Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors

Stoma Care Nurse Consultations Regarding Leakages and Peristomal Skin Complications During the First Year After Ostomy Creation: A Chart Review

In the first year after ostomy creation, affected persons require substantial support to manage potential complications and adjust to their new life situation. This study aimed to describe the number of visits to the stoma care nurse, the occurrence of leakage and peristomal skin complications, and the use of ostomy products to prevent these complications among persons consulting a stoma care nurse during the first year after surgery. A descriptive study was conducted using data from medical charts for 240 adults with ileostomy or colostomy. Persons with an ileostomy were more burdened by leakage and peristomal skin complications and visited the stoma care nurse more often than those with a colostomy. On average, across ostomy types, episodes of leakage and peristomal skin complications each elicited around one additional nurse visit and increased use of supporting ostomy products. Persons undergoing acute surgery, with a high ASA classification, and females experienced more episodes of leakage, peristomal skin complications and nurse visits. A patient-tailored approach based on risk factors, such as surgery type, ASA class and sex, could potentially reduce the occurrence of complications and the associated healthcare resource utilisation, including stoma care nurse visits. High variability in results further underscores the importance of personalised care.

Peristomal Erosion in a Man With Crohn Disease

A man in his 50s with a 10-year history of Crohn disease had intermittent bowel obstructions leading to total proctocolectomy and ileostomy, and 5 weeks after surgery he developed a painful, erosive lesion around his stoma on the anterior abdominal wall. What is your diagnosis?

Construction and validation of a predictive model for the return to work of patients with permanent colorectal stoma: a cross-sectional study

BACKGROUND

The issue of patients returning to work is increasingly garnering attention from countries worldwide. This study aims to investigate the risk factors associated with patients returning to work after undergoing permanent enterostomies. Additionally, it seeks to establish and validate a nomogram prediction model, thereby providing a more effective reference for patients aiming to return to work.

METHODS

This study was a cross-sectional investigation conducted between September 2022 and September 2023. We conveniently selected 293 postoperative patients with permanent colorectal stomas due to colorectal cancer from three tertiary hospitals in Liaoning Province. Participants were categorized into Returned and Non-Returned groups based on their return to work status. Data were collected using a general information questionnaire, a Stoma Acceptance Questionnaire, and the Ostomy Adjustment Inventory. Binary logistic regression analysis was performed using SPSS 25.0 software to identify independent influencing factors. A predictive model was constructed using R Studio 4.3.0 software. Internal validation was conducted through 1,000 rounds of Bootstrap resampling, and model performance was assessed using Receiver Operating Characteristic (ROC) curves, the Hosmer-Lemeshow (H-L) test, and calibration curves.

RESULTS

After surgery, the return-to-work rate for patients with permanent colorectal stomas was 29.69%. Age, education level, postoperative time, stoma complication, adjuvant therapy, stoma acceptance score, and ostomy adjustment inventory score were identified as independent factors influencing the return-to-work status of these patients (P < 0.05). These factors were incorporated into a logistic regression model generated by R software, resulting in a ROC curve with an area under the curve (AUC) of 0.916 (95% CI: 0.884-0.947). The Youden index was 0.731, and the cutoff value was 0.228. Sensitivity and specificity were 0.920 and 0.811, respectively. The H-L test demonstrated good model fit (χ2 = 12.858, P = 0.117, P > 0.05). Calibration curves indicated a close alignment between predicted and actual probabilities.

CONCLUSIONS

The postoperative return-to-work rate is low in patients with permanent enterostomies. The prediction model developed in this study demonstrates strong performance and offers predictive value, providing a scientific foundation for assessing patients' return to work. Caregivers should prioritize the early identification of various patient types for proactive intervention to enhance the rate of postoperative return to work.

Clinical status and future prospects of neoadjuvant immunotherapy for localized mismatch repair-deficient cancers: a review

Frameshift mutations accumulate in cancers related to mismatch repair deficiency (dMMR), which has the potential to produce various neoantigens, representing a distinct subset of cancers that respond considerably to immunotherapy. In recent years, robust evidence has supported the first-line application of immunotherapy for patients with metastatic dMMR cancers, which provoked extensive investigations of the feasibility and efficacy of immunotherapy in up-front settings, including neoadjuvant therapy. Several completed trials with small sample sizes suggested that neoadjuvant immunotherapy can achieve an impressively high complete response rate, for the first time offering the potential of systemic therapy to cure cancer without the need for surgical resection. However, a difficult dilemma emerges: clinicians are now facing a selection between the standard of care with good evidence for proficient MMR but suboptimal for dMMR cancers and the emerging immunotherapy with promising results but only based on a limited number of patients with shorter duration of follow-up. This review aims to provide a comprehensive summary of the biological rationale and clinical status of neoadjuvant immunotherapy in patients with dMMR cancers. Furthermore, I elaborate on particular issues that must be taken into consideration for further advancement in the field.

The clinical and economic burden of illness in the first two years after ostomy creation: a nationwide Danish cohort study

BACKGROUND

Living with an ostomy is often associated with costly complications. This study examined the burden of illness the first two years after ostomy creation.

METHODS

Data from Danish national registries included all adult Danes with an ostomy created between 2002 and 2014.

RESULTS

Four cohorts consisted, respectively, of 11,385 subjects with a colostomy and 4,574 with an ileostomy, of which 1,663 subjects had inflammatory bowel disease (IBD) and 1,270 colorectal cancer as cause of their ileostomy. The healthcare cost was significantly higher for cases versus matched controls for all cohorts. In the first year, the total healthcare cost per person-year was €27,962 versus €4,200 for subjects with colostomy, €29,392 versus €3,308 for subjects with ileostomy, €15,947 versus €2,216 when IBD was the underlying cause, and €32,438 versus €4,196 when it was colorectal cancer. Healthcare costs decreased in the second year but remained significantly higher than controls. Hospitalization and outpatient services were primary cost drivers, with ostomy-related complications comprising 8-16% of hospitalization expenses.

CONCLUSION

Compared to controls, subjects with an ostomy bear a significant health and financial burden attributable to ostomy-related complications, in addition to the underlying disease, emphasizing the importance of better ostomy care to enhance well-being and reduce economic strain.

Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme

The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.

Neoadjuvant Immune Checkpoint Inhibitor Therapy for Localized Deficient Mismatch Repair Colorectal Cancer: A Review

Importance

Colorectal cancers (CRCs) with deficient DNA mismatch repair (dMMR) account for 15% of all CRCs. Deficient MMR is a predictive biomarker associated with responsiveness to immune checkpoint inhibitors (ICIs) in solid tumors, including CRC. The remarkable effectiveness of ICIs in metastatic CRC has led to their evaluation in the neoadjuvant and adjuvant treatment of localized disease.

Observations

Multiple prospective phase 2 studies in limited numbers of patients with localized dMMR CRC demonstrate high complete clinical and pathological response rates (60%-100%) to neoadjuvant ICIs, with low rates of grade 3 or higher ICI-related toxic effects. Given the median follow-up of 12 to 25 months in these studies, longer-term monitoring is needed to determine the durability of response and to ensure that oncologic outcomes are not compromised in patients undergoing nonoperative management. Neoadjuvant ICI therapy is especially attractive for patients with rectal cancer given the significant morbidity that accompanies pelvic irradiation and total mesorectal excision. Ongoing and planned prospective phase 2 trials will provide further data on important issues, including optimal neoadjuvant treatment duration, ICI monotherapy vs combination, and the need for adjuvant ICI therapy.

Conclusions and Relevance

While this review found that early results of neoadjuvant immunotherapy for localized dMMR CRC show high rates of major and complete pathological response, longer-term follow-up data are needed to ensure that oncologic outcomes are not compromised and are ideally improved. Neoadjuvant ICI therapy in localized dMMR CRC represents a potential paradigm shift with implications for organ preservation.

Prospective evaluation of bowel function and quality of life after colon cancer surgery - is it time for routine screening for late sequelae?

AIM

Bowel dysfunction after colon cancer (CC) surgery is widely neglected in current follow up programmes. This study explored changes in bowel function and quality of life (QoL) from three (3 m) to twelve months (12 m) after surgery in CC patients undergoing right- or left-sided colon resection (RightSCR/LeftSCR) and investigated differences between the two groups 12 m after surgery.

METHOD

CC patients undergoing surgical resection in 2018-2020 at five surgical departments were included in this population-based prospective cohort study. Included patients completed electronic surveys consisting of a collection of validated scores 3 m and 12 m after surgery.

RESULTS

A total of 708 CC patients (423 RightSCR, 285 LeftSCR) were included. In RightSCR, no improvement was observed from 3 m to 12 m in most scores/items, on the contrary, symptom worsening in flatus- and faecal incontinence and urgency was observed (p < 0.05). Also, the proportion of patients rating their bowel function as very good/good decreased (p < 0.05) in this group. In LeftSCR improvement was found in flatus and faecal incontinence, urgency and night-time defaecation (p < 0.02), while no improvement was observed in the remaining scores/items. At 12 m, higher proportions of RightSCR than LeftSCR reported loose stools, incontinence and urgency (all p < 0.001), whereas LeftSCR more often reported hard stools and flatus incontinence (p < 0.05). Among all CC patients 18.3% reported bowel-related impairment of QoL at 12 m with no differences between the two groups.

CONCLUSION

From 3 m to 12 m no significant change was observed in the majority of bowel function and QoL scores/items, however, some symptoms worsened in RightSCR, while a few improved in LeftSCR. Bowel dysfunction and impaired QoL were still common in both groups at 12 m, although the symptom pattern differed between the groups. These findings call for a systematic screening for bowel dysfunction to ensure early treatment of symptoms.

Stoma product selection: an update

There are three main output stomas-colostomy, ileostomy and urostomy. Each of these requires a different stoma appliance to collect and contain the stoma output. This article discusses stoma product selection, things to consider before choosing a product, as well as caring for the stoma.

Using peristomal body profile assessment to improve leakage-related quality of life for individuals with an ostomy

BACKGROUND

Improper fitting between peristomal body profile and ostomy product(s) is one of the main reasons for leakage among individuals with an ostomy.

AIM

To evaluate clinical usability of the Body Assessment Tool developed by Coloplast that is available free of charge. The aim was also to study how changing to product(s) that were best suited to an individual, guided by peristomal body profile, affected the number of leakages and individuals' quality of life.

METHODS

The study consisted of questionnaires administered before and after the study, which spanned 4-5 weeks. A total of 22 nurses and 68 individuals with an ostomy participated in four Nordic countries.

FINDINGS

Of the 22 nurses, 21 recommended use of the tool. A shift to best fitting ostomy product(s) resulted in a significant decrease in the number of leakages (from 5.9 to 1.8 per 7 days) and a substantial improvement in quality of life.

CONCLUSION

The findings support the use of the Body Assessment Tool in clinical practice and the results showed that optimally fitting ostomy product(s) reduced the number of leakages and increased individuals' quality of life.

A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction

The efficacy and safety of self-expanding metallic stent (SEMS) placement as a bridge to elective surgery versus emergency surgery to treat malignant colonic obstruction is debated. This study aimed to evaluate the outcomes of patients with malignant colonic obstruction treated using different procedure. Subjects admitted to the authors' department with colonic obstruction (n = 87) were studied. They underwent colonic stenting as a bridge to elective surgery (SEMS group: n = 14) or emergency surgery (ES group: n = 22).Their demographic characteristics, stoma rate, laparoscopy rate and postoperative complications were analyzed, and the potential risk factors of postoperative complications and the optimal time interval from SEMS implantation to elective surgery were explored. The stoma rate was 15.4% in the SEMS group versus 60.0% in the ES group (P = 0.015), and the postoperative complication rate was 7.7% in the SEMS group versus 40.0% in the ES group (P = 0.042). The proportion of patients undergoing laparoscopy in SEMS group was significantly higher than that in ES group (69.2% vs. 15.0%; P = 0.003).The effect of ASA grade on postoperative complications was statistically significant (OR = 24.565; P = 0.008). The Receiving operating characteristic (ROC) curve could not determine the optimal time interval between SEMS implantation and elective surgery (AUC = 0.466). SEMS implantation has the advantages of lower temporary stoma rate, less postoperative complications and higher laparoscopy rate compared with ES in the treatment of left malignant intestinal obstruction. ASA grade is a risk factor for postoperative complications. However, larger sample size prospective randomized controlled trials (RCT) are still needed to confirm long-term oncological outcomes.