. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-CR38) colorectal questionnaire was the most common measurement tool found among the reviewed studies (70%), and body image distress was reported by 25.5% to 86% of participants. Excluding gender, age, type of surgery, adjuvant therapy, time from diagnosis, social support, and stoma status, changes in bowel habits was identified as affecting the body image of patients with CRC.

CONCLUSION

Changing bowel habits emerged as a significant factor causing body image distress for CRC survivors.

IMPLICATIONS FOR PRACTICE

Clinicians should raise awareness about body image distress in patients with CRC, focus on finding effective measures and interventions intended to help alleviate symptoms of bowel dysfunction, and prepare patients to adapt to altered bowel functions.

Multidimensional Quality of Life After Robotic Versus Laparoscopic Surgery for Rectal Cancer: A Systematic Review and Meta-Analysis

INTRODUCTION

Maximizing patients' quality of life (QoL) is a central goal in surgical oncology. Currently, both laparoscopic and robotic surgery are viable options in rectal cancer (RC) resections. The aim of this systematic review was to analyze the differences in postoperative QoL between the two operative modalities.

METHODOLOGY

This review was conducted in adherence to the PRISMA guidelines. MEDLINE, Embase, Scopus, and CENTRAL databases were searched for articles comparing QoL in patients undergoing laparoscopic versus robotic surgery for RC. Seven studies were included (two randomized controlled trials, four prospective cohorts, and one retrospective cohort) out of which six reported data suitable for meta-analysis. Global QoL and QoL subdomains, such as physical and social functioning, were meta-analyzed using a random-effects model. Risk of bias was assessed using the ROBINS-I and Cochrane RoB-2 tools.

RESULTS

Data on 869 patients (440 laparoscopic and 429 robotic surgery) across six studies were meta-analyzed. There was no significant difference in global QoL (Mean Difference:-0.43 [95% Confidence Interval:-3.49-2.62]). Physical functioning was superior after robotic surgery (1.92 [0.97-2.87]). However, nausea/vomiting, pain, and fatigue did not differ between groups. Perception of body image was worse after laparoscopic surgery (-5.06 [-9.05- -1.07]). Other psychosocial subdomains (emotional, cognitive, role, and social functioning) were comparable between groups.

CONCLUSION

Laparoscopic and robotic surgery for RC have comparable QoL overall, for both physical and psychological dimensions. Our results may assist the management-related decision-making in surgical treatment of RC.

Sexual dysfunction in female patients with anal cancer treated with curative intent: A systematic review of the literature

BACKGROUND AND PURPOSE

Patients with anal squamous cell carcinoma (SCC) are treated with sphincter-preserving radiation therapy and concurrent chemotherapy, achieving excellent oncologic outcomes. Patients, however, may experience treatment-related morbidity including sexual dysfunction. The objective of this systematic review was to review the literature on sexual dysfunction in female patients treated for anal cancer and to identify knowledge gaps.

MATERIALS AND METHODS

This systematic review was registered in PROSPERO prior to initiation. Databases searched included MEDLINE, Embase, PubMed, Cochrane, and Google Scholar. There were no restrictions on the study time period. Studies were limited to English. All study designs were included except review articles, letters to the editor, and case reports with less than ten patients.

RESULTS

In total, 1801 studies were retrieved and 19 met the inclusion criteria, including: 13 cross-sectional surveys, 3 prospective studies, 1 longitudinal intervention study, 1 retrospective chart review, 1 case control study. Sexual function was assessed using the female sexual functioning index (FSFI), EORTC-QLQ-CR30 and -CR38; response rates were low (<50 % in most studies). Sexual dysfunction was reported by up to 85 % of women; the most common symptoms being dyspareunia (17-65 %), vaginal dryness (22-88 %), and loss of libido (38-95 %). Gastrointestinal issues, such as bowel problems, and body image concerns additionally affected sexual function and quality of life.

CONCLUSION

Sexual dysfunction is a common issue affecting most female patients treated for anal cancer and there is a paucity of evidence on the management of this important survivorship issue. There is additionally a lack of ethnic, economic, and educational diversity and there are no studies addressing the unique needs of LGBTQ individuals - future studies should make a concerted effort to include a diverse patient population.

Cancer-related psychosocial challenges

Over the past decade, cancer incidence has increased globally while its mortality has decreased. Accordingly, healthcare practitioners aim to provide comprehensive care to cancer patients. The biopsychosocial model suggests medical professionals' understanding of how psychosocial factors influence the entire course of cancer is critical. However, until now, an integrative review summarising the full scope of these psychosocial domains has been lacking. This review substantiates that cancer patients, survivors, their caregivers, and oncology professionals face substantial psychosocial challenges. Cancer patients and survivors may experience deterioration of self-concept, disturbance of body image, sexual problems and difficulties in social relationships while attempting to cope with casual issues. The burdens of care provision and the impact on the health of caregivers of cancer patients are also noteworthy. Improving the quality of patient-doctor communication and overcoming burnout are significant challenges for oncology healthcare professionals.

Psychological and Sexual Distress in Rectal Cancer Patients and Partners

BACKGROUND

Rectal cancer (RC) patients experience unique sources of distress, including sexual dysfunction and body image concerns, which can also cause distress among partners. This preliminary study investigated patterns of psychological distress, sexual functioning, sexual distress, and relationship satisfaction among RC patient-partner couples at pivotal points during cancer treatment.

METHODS

Twenty couples participated (N=40). Patients and partners completed a series of validated measures of psychological distress (ET), sexual functioning (FSFI; IIEF), sexual distress (GMSEX; Sexual Distress Scale) and relationship satisfaction (GMREL) at time of diagnosis, 3 weeks after radiation, 4 weeks post-surgery, and after chemotherapy and surgery for ostomy closure. Descriptive statistics, t-tests, and repeated-measures ANOVA were used to analyze scores over time, first for patients and partners, and then by sex.

RESULTS

Relationship satisfaction remained elevated over time. In this sample, 55% of patients and 78.9% of partners reported clinically significant rates of psychological distress at diagnosis, which decreased to 23% and 46% respectively at the last assessment. Sexual satisfaction and distress worsened for patients and partners between baseline and surgery for ostomy closure. Both male and female participants reported statistically significant declines in sexual function from baseline to end of treatment (p< .05).

DISCUSSION

Relative to relationship satisfaction, psychological and sexual health outcomes seem more vulnerable to the effects of RC treatment during the first year after diagnosis, both for patients and partners and for men and women. Results support the need for psychosocial care and sexual education/counseling for couples coping with RC. This article is protected by copyright. All rights reserved.

Association between Subjective Body Image, Body Mass Index and Psychological Symptoms in Chinese Adolescents: A Nationwide Cross-Sectional Study

Background: Conflicting findings were reported about the associations between subjective body image (SBI), body mass index (BMI) and psychological symptoms in China and other countries in the world. In this study, we aim to explore the associations between SBI, BMI, and psychological symptoms based on a large-scale, national wide survey among Chinese adolescents. Methods: The 2014–2015 China Education Panel Survey (CEPS) database, with 8134 middle school students (4137 boys and 3997 girls), was analyzed to explore the association between SBI, BMI and psychological symptoms. SBI was assessed by one question about the perception of own body shape with options “very thin”, “slightly thin”, “average”, “weak heavy”, and “very heavy”. BMI was calculated by the self-reported body weight and height. Psychological symptoms were evaluated by 10 items involving both aspects of depression and anxiety. Results: The results indicated that both boys and girls who perceived weak or very heavy weight were positively associated with psychological symptoms (p < 0.05). For boys, perceiving very thin body image was also in higher risk of psychological symptoms (p < 0.05), after controlling social-demographic variables and BMI. Comparing with normal weight boys or girls, obese boys (β = −2.22, 95% CI −3.37~−1.07) and overweight girls (β = −1.03, 95% CI −2.01~−0.06) were in lower levels of psychological symptoms after controlling for SBI. Other factors associated with psychological symptoms were family economic status, academic performance, and self-rated health status. Conclusions: A deviation from an “average” SBI was positively associated with psychological symptoms, which should be scanned when evaluating the Chinese adolescents’ mental health. These findings provide epidemiological evidence for the association between SBI and psychological symptoms in non-western social contexts.

Racial differences in anxiety, depression, and quality of life in women with polycystic ovary syndrome

OBJECTIVE

To evaluate racial differences in the anxiety and depression prevalence and scores in women with polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional.

SETTING

Academic institution.

PATIENTS

Reproductive-aged women with PCOS (n = 272) and controls (n = 295).

INTERVENTIONS

Hospital anxiety and depression scale and modified PCOS quality-of-life survey (MPCOS-Q).

MAIN OUTCOME MEASURES

Differences in depression and anxiety scores and quality-of-life score measured using the hospital anxiety and depression scale and MPCOS-Q were determined between White and Black women with PCOS. Multivariable correlation regressions assessed the association of the Ferriman-Gallwey score, total testosterone, body mass index (BMI), and homeostatic model assessment of insulin resistance with anxiety, depression, and quality-of-life scores.

RESULTS

Multivariable regression controlling for age, BMI, and socioeconomic status showed that White women with PCOS had a significantly higher prevalence of anxiety than Black women with PCOS (75.9% vs. 61.3%) and significantly higher anxiety scores (mean ± SD, 10.3 ± 4.1 vs. 8.7 ± 4.6). The prevalence of depression (24.4% vs. 29%) and depression scores (4.8 ± 3.6 vs. 5.1 ± 4.0) was not significantly different. In multivariable correlation regressions, the interaction between BMI and race in its association with anxiety scores was significant. The association of race with Ferriman-Gallwey score, total testosterone, or homeostatic model assessment of insulin resistance was not significant. In multivariable models, although the total MPCOS-Q scores were similar, the infertility domain was significantly lower in Black women with PCOS (mean ± SD, 12.6 ± 7.8 vs. 17.5 ± 6.8) indicating a lower quality of life related to infertility.

CONCLUSION

Racial differences identified in the prevalence of anxiety and MPCOS-Q domains suggest the importance of routine screening and provide an opportunity for targeted interventions based on race.

Body image in colorectal cancer patients: A longitudinal study

OBJECTIVE

To assess changes in body image distress (BID) over time, identify factors associated with BID, and explore the mediating role of body image on the longitudinal association between stoma status (permanent stoma, temporary stoma, or nonstoma) and psychological distress in postoperative colorectal cancer (CRC) patients in China.

METHODS

Participants (N = 255) 1-2 weeks postsurgery completed self-report questionnaires assessing BID (Body Image Scale) and psychosocial distress (Distress Thermometer, Hospital Anxiety and Depression Scale); 212 (83%) completed 6-month follow-up surveys. Generalized estimating equations were used to identify factors associated with BID for longitudinal data analysis.

RESULTS

A total of 46.7% of participants reported BID at follow-up. Prevalence of BID and BID scores did not significantly change over time in the total sample. Body image scores decreased in patients whose temporary stoma was removed during follow-up (p < 0.05). Prevalence of BID decreased in nonstoma patients at follow-up (p < 0.05). There were significant decreases in the prevalence and scores of distress, anxiety, and depression between baseline and follow-up (p < 0.001). Stoma presence, later clinical stages, greater distress, anxiety, and depression were risk factors for poorer body image. Body image had partial mediating effects on the longitudinal association between stoma status and distress.

CONCLUSIONS

Our findings indicate that BID remains stable even as psychological distress decreases. BID should be addressed early postoperation to avoid persistent impairment in CRC patients.

Quality of life in Mexican colorectal cancer patients: analysis with sociodemographic, medical, and psychological variables

In this study, we evaluated the influence of sex, age, clinical stage, and colostomy/ileostomy variables on the quality of life of Mexican patients with colorectal cancer. Using a descriptive cross-sectional design, 192 colorectal cancer patients were included in the study. Significant differences were observed in emotional functioning between patients with rectal cancer and those with colon cancer. Presence of colostomy/ileostomy was associated with significantly impaired social functioning. Body image was significantly different based on gender and diagnosis. Likewise, significant differences were observed with respect to symptoms of the general and specific quality of life modules for colorectal cancer: these included significant difference between male and female patients with respect to taste; significant difference between rectal and colon cancer with respect to presence of blood and mucous in stool, urinary incontinence, and buttock pain; and significant difference between patients with and without colostomy/ileostomy with respect to constipation, stool frequency, sore skin, and embarrassment. We observed significant correlation of dimensions of the quality of life with distress, post-traumatic stress, and optimism. Interventions for improving the quality of life of patients with colorectal cancer should be individualized based on the specific diagnosis and the presence/absence of colostomy/ileostomy.

Factors influencing body image in posttreatment oral cavity cancer patients

OBJECTIVE

The purpose of this study of posttreatment oral cavity cancer (OCC) patients was to identify factors associated with self-reported overall body image, perceived attractiveness, and dissatisfaction with body appearance.

METHODS

This cross-sectional study recruited patients with OCC from the outpatient radiation department of a single cancer center in Northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Hospital Anxiety and Depression Scale (HADS), the Liebowitz Social Anxiety Scale (LSAS), the University of Washington Quality of Life Scale (UW-QOL), and the Body Image Scale (BIS).

RESULTS

A total of 168 patients were included in this current study, 76 females and 92 males. Negative overall body image was associated with greater degree of depression, greater fear of social interactions, poorer social-emotional function, receipt of surgery, female gender, and greater avoidance of social interaction; these factors explained 49.0% of the variance in this outcome measure. Poor perceived attractiveness was associated with greater depression, greater fear of social interaction, and receipt of surgery; these factors explained 25.4% of the variance in this outcome measure. Dissatisfaction with body appearance was associated with poor social-emotional function, greater fear of social interaction, receipt of reconstruction, advanced cancer stage, and female gender; these factors explained 52.2% of the variance in this outcome measure.

CONCLUSIONS

This study of posttreatment OCC patients indicated that depression and fear of social interaction strongly influenced overall body image, perceived attractiveness, and dissatisfaction with body appearance.

Sexual Function in Women with Colorectal/Anal Cancer

BACKGROUND

Treatments for colorectal and anal cancers can have a detrimental impact on sexual function. Type of treatment, which may include surgery, radiation, and/or chemotherapy, varies by disease site and severity. Treatment and long-term side effects can impact sexual function and intimacy for patients and their partners.

AIM

To review the literature regarding treatment for colorectal/anal cancer and its impact on female sexual function, and to provide an assessment of medical outcomes and patient-reported outcomes (PROs) of women with a history of colon, rectal, or anal cancer seeking sexual health treatment.

METHODS

We performed a PubMed search to identify peer-reviewed, English-language articles published between 2008 to 2018, using the following search terms: "colorectal cancer," or "rectal cancer," or "anal cancer" and "sexual function," or "sexual dysfunction." We also assessed the medical outcomes and PROs from our recent cross-sectional cohort study of 99 women with a history of colon, rectal, or anal cancer seeking sexual health treatment.

MAIN OUTCOME MEASURES

Sexual function, quality of life, and PROs after colorectal/anal cancer.

RESULTS

A total of 23 studies were identified. Study designs included 15 cross-sectional survey studies, 5 longitudinal studies, 2 psychoeducational interventions, and 1 pilot study. 10 studies included only women, and 13 included both men and women. The literature and our cohort confirmed that women with colorectal/anal cancer experience changes in sexual function after diagnosis and throughout the continuum of care; however, the scarcity of data in this area indicates a need for additional intervention trials and longitudinal studies.

CONCLUSIONS

Research studies with large sample sizes and long study durations are needed to help us better understand the needs of female survivors of colorectal/anal cancer. Women with colorectal/anal cancer need simple strategies and resources to address concerns of sexual function after cancer treatment. Such interventions have been shown to enhance survivorship and quality of life. Canty J, Stabile C, Milli L, et al. Sexual Function in Women with Colorectal/Anal Cancer. Sex Med Rev 2019;7:202-222.

Anxiety and Depression in Cancer Survivors

Most cancer survivors adjust well to life after cancer but some experience persisting negative mood, such as cancer-related fears, posttraumatic stress, anxiety, or depression. Mood fluctuations may not reach criteria for a clinical diagnosis but subclinical symptoms can interfere with quality of life. Women, adolescents, and young adults are particularly at risk for mood disturbances. Behavioral interventions, such as cognitive behavioral therapy and pharmacologic treatments, can effectively treat these distressing emotions. Much of the research on managing emotional needs after cancer has been completed with breast cancer survivors and more work is needed with diverse groups of survivors.

Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection - A Matched-Controlled Study

BACKGROUND

Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome.

OBJECTIVE

The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group).

DESIGN

This was a matched controlled study.

SETTINGS

This study was conducted at multiple centers.

PATIENTS

The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years.

MAIN OUTCOME MEASURES

Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score).

RESULTS

The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function.

LIMITATIONS

This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study with a limited number of patients and with quality-of-life measurements on nonpredefined and variable intervals after surgery.

CONCLUSIONS

After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains. However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 66.7% of the patients in the total mesorectal excision group. See Video Abstract at http://links.lww.com/DCR/A395.