Gender differences in quality of life among long-term colorectal cancer survivors with ostomies

Gender differences in the predictors of quality of life in patients with cancer: A cross sectional study

PURPOSE

The aim of the present study was to explore potential differences in the sociodemographic (with a special focus on gender differences) and psychological predictors of quality of life in individuals diagnosed with cancer.

METHODS

A cross-sectional, observational study was carried out involving individuals struggling with different forms of cancer (N = 430). Linear regression was used to investigate the concurrent predictive role of the independent variables, stratified by gender, for each of the five cancer-specific quality of life domains and overall quality of life.

RESULTS

Sociodemographic characteristics had only a negligible to small role in predicting quality of life in both men and women. In contrast, the psychological variables explained a significantly larger portion of the variance in both genders. There were no statistically significant gender differences regarding the raw quality of life domain scores; however, their predictors were markedly different in the two groups.

CONCLUSION

The results of the present study indicate that it is imperative to take gender differences into consideration when planning psychosocial interventions also focusing on strengths, resources, and coping strategies. Considering the consistently emerging importance of family support in patients' quality of life, offering psychological interventions to caregivers/family members seems warranted to empower them to provide support to patients throughout the illness trajectory.

Patients' experiences of living with a stoma in rural areas in Northern Sweden

Introduction: Stoma complications are common and interfere with many aspects of everyday life. Stoma problems are usually managed by a specialised stoma nurse, a service not present in the rural areas of South Lapland in Sweden. The aim of this study was to describe how stoma patients in rural areas experience living with a stoma.Methods: A qualitative descriptive study with semi-structured interviews were conducted with 17 stoma patients living in rural municipalities and who received a part of their care at the local cottage hospital. Qualitative content analysis was employed.Results: Initially, the stoma was experienced as very depressing. Participants had difficulties in properly managing the dressing. Over time they learned how to properly care for their stoma, making their life easier. Both satisfaction and dissatisfaction with the healthcare were experienced. Those who were dissatisfied expressed a lack of competence in dealing with stoma-related problems.Conclusions: Living with a stoma in a rural area in northern Sweden is experienced as a learning process and acceptance of the stoma's existence is important. This study emphasises the need for increased knowledge of stoma-related problems in rural primary healthcare in order to help patients cope with everyday life.

Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review

(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.

Depression after stoma surgery: a systematic review and meta-analysis

BACKGROUND

Depression is the leading cause of global disability and can develop following the change in body image and functional capacity associated with stoma surgery. However, reported prevalence across the literature is unknown. Accordingly, we performed a systematic review and meta-analysis aiming to characterise depressive symptoms after stoma surgery and potential predictive factors.

METHODS

PubMed/MEDLINE, Embase, CINAHL and Cochrane Library were searched from respective database inception to 6 March 2023 for studies reporting rates of depressive symptoms after stoma surgery. Risk of bias was assessed using the Downs and Black checklist for non-randomised studies of interventions (NRSIs), and Cochrane RoB2 tool for randomised controlled trials (RCTs). Meta-analysis incorporated meta-regressions and a random-effects model.

REGISTRATION

PROSPERO, CRD42021262345.

RESULTS

From 5,742 records, 68 studies were included. According to Downs and Black checklist, the 65 NRSIs were of low to moderate methodological quality. According to Cochrane RoB2, the three RCTs ranged from low risk of bias to some concerns of bias. Thirty-eight studies reported rates of depressive symptoms after stoma surgery as a proportion of the respective study populations, and from these, the median rate across all timepoints was 42.9% 42.9% (IQR: 24.2-58.9%). Pooled scores for respective validated depression measures (Hospital Anxiety and Depression Score (HADS), Beck Depression Inventory (BDI), and Patient Health Questionnaire-9 (PHQ-9)) across studies reporting those scores were below clinical thresholds for major depressive disorder according to severity criteria of the respective scores. In the three studies that used the HADS to compare non-stoma versus stoma surgical populations, depressive symptoms were 58% less frequent in non-stoma populations. Region (Asia-Pacific; Europe; Middle East/Africa; North America) was significantly associated with postoperative depressive symptoms (p = 0.002), whereas age (p = 0.592) and sex (p = 0.069) were not.

CONCLUSIONS

Depressive symptoms occur in almost half of stoma surgery patients, which is higher than the general population, and many inflammatory bowel disease and colorectal cancer populations outlined in the literature. However, validated measures suggest this is mostly at a level of clinical severity below major depressive disorder. Stoma patient outcomes and postoperative psychosocial adjustment may be enhanced by increased psychological evaluation and care in the perioperative period.

Diagnosis, causes, and treatment of dyspareunia in postmenopausal women

IMPORTANCE AND OBJECTIVES

Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women.

METHODS

This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia.

FINDINGS

Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists.

CONCLUSIONS

Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.

Effects of the Quality of Life on the Adaptation of People With An Intestinal Stoma

The study aimed to examine the effects of the quality of life on the adaptation of people with an intestinal stoma. Cross-sectional study with 152 people with an ostomy. Three instruments were used: the sociodemographic and clinical characterization, Scale for the Level of Adaptation of Ostomy Patients, and City of Hope Quality of Life - Ostomy Questionnaire. The multiple linear regression model, multivariate technique, and cluster were used. The determination coefficient showed that 94.1% of the variability of the Adaptation scores is explained by the dimensions of quality of life. It can be seen that the highest standardized coefficients are the psychological dimension (β = .386) and the social dimension (β = .365), in which they produce the greatest changes in the average adaptation scores. The psychological and social well-being dimensions are the ones that most contribute to raising the levels of adaptation.

The Impact of Bevacizumab and Chemotherapy on Quality of Life in Metastatic Colorectal Cancer Patients

Health-related quality is of life of great importance in cancer care. This prospective study aimed to evaluate the impact of chemotherapy and bevacizumab on the activities of daily living, cancer symptoms, and general well-being in 59 metastatic colorectal cancer patients. We gathered information using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. The paired sample t-test, MANOVA test, and Pearson's correlation test were used to analyze the presence of significant differences in mean scores before and after 6 months of treatment. The results revealed significant differences in the functioning and symptoms that influence patients' quality of life after 6 months of treatment: increased pain (p = 0.003), nausea and vomiting (p = 0.003), diarrhea (p = 0.021) and decreased appetite (p = 0.003). At the same time, there were several aspects that improved the quality of life. Increases in emotional function (p = 0.009), cognitive function (p = 0.033), and perception of body image (p = 0.026) were observed after 6 months of treatment. Elderly patients reported a higher frequency of stools (p = 0.028), and young patients had increased concerns about body perception (p = 0.047). Assessing the quality of life of metastatic colorectal cancer patients is an important way to identify and treat symptoms related to both cancer and therapy by establishing a holistic care plan and implementing measures to increase the quality of life.

Ostomy-related problems and their impact on quality of life of Saudi ostomate patients: A mixed-methods study

AIM AND OBJECTIVE

The aim of this study is to explore the health-related quality of life outcomes and ostomy-related obstacles among patients with ostomy in Saudi Arabia.

BACKGROUND

Negative effects on quality of life for patients following ostomy creation are a globally important health concern. Paucity of understanding factors that influenced quality of care after ostomy surgery hinders the ability of healthcare providers to offer appropriate care to improve patient's quality of care.

METHODS

This mixed-methods study was undertaken through survey (COHQOL-Q Arabic version) for collecting the quantitative data (n = 421) and semi-structured interview for collecting qualitative data (n = 12). This study employed STROBE and GRAMMS checklists.

RESULTS

Multiple health-related quality of life challenges was indicated by Saudi patients with intestinal stomas. Ostomy surgery interferes with religious practice in Muslim people, particularly obtaining Hajj worship and fasting for Ramadan. The overall QOL mean score was moderate level (M = 7.57) for ostomy patients in Saudi Arabia. The highest domain mean score was the social well-being (M = 7.84) and the lowest in the physical well-being (M = 7.18). Reshaping of religious practices, apprehension and adaptation to living with a stoma were the most common themes that participants discussed related to ostomy issues they experienced following ostomy surgery.

CONCLUSION

The study findings reported a greater understanding of challenges that patients with stoma experience in Saudi Arabia. The process of the adaptation and the change of their lifestyle also affects patient's quality of life. The healthcare providers can use the study results to create a supportive intervention strategy that needed for maximise QOL for people with stoma.

RELEVANCE TO CLINICAL PRACTICE

This study identifies issues associated with stoma creation among Saudi people and can help in planning and providing the required nursing care which may support in the reduction of predictable problems. Recommendations for future studies related to nursing professional practice are indicated.

Adjustment to an Ostomy: An Integrative Literature Review

This integrative literature review summarizes recent literature relating to patient adjustment to stoma. The search strategy included 5 databases (CINAHL Plus, PsychINFO, Web of Science, Scopus, and MEDLINE); 65 articles meeting criteria were retrieved. Eleven were removed as duplicates, and a further 29 were removed when read in full, yielding 25 elements. Three were randomized controlled trials; 2 were prospective descriptive studies; 15 were cross-sectional descriptive studies; and 5 were qualitative studies. The quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The calculated mean quality score was 97%, and no studies were excluded on quality grounds. Limited evidence suggests that adjustment occurs over time and provides some insight concerning how rehabilitation leads to resumption of an altered normality. Some evidence suggests that long-term adjustment is associated with demographic and pre- and postoperative factors. A knowledge gap was identified regarding the role of support groups, which in other fields has been shown to positively benefit psychological well-being. This review revealed a paucity of interventional studies seeking to test ways to address adjustment-related problems. Longitudinal studies are recommended as ostomy care nurses work to facilitate adjustment in the person with a stoma over time.

Marginalization in the Medical Encounter: Ostomy Patients Experience of Perceived Stigmatizing Sentiments from Medical Clinicians

Introduction

Ostomy¹ stigma negatively impacts the health of people with an ostomy and contributes to a lower quality of life and health outcomes.

Objective

To assess whether participants experience perceived stigmatizing sentiments (SS) from medical clinicians at the time of their ostomy procedure.

Methods

Using a nonprobability sample of 312 persons with an ostomy, we conducted a retrospective descriptive study. We measured SS as patients’ self-reports of verbal and non-verbal communication from clinicians that were perceived to be negative and may contribute to ostomy stigma. We used thematic analyses to analyze open-ended written comments.

Results

Findings indicate that ostomy patients experience stigmatizing sentiments from their medical clinician before and after surgery. Sixteen percent of patients reported a SS, such as clinicians stating feelings of disgust, showing visible signs of disgust, or treating patients negatively regarding the ostomy.

Conclusion

The perceived treatment that this patient cohort experienced in healthcare likely contributes to ostomy stigmatization and may impact ostomy patients’ psychosocial adjustment. Future research should examine the specific consequences of perceived stigmatizing sentiments from medical clinicians.

Challenges faced by people with a stoma: peristomal body profile risk factors and leakage

AIM

The Ostomy Life Study 2019 aimed to obtain a better understanding of the challenges faced by people with stoma.

METHODS

Online survey with participants from 17 countries.

FINDINGS

Of the 54 614 individuals invited to take part, 5187 responded; 62% of the respondents avoided physical and social activities because of their stoma and 37% had never consulted their stoma care nurse to have the fit of their stoma product checked. In a subgroup receiving questions on leakage (n=4209), output under the baseplate and leakage onto clothes were experienced within the previous month by 76% and 26% of respondents, respectively. Higher chance of leakage was associated with an irregular stoma shape and peristomal body profile; a stoma level at or below the skin surface; and the presence of creases, folds and other changes in the peristomal area.

CONCLUSION

Leakage and access to a stoma care nurse to provide the necessary care and guidance remain important concerns for individuals with a stoma.

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.

Resilience and related factors in colorectal cancer patients: A systematic review

PURPOSE

To explore resilience and its related factors in adult colorectal cancer patients.

METHODS

Three databases (CINAHL, Scopus and PubMed) were searched for literature published from January 2009 to February 2021 using the terms colorectal and resilience or resilient or resiliency. The review was registered with PROSPERO and followed the PRISMA statement guidelines.

RESULTS

The studies (n = 11) showed that most colorectal cancer patients exhibit moderate levels of resilience. Resilience was identified as a mediator in the positive or negative aspects of illness, while three studies investigated resilience as an outcome variable. Resilience was associated with social support, mental and physical burden, post-traumatic growth, hope, and quality of life. The studies showed that resilience might not be an immutable situation; social support seemed to provide patients the tools necessary for managing their illness, as well as helped them confront future events. The interventions designed to help with self-care issues and coping strategies eased a patient's mental and physical burden, and improved resilience.

CONCLUSIONS

Resilience among colorectal cancer patients was connected to both negative and positive aspects of the illness. Psychosocial and illness-related practical support might be key for strengthening resilience in these patients. However, longitudinal and intervention studies are required to confirm these indications. Research should study resilience as an outcome variable and provide information related to resilience at different phases of cancer, and what type of support is offered by professionals.

Prospective Longitudinal Assessment of Health-related Quality of Life in Patients With Brain Metastases Undergoing Radiation Therapy

OBJECTIVE

We conducted a prospective clinical trial of patients receiving radiation (RT) for brain metastases to identify clinical predictors of pre-RT and post-RT health-related quality of life (hrQoL).

MATERIALS AND METHODS

Patients with brain metastases completed overall (European Organisation for Research and Treatment of Cancer QLQ C15-PAL) and brain tumor-specific (QLQ-BN20) hrQoL assessments pre-RT (n=127) and 1 (n=56) and 3 (n=45) months post-RT. Linear and proportional-odds models analyzed patient, disease, and treatment predictors of baseline, 1-, and 3-month hrQoL scores. Generalized estimating equations and repeated measures proportional-odds models assessed predictors of longitudinal hrQoL scores.

RESULTS

Most patients underwent stereotactic radiosurgery (SRS) (69.3%) and had non-small-cell lung (36.0%) metastases. Compared with SRS, receipt of whole brain RT was associated with a higher odds of appetite loss (baseline P=0.04, 1 mo P=0.02) and greater motor dysfunction (baseline P=0.01, 1 mo P=0.003, 3 mo P=0.02). Receipt of systemic therapy was associated with better emotional functioning after RT (1 mo P=0.03, 3 mo P=0.01). Compared with patients with breast cancer, patients with melanoma had higher odds of better global hrQoL (P=0.01) and less pain (P=0.048), while patients with lung cancer reported lower physical function (P=0.048) 3 months post-RT. Nonmarried patients had greater odds of higher global hrQoL (1 mo P=0.01), while male patients had lower odds of reporting more hair loss (baseline P=0.03, 3 mo P=0.045). Patients 60 years and above had lower odds of more drowsiness (P=0.04) and pain (P=0.049) over time.

CONCLUSIONS

Patients receiving SRS versus whole brain RT and systemic therapy reported better posttreatment hrQoL. In addition, melanoma metastases, nonmarried, male, and older patients with reported better hrQoL in various as well as domains after intracranial RT.

Multinational survey on living with an ostomy: prevalence and impact of peristomal skin complications

BACKGROUND

Peristomal skin complications (PSCs) impair life for people with an ostomy. Visual signs of PSCs include discolouration, but sensation symptoms like pain, itching, and burning are equally important and underreported.

AIM

To provide improved understanding of PSC prevalence and associated challenges in the communities of ostomy patients and ostomy care nurses.

METHODS

The Ostomy Life Study 2019 encompassed a patient survey (completed by 5187 people with an ostomy) and a nurse survey (completed by 328 ostomy care nurses).

FINDINGS

In total, 88% of patients experienced PSCs and 75% experienced PSC symptoms in the absence of discolouration. Eighty per cent of nurses considered ostomy-related issues to be the main reason for PSCs, and a correlation between PSC severity and number of nurse consultations was demonstrated.

CONCLUSION

This study revealed a remarkably high PSC incidence in the absence of discolouration and highlighted direct consequences of having compromised skin and the health-economic consequences.

Quality of Life in Patients Living with Stoma

BACKGROUND

Background and Objective: Quality of life of patients can be affected a treatment. A good quality of life is essential to achieve a goal in treating patients. This study aims to assess stoma related quality of life.

METHODS

A cross-sectional study was done at St. Paul's Hospital millennium Medical College from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on sociodemographic variables, type, and indications of the stoma. Data was collected using structured questionnaire adopted from the City of Hope and Beckman Research Institute after modifications to make it in line with the Ethiopian context.

RESULTS

The mean score for the overall quality of life for stomata was 7.42 ± 0.53. Around 70% of patients have adjusted their dietary style due to stoma. More than half of them reported feelings of depression following stoma surgery. Only 34% of patients resumed sexual activity and only 11% were satisfied with it. None of them were enrolled in stoma association or support group. Factors such as type of ostomy (temporary/permanent), adjustment in dietary style due to stoma, depression, change in diet for not passing gas in public, and change in clothing style had significant effects on overall quality of life and its subscales (P < 0.05).

CONCLUSIONS

This study demonstrated that living with stoma has a greater impact on the overall aspect of quality of life.

Cancer survivors' greatest challenges of living with an ostomy: findings from the Ostomy Self-Management Telehealth (OSMT) randomized trial

OBJECTIVES

An ostomy results in lifelong quality of life changes for a cancer survivor. We describe the greatest challenges reported from a randomized trial of cancer survivors with stomas (ostomies).

METHODS

Cancer survivors with ostomies participating in a multi-site randomized prospective trial of an Ostomy Self-Management Telehealth (OSMT) program versus usual care (UC) were surveyed at six months post accrual. An open-ended question requested greatest challenges after ostomy surgery. Quantitative descriptive and qualitative analyses were used to examine greatest challenges reported.

RESULTS

A total of 118 trial participants identified greatest challenges with 55 in the OSMT and 63 in the UC. Six conceptual domains were used to code comments-physical, psychological, social, and spiritual quality of life; ostomy-specific issues, and healthcare issues. The OSMT contributed 187 comments, and UC contributed 235 comments. Ostomy specific issues and social well-being had the most comments overall with UC contributing more comments in all domains except physical well-being. Word Clouds revealed post-operative and treatment-related issues and going out in public as the most common challenges in both groups. Word Clouds compared types of ostomies revealing bowel function challenges (colostomy group), difficulties going out in public (ileostomy group), and positive support (urostomy group).

CONCLUSIONS

Fewer challenges submitted by the OSMT group provide the beginning evidence of the OSMT program impact. Dominant challenges across both groups were social well-being and ostomy care. Challenges varied by type of ostomy. Findings support long-term care and support for all cancer survivors with ostomies.

TRIAL REGISTRATION

NCT02974634.

Quality of life among ostomy patients: A narrative literature review

AIM AND OBJECTIVE

This study aims to identify and summarise factors related to ostomy patients' experiences and how these impact the perceived quality of life for those patients.

BACKGROUND

Ostomy formation is a common therapeutic technique used to treat different colorectal diseases such as colorectal cancer. Although surgical intervention and ostomy formation may prolong a patient's life, it may cause many problems in their daily lifestyle and affect their quality of life. The surgical creation of an ostomy has a significant impacts on a patient's quality of life from multiple perspectives, including physical, psychological, social and spiritual aspects.

DESIGN

A narrative literature review, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline).

METHODS

This review analysis of search filters was conducted in the following databases: PubMed (MEDLINE), CINAHL, Embase, ProQuest, Science Direct, Scopus, and PsycINFO. A validation data set of 283 research articles between January 2000 and December 2019 were used to identify the impact of stoma surgery on patients' quality of life.

RESULT

Thirty-seven studies were identified as suitable for inclusion in this literature review. The results of the review indicate that quality of life (QoL) in patients who have an ostomy is influenced by many modifiable factors. Exercise, preoperative stoma site identification, family support, maintenance of social networks, education, spirituality and financial stability are all potentially modifiable factors that can improve the QOL for ostomy patients.

CONCLUSION

This review has identified multiple challenges that ostomy patients experience, which were clustered according to physical, psychological, social and spiritual challenges.

RELEVANCE TO CLINICAL PRACTICE

This study identifies issues associated with stoma creation and can help in planning and providing the required nursing care which may assist in the reduction of predictable challenges. Recommendations for future research related to nursing practice are stated.

Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research

INTRODUCTION

With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early-stage and advanced CRC survivors.

METHODS

CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis.

RESULTS

Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early-stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas.

CONCLUSION

CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment-specific impacts on QoL and long-term (>5 years) impacts on CRC survivors.

Sociodemographic and clinical features and quality of life in stomized patients

Objectives To identify users with an intestinal ostomy concerning their sociodemographic and clinical characteristics, and to determine the scores for quality of life according to the domains of the questionnaire City of Hope.

Method This is a household, descriptive, transversal, quantitative-approach survey, accomplished with 30 registered users at the Ostomy Association of the State of Paraíba, Brazil. A specific form for ostomy patients was applied, and data analysis was performed with the use of the software Statistical Package for Social Sciences (SPSS) version 20.0. This study was approved by CAAE No. 17224613.8.0000.5183.

Results Most participants were over 60 years, were Catholics, with elementary education, an income up to three minimum wages, married or in a stable relationship, with almost all quality of life scores above the midpoint of the range of the variables of the domains surveyed by the questionnaire City of Hope.

Conclusion The questionnaire led to the conclusion that the respondents with ostomy had a satisfactory quality of life.

A feasibility and acceptability study of an adaptation of the Mindful Self-Compassion program for adult cancer patients

OBJECTIVES

Psychosocial interventions that mitigate psychosocial distress in cancer patients are important. The primary aim of this study was to examine the feasibility and acceptability of an adaptation of the Mindful Self-Compassion (MSC) program among adult cancer patients. A secondary aim was to examine pre-post-program changes in psychosocial wellbeing.

METHOD

The research design was a feasibility and acceptability study, with an examination of pre- to post-intervention changes in psychosocial measures. A study information pack was posted to 173 adult cancer patients 6 months-5 years post-diagnosis, with an invitation to attend an eight-week group-based adaptation of the MSC program.

RESULTS

Thirty-two (19%) consented to the program, with 30 commencing. Twenty-seven completed the program (mean age: 62.93 years, SD 14.04; 17 [63%] female), attending a mean 6.93 (SD 1.11) group sessions. There were no significant differences in medico-demographic factors between program-completers and those who did not consent. However, there was a trend toward shorter time since diagnosis in the program-completers group. Program-completers rated the program highly regarding content, relevance to the concerns of cancer patients, and the likelihood of recommending the program to other cancer patients. Sixty-three percent perceived that their mental wellbeing had improved from pre- to post-program; none perceived a deterioration in mental wellbeing. Small-to-medium effects were observed for depressive symptoms, fear of cancer recurrence, stress, loneliness, body image satisfaction, mindfulness, and self-compassion.

SIGNIFICANCE OF RESULTS

The MSC program appears feasible and acceptable to adults diagnosed with non-advanced cancer. The preliminary estimates of effect sizes in this sample suggest that participation in the program was associated with improvements in psychosocial wellbeing. Collectively, these findings suggest that there may be value in conducting an adequately powered randomized controlled trial to determine the efficacy of the MSC program in enhancing the psychosocial wellbeing of cancer patients.

Living with paradox: A qualitative study of colorectal cancer patients' experiences in managing their health after cancer treatment

OBJECTIVES

Managing one's health after colorectal cancer may present specific challenges given long-term impacts to biopsychosocial functioning. Understanding experiences of managing one's health post-treatment is important to informing patient-centred supportive care.

METHODS

A qualitative study with 19 patients who had completed treatment for colorectal cancer to explore the experience of managing one's health. Following Thorne's Interpretive Description, we conducted interviews using either focus groups or individual interviews. Transcribed data were analysed following Thorne's approach. Sociodemographic and clinical characteristics were also collected.

RESULTS

The metaphor of living with paradox was the main theme characterising the experiences of managing one's health in the post-treatment period. Participants described the ambiguity of health, their need to accept the new normal, losing control and taking back control, experiencing positive and negative life changes, and the need to continually reframe their perspectives to focus on the positives.

CONCLUSION

Our findings suggest that providing patient-centred care to colorectal cancer survivors post-treatment involves recognising their changing and sometimes conflicting experiences. Their ability to manage their health may fluctuate and their supportive care needs may not fit with a particular trajectory. Cancer care systems should strive for flexibility in the structure and timing of support available.

Health services research in colorectal cancer: a quasi-experimental interventional pilot study on in- and outpatient oncology

Introduction

Due to frequent treatment side effects and weight loss, colorectal cancer patients require oncologic care and nutritional counseling both during and after hospitalization. The current study evaluated differences in discharge and side effects management and nutritional behavior between colorectal cancer patients of a control group without systematic counseling and of an intervention group with access to structured in- and outpatient oncology nurse and nutritional counseling.

Methods

The presented explorative, quantitative, single-center, interventional pilot study is a health services research project with a quasi-experimental design. Using a self-designed standardized questionnaire, data were collected from the control group (n = 75) before and from the intervention group (n = 114) after the introduction of in- and outpatient oncology nurse and structured systematic nutritional counseling. The in- and outpatient counseling services were developed and evaluated in the form of a structured nurse-led counseling concept.

Results

Intervention group patients profited significantly from inpatient oncology nurse counseling in seven different areas of discharge management. No differences were observed concerning patient-reported general and gastrointestinal side effects except for xerostomia and dysphagia, but of the patients participating in both in- and outpatient oncology nurse counseling, 90.0% were better able to cope with general side effects of treatment. Patients with in- and outpatient structured systematic nutritional counseling more frequently received nutritional information (p = 0.001), were better at gauging food intolerances (p = 0.023), and followed the dietician's advice in cases of gastrointestinal side effects significantly more often (p = 0.003) than control patients. Counselor-reported outcomes concerning gastrointestinal side effects showed improvement in most of the patients taking part in systematic in- and outpatient nutritional counseling, except for weight loss in 4 patients.

Conclusion

In- and outpatient counseling in discharge and side effects management and nutrition improve the outcomes of colorectal cancer patients. Outpatient counseling should be further developed and evaluated in future studies.

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.

Peoples' Experiences With Pouches (PEWP) Study: Ostomate-Provider Interactions

Background:

Minimal research focuses on interactions between providers and new ostomy patients. Studies show that provider communication is important for patient health outcomes.

Objective:

The purpose of this study was to investigate ostomy patients’ perceptions of provider communication following surgery and whether interactions adequately prepare ostomy patients to care for their new appliance.

Method:

Using a nonprobability national sample of 381 ostomy patients, we conducted a retrospective quantitative study. We measured adequacy of provider communication from self-reports from ostomy patients.

Results:

The results show that almost half of the sample (49%) reported receiving inadequate communication from providers. We also found a relationship between ostomy patients’ educational level and their perceptions of receiving adequate communication. Notably, patients with lower educational attainment reported receiving adequate communication up to 4 times more than patients with higher educational attainment.

Conclusion:

Our results suggest that not only do ostomy patients need better communication from providers following their surgery but also patients with higher educational attainment appear to expect more information from providers than patients with lower educational attainment.

The experience of health-related quality of life in extended and permanent cancer survivors: A qualitative systematic review

OBJECTIVE

This qualitative systematic review aims to synthesize qualitative evidence from primary studies on experiencing health-related quality of life (HRQoL) in extended and permanent cancer survivors.

METHODS

A systematic literature search was performed in PubMed, CINAHL, LILACS, PsycINFO, Scopus, and Web of Science. It followed guidelines from the statement in the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A quality appraisal of each study was undertaken using the Critical Appraisal Skills Programme. Data synthesis was conducted according to the thematic synthesis approach. Confidence in each review finding was assessed using the Confidence in the Evidence from Reviews of Qualitative research (Grade-CERQual).

RESULTS

Twenty-four studies from nine countries were selected for the final sample. Analysis of the studies' results allowed for the construction of nine descriptive themes that were interpreted into three analytical themes: "The body as a representation of HRQoL," "Living through and beyond cancer: the re-signification of HRQoL," and "Employing resources to improve HRQoL." According to the CERQual approach, moderate confidence estimations were achieved for the results.

CONCLUSIONS

The themes reflect that the HRQoL experience is re-signified by survivors from the privilege of being alive. This process happens with the support of social resources, family, hope, and spirituality. Based on the findings, it is suggested that health staff should be able to recognize the impact that cancer survival has on HRQoL and develop a care plan that addresses needs to sustain health in these survivors.

Patient-reported outcomes and experiences from the perspective of colorectal cancer survivors: meta-synthesis of qualitative studies

BACKGROUND

Colorectal cancer (CRC) is prevalent in the developed world. Favourable survival rates highlight the need to better understand CRC survivors' experiences of long-term impacts of treatment, which can in turn inform decision making. This systematic review aimed to identify and synthesise CRC survivors' experiences of long-term impacts on health-related quality of life.

METHODS

We searched Medline, Embase and PsychINFO from inception to January 2019. Qualitative studies describing CRC survivors' experiences at least 1-year post-treatment were included. Study eligibility, quality assessment (COREQ guidelines), and data synthesis was performed independently by two reviewers and discussed with the study team.

RESULTS

Of 1363 papers retrieved, 20 reporting 15 studies met eligibility. Thematic synthesis produced 12 themes: symptoms, physical, social, psychological and sexual functioning, impact on relationships, informal care needs provided by family/friend, supportive care needs provided by healthcare professional, health care experiences, health behaviour, financial toxicity and occupational experiences. Stoma problems (e.g. leakage, skin irritation) were common in ostomates. Survivors with no/reversed stoma experienced unexpected, long-term altered and unpredictable bowel functioning. Survivors often regulated timing, amount and foods consumed to manage bowel functioning. Less common symptoms included fatigue, impaired sleep and anal pain. Stoma problems and altered bowel functioning impaired survivors' physical, social, sexual and psychological functioning. Cognitive functioning and heredity issues were not reported in any paper.

CONCLUSION

CRC survivors experience ongoing symptoms and functioning impairments more than 1-year post-treatment completion. Many survivors find their own ways to manage symptoms rather than seek professional help. Follow-up care for CRC survivors should integrate screening for long-term effects and provide targeted supportive care.

Sexual health in colon cancer patients: A systematic review

OBJECTIVE

Despite the impact that diagnosis and treatment can have on patients' sexual health, very little research has been conducted on the impact of colon cancer on sexual health. The aim of this systematic review was to assess the prevalence of sexual dysfunctions in colon cancer and describe the sociodemographic, clinical, and psychological correlates of sexual dysfunction.

METHODS

Four electronic databases (PsycINFO, PubMed, AcademicSearchPremier, Cochrane Library) were searched for studies reporting sexual adjustment outcomes for colorectal cancer patients from January 1990 to July 2019.

RESULTS

Of the 380 articles screened, 14 were included in this review. Sexual function is affected by colon cancer: patients' sexual satisfaction decreases significantly, as does the frequency of sexual intercourse. There is an increase in sexual problems (desire, excitement, or pleasure disorders). Male gender, advanced age, distress, and the comorbidities increase sexual disorders. In addition, it appears that partner distress negatively affects patients' sexual health. Taking such difficulties into account appears key for these patients and their partners. They could benefit from better care throughout treatment and in remission.

CONCLUSION

The results of this systematic review highlight the importance of taking an interest in the sexual health of patients with colon cancer.

The impact of participation restrictions on everyday life in long-term colorectal cancer survivors in the EnCoRe study: A mixed-method study

PURPOSE

Knowledge about long-term colorectal cancer (CRC) or treatment related health and functioning problems and on its impact on participation of CRC survivors in domestic life and in society is limited. We aimed to explore the nature and impact of cancer (treatment) related participation restrictions on everyday life of long-term CRC survivors, their current satisfaction with participation, and associations of health and functioning problems with participation satisfaction, using the International Classification of Functioning, Disability and Health (ICF) to comprehensively study participation.

METHOD

Mixed-method study in 2-10 years post-diagnosis stage I-III CRC survivors (n = 151) from the cross-sectional part of the EnCoRe study. Participation restrictions were explored by semi-structured interviews in a subsample reporting participation restrictions (n = 10). Role functioning (SF36-Health Survey), fatigue (Checklist Individual Strength), and peripheral neuropathy symptoms (EORTC QLQ-CIPN20) were assessed in all participants and associations with self-reported participation satisfaction were analyzed by multivariable logistic regression models.

RESULTS

19% of CRC survivors reported dissatisfaction with participation. Participation restrictions were reported for interpersonal relationships, work/employment, and social/civic life. CRC survivors reporting better physical and emotional role functioning were significantly less likely to be dissatisfied with their participation, whereas survivors reporting higher levels of fatigue or more peripheral neuropathy symptoms were more likely to be dissatisfied with participation.

CONCLUSIONS

Colorectal cancer (treatment) related health and functioning problems negatively impacts the ability of nearly 1 in 5 long-term CRC survivors to participate in everyday life situations and their satisfaction with participation. Follow-up care needs to be able to identify and address these problems.

The impact of surviving bowel cancer on occupation: A scoping review

Introduction

The number of people surviving bowel cancer is increasing globally, with many of those affected living with long-term psychological and physical sequelae that potentially disrupt occupations.

Method

A scoping review – guided by Arksey and O’Malley’s methodological framework – was conducted to provide an overview of what is known about the impact of having had bowel cancer on occupations, and to reveal the potential role of occupational therapy. A systematic search of four databases and a grey literature repository generated 244 results. Applying inclusion and exclusion criteria, 33 items addressing bowel cancer and occupations were selected and thematically analysed.

Results

Researchers have identified six domains of occupation that are impacted by bowel cancer (social activity, physical activity, sexual activity, employment and role functioning, physical functioning, and self-care) but survivors report a distinct lack of health professional support after completion of medical treatment and being left to devise self-management strategies to accommodate the long-term effects of their cancer.

Conclusion

The sequelae of bowel cancer can have a significant impact on occupational participation. There is scope for increasing and improving occupational therapy input to assist people with cancer-related loss of function to re-engage in valued occupations and improve wellbeing.

Quality of life, pain and anxiety in patients with nephrostomy tubes

Objective:

to evaluate the impact on the quality of life as well as anxiety and pain in patients with nephrostomy tubes.

Method:

this is a longitudinal descriptive study performed on a sample of n=150 patients. To evaluate the quality of life, the EuroQol-5D questionnaire was used; anxiety was quantified by the Beck Anxiety Inventory; to study pain, a visual analogue scale was employed.

Results:

statistically significant differences were found in the quality of life, with its worsening (r = 0.51; p <0.01) when evaluated at the first tube replacement. Patients presented mild to moderate anxiety before the procedure, which was reduced at the first tube replacement, although this difference was not significant (r = 0.028, p = 0.393). Finally, the degree of pain was also significantly reduced (r = 0.13, p<0.01) after six weeks. As for gender, women presented the worst values ​​in the three variables studied (worse quality of life and greater anxiety and pain).

Conclusions:

nephrostomy tubes have a negative impact on the patient’s quality of life. During the time they live with these tubes, patients have mild to moderate pain and anxiety.

Living With an Intestinal Stoma: A Qualitative Systematic Review

The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy.

Gender differences in health-related quality of life among patients with colorectal cancer

Background

Evidence has shown that colorectal cancer (CRC) survivors, especially women have a lower health-related quality of life (HRQOL). This study aimed to assess the QOL of CRC survivors as well as gender-related differences in the QOL of CRC patients in Northwest of Iran.

Methods

This cross-sectional study was conducted in East Azarbijaban. All patients aged ≥18 years, and diagnosed with CRC regardless of its stage and plans for treatment, and also referred to teaching hospitals within a two years' time frame of 2014-2016, were included in this study. The Persian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was completed for each patient by two trained interviewers. Student t-test and χ² test were used to analyze Gender differences among patients, clinical-epidemiological characteristics, as well as the scores of QLQ-C30 dimensions. Multiple linear regression models were used to assess the relationship between the score of the EORTC QLQ-C30 questionnaire and gender.

Results

Overall 303 patients (167 male, 136 female) with a diagnosis of CRC were included in the study. The mean age of participants was 58.16±13.58 years. The mean scores of physical (b=-14.80, P=0.001) and social functioning (b=-9.14, P=0.038) of women with CRC were more negatively affected than men with CRC. In addition, women had a higher mean score in pain (b=10.74, P=0.022) and fatigue (b=12.53, P=0.007) symptom subscales in comparison to men. Based on the results of multivariate linear regression analysis, gender, occupation, and adjuvant therapy can be considered as the independent and strong predictor factors of functional scale in our CRC patients.

Conclusions

Women appear to be more affected than men by impaired physical and social functioning after the development of cancer, and they reported more fatigue and pain than men. Therefore, it might be advisable to consider strategies to improve the HRQOL in women.

Recovering from Cystectomy: Patient Perspectives

Background:

Bladder cancer patients who undergo cystectomy and urinary diversion face functional and quality-of-life challenges. Little is known about these patients’ experiences during decision-making, surgery, and recovery, or how they vary by treatment setting.

Objective:

To learn about patients’ experiences with treatment choice, surgical care, and recovery across health settings. Understanding patient experiences is essential to closing care gaps and developing patient-reported measures.

Methods:

We conducted focus groups with cystectomy patients and family caregivers at a large comprehensive health care system (N = 32 patients) and an NCI-designated comprehensive cancer center (N = 25 patients and 5 caregivers). Using standard qualitative methods, we identified themes that are not well-represented in existing research.

Results:

Across both systems, patients described variable experiences in decision-making about their cystectomy and urinary diversion. Some felt overwhelmed by information; others felt poorly informed. Many found self-care equipment challenging; many felt they knew little about what to expect regarding chemotherapy, recovery, and transitioning home. At times, health care personnel could not help manage patients’ ostomies or catheterization equipment. Our study also contributes a grounded theoretical framework for describing meaningful domains of patient experience with cystectomy and urinary diversion. We identified a common trajectory that includes decision-making, surgery and post-operative recovery, mastery of self-care, and reintegration.

Conclusions:

Patients with radical cystectomy and urinary diversion report a wide variety of experiences not captured by quantitative measures. These findings demonstrate that many cystectomy patients could benefit from additional post-operative support. We offer a framework to measure patient-centered domains in future research.

Ongoing ostomy self-care challenges of long-term rectal cancer survivors

PURPOSE

Surgical treatment for rectal cancer (RC) can result in an intestinal ostomy that requires lifelong adaptation and investment of physical, cognitive, and financial resources. However, little is known about the extent of ongoing challenges related to ostomy self-care among long-term RC survivors. We analyzed the prevalence of self-reported ostomy self-care challenges and the physical and environmental factors that can support or undermine ostomy self-care.

METHODS

We mailed surveys to long-term (≥ 5 years post-diagnosis) RC survivors, including 177 adults with ostomies who were members of integrated health systems in northern California, Oregon, and Washington State. Potential participants were identified through tumor registries. Data were also extracted from electronic health records.

RESULTS

The response rate was 65%. The majority of respondents were male (67%), and the mean age was 75 years. Sixty-three percent of respondents reported at least one ostomy self-care challenge. The most common challenges were leakage or skin problems around the ostomy and needing to change the pouching system too frequently. Twenty-two percent reported difficulty caring for their ostomy. Younger age and higher BMI were consistently related to ostomy self-care challenges.

CONCLUSIONS

The majority of RC survivors reported ostomy-related self-care challenges, and 31% experienced problems across multiple domains of ostomy self-care. In addition, most survivors reported significant physical challenges that could lead to ostomy-related disability. Although the participants surveyed had access to ostomy care nurses, the care gaps we found suggest that additional work is needed to understand barriers to ostomy care, reduce unmet needs, and improve well-being among this group.

Do cancer patients use the term resilience? A systematic review of qualitative studies

PURPOSE

Resilience is a dynamic process of positive adaptation to adversity, including cancer. While the term is used frequently by researchers, controversy exists over its conceptualisation and little is known if and how cancer patients use the term resilience. We examined qualitative studies exploring cancer patient experiences/perceptions of resilience to understand: (a) definitions of resilience as identified by patients and researchers and (b) the themes relating to attributes of resilience as identified by patients.

METHODS

Four electronic databases (MEDLINE, PsycINFO, SCOPUS, and CINAHL) were searched from database inception to November 2017, identifying qualitative studies of adult cancer patients/survivors which included resilience and cancer in the title, abstract, or medical subject headings. Articles were excluded if resilience was not a theme or outcome or was discussed primarily in the context of non-individuals. Thematic analysis was used to code studies and generate analytical themes, and a single author identified definitions of resilience within the studies.

RESULTS

Five hundred and seventy-three non-duplicate citations were screened, resulting in 65 citations screened for full-text review. Of these, 33 were excluded, leaving 32 studies. Four thematic categories emerged; coping strategies, social support, spirituality, and growth, within which 79 individual themes were identified. Eight researcher definitions and no patient definitions of resilience were identified.

CONCLUSION

This review found no cancer patient definitions of resilience and that cancer patients are seldom quoted using the term resilience directly, instead identifying coping strategies, social support, growth, and spirituality as attributes associated with resilience.

Quality of life in colorectal cancer outpatients

Aim

This study aimed to longitudinally analyze Quality of Life and its association with physical and psychosocial factors of patients with colorectal cancer.

Method

Fifty-one outpatients undergoing treatment for colorectal cancer were elected for convenience and were evaluated twice during their treatment. Evaluations were performed for Quality of Life, as well as socio-demographic, diagnostic and therapeutic variables. Afterwards, descriptive and inferential statistical analysis were performed, establishing the appropriate comparisons.

Results

The results identified a characteristic profile with a relatively homogeneous distribution: 51% were men with an average age of 60.1 years old (SD = 9.3 years) at the baseline. In general, concerning psychosocial aspects, there was a higher Quality of Life than other studies with the same population, in addition to a significant improvement over time in all subscales of performance and symptoms. Furthermore, it was evidenced that the physical aspects considerably influenced the self-report of the Quality of Life.

Conclusion

The recognition of the interferences that physical aspects pose to Quality of Life, should permeate the practices of teams involved in the care of these patients.

Factors associated with self-reported history of depression diagnosis among cancer survivors aged 18 years and over in the United States

OBJECTIVE

According to the American Cancer Society, 25% of cancer survivors in the United States develop depression. The objective of this study is to assess factors associated with self-reported history of depression diagnosis among cancer survivors aged ≥18 years in the United States.

METHODS

Data were analyzed from the 2014 Behavioral Risk Factor Surveillance System (N = 6079). The Behavioral Risk Factor Surveillance System collects data about US residents regarding their health-related risk behaviors and events, chronic health conditions, and use of preventive services. Respondents were considered to have a history of depression diagnosis if they answered yes to the question "Has a doctor or other health care provider EVER told you that you have a depressive disorder, including depression, major depression, dysthymia, or minor depression?" Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with depression in cancer survivors. Analyses were conducted using SAS 9.4.

RESULTS

After adjusting for demographic and socioeconomic factors, females (AOR: 1.70; 95% CI, 1.50-1.97); those with an annual household income of $24 999 or less (AOR: 2.48; 95% CI, 1.95-3.16); $25 000 to $49 999 (AOR: 1.62; 95% CI, 1.31-2.02), and $50 000 to $74 999 (AOR: 1.35; 95% CI, 1.10-1.71); those who were not married (AOR = 1.37; 95% CI, 1.17-1.60); and those who perceived their health as poor (AOR = 2.33; 95% CI, 2.01-2.70), were significantly more likely to report a diagnosis of depression.

CONCLUSIONS

The results indicate that gender, income, marital status, and perceived health status were associated with self-reported depression among cancer survivors aged ≥18 years in the United States.

Health-related quality of life in Chinese inpatients with lung cancer treatedin large general hospitals: across-sectional study

OBJECTIVE

In China, psychosocial problems of patients with cancer are under-recognised and undertreated in medical oncology practice. This study examined the health-related quality of life (QOL) in inpatients with lung cancer treated in large general hospitals and explored the demographic, clinical and psychosocial factors associated with QOL.

DESIGN

Cross-sectional study.

PARTICIPANTS AND SETTING

Altogether, 148 inpatients with lung cancer were consecutively recruited from two large general hospitals in Tianjin, China.

MAIN OUTCOME MEASURED

QOL, pain intensity, depressive and anxiety symptoms, and social support were assessed with WHO QOL Scale Brief Version, four-point Verbal Rating Scale, Hospital Anxiety and Depression Scale and Social Support Rating Scale, respectively.

RESULTS

Compared with the normative data for the Chinese general population, patients had significantly lower scores in physical (t=-25.860, p<0.001) and psychological (t=-18.225, p<0.001) QOL. Being unmarried (β=-2.471, 95% CI -4.908 to -0.034), poor economic status (β=-1.764, 95% CI -2.964 to -0.564), cancer metastasis (β=-1.328, 95% CI -2.632 to -0.024), poor performance status (β=-0.959, 95% CI -1.542 to -0.376), depression (β=-0.465, 95% CI -0.631 to -0.299), anxiety (β=-0.208, 95% CI -0.354 to -0.062) and low utilisation of social support (β=-0.344, 95% CI -0.577 to -0.111) were independently associated with poor physical QOL, while female gender (β=-1.494, 95% CI -0.649 to -2.339), less education years (β=-0.209, 95% CI -0.294 to -0.123), currently receiving chemotherapy (β=-1.536, 95% CI -3.051 to -0.021), small-cell cancer (β=-1.157, 95% CI -2.223 to -0.091), more intense pain (β=-0.535, 95% CI -0.919 to -0.151), poor performance status (β=-0.930, 95% CI -1.383 to -0.477), anxiety (β=-0.178, 95% CI -0.248 to -0.108) and inadequate subjective social support (β=-0.137, 95% CI -0.153 to -0.121) were independently associated with poor psychological QOL.

CONCLUSIONS

Inpatients with lung cancer treated in Chinese large general hospitals have poorer QOL than the general population. Effective prevention and management of psychosocial problems are potentially effective to improve their QOL.

Sexual quality of life, body image distress, and psychosocial outcomes in colorectal cancer: a longitudinal study

PURPOSE

The objectives were to assess changes in sexual QOL and body image distress over time and to examine longitudinal associations between sexual QOL and body image variables with psychosocial outcomes in a sample of colorectal cancer patients.

METHODS

Participants (N = 141) completed a mail-based survey assessing sexual QOL [sexual distress (ISS), treatment impact on sexual function (SFQ), sexual function (FSFI; IIEF)], body image distress (BIS), and psychosocial outcomes [relationship quality (DAS-4), depressive symptoms (CESD-SF), and health-related QOL (HRQOL; FACT-C)]; 88 patients completed 6-month follow-up surveys (62%). Gender and cancer subgroups (male vs. female; rectal vs. colon cancer) were compared and longitudinal models examined associations between sexual QOL and body image variables with psychosocial outcomes over time and by subgroup.

RESULTS

Impairments in sexual QOL and body image distress were common. Women and patients with rectal cancer reported worse body image distress compared to men (p = .005) and those with colon cancer (p = .03), respectively; compared to patients with colon cancer, those with rectal cancer reported worse treatment impact (p < .001) and marginally worse sexual function and HRQOL (p's = .05). At 6-month follow-up, body image distress decreased (p = .02), while sexual QOL was stable (e.g., 58% classified as dysfunctional at both time points, p = .13). For most sexual and body image predictors, worse impairment was associated with worse psychosocial outcomes over time. Several significant gender and cancer subgroup effects were found.

CONCLUSIONS

Sexual QOL and body image are compromised after colorectal cancer and tend to remain impaired if unaddressed. Sexual concerns should be addressed early to limit broader-reaching psychosocial effects.

A Randomized Controlled Trial Determining Variances in Ostomy Skin Conditions and the Economic Impact (ADVOCATE Trial)

PURPOSE

To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramide-infused ostomy skin barriers and control skin barriers.

DESIGN

The ADVOCATE trial is a multi-centered randomized controlled trial, and double-blinded international study with an adaptive design.

SUBJECTS AND SETTING

The sample comprised 153 adults from 25 sites from the United States, Canada, and Europe. Participants were seen in hospital and outpatient care settings.

METHODS

Data were collected by investigators at each site during face-to-face visits and during telephone check-in calls between visits. Cost of care data were collected using a questionnaire developed specifically for the study. The peristomal skin was assessed using the Ostomy Skin Tool. Health-related quality of life was measured using the SF-12v2. Patient-reported outcomes were collected using a patient-centered study-specific questionnaire. Cost of care was analyzed via analysis of covariance comparing total cost of care for 12 weeks between the 2 groups. The incidence of PSC was analyzed via Barnard's exact test comparing the incidence of PSCs between the control and treatment groups. Tertiary outcomes were exploratory in nature and not statistically powered.

RESULTS

Use of the ceramide-infused barrier significantly reduced stoma-related cost of care over a 12-week period, resulting in a $36.46 decrease in cost (14% relative decrease). The adjusted average costs were $223.73 in the treatment group and $260.19 in the control group (P = .017). The overall incidence of PSCs in the study was 47.7%; PSC incidence was 40.5% for the treatment group versus 55.4% for controls (P = .069, 95% confidence interval of the difference: -1.2 to 30.4). Significantly more participants using the ceramide-infused skin barrier were "very satisfied" with barrier performance (75% vs 55%; P = .033), prevention of leakage (63% vs 38%; P < .01), and prevention of itching (53% vs 31%; P = .016). General postoperative improvement in health-related quality of life was noted in both groups.

CONCLUSIONS

The use of a ceramide-infused barrier significantly decreased cost and increased satisfaction with patient-reported outcomes.

Exploring Positive Survivorship Experiences of Indigenous Australian Cancer Patients

Amongst Indigenous Australians, "cancer" has negative connotations that detrimentally impact upon access to cancer care services. Barriers to accessing cancer services amongst Indigenous Australians are widely reported. In contrast, factors that facilitate this cohort to successfully navigate cancer care services ("enablers") are scarcely reported in the literature. Through qualitative interviews, this article examines factors that assist Indigenous Australians to have positive cancer experiences. Semi-structured interviews were conducted with twelve adult Indigenous oncology patients recruited from a tertiary hospital in Queensland, Australia during 2012-2014. Data generated from the interviews were independently reviewed by two researchers via inductive thematic analytical processes. Discussions followed by consensus on the major categories allowed conclusions to be drawn on potential enablers. Two major categories of enablers were identified by the researchers: resilience and communication. Individual's intrinsic strength, their coping strategies, and receipt of support improved participant's resilience and consequently supported a positive experience. Communication methods and an effective patient-provider relationship facilitated positive experiences for participants. Despite potential barriers to access of care for Indigenous cancer patients, participants in the study demonstrated that it was still possible to focus on the positive aspects of their cancer experiences. Many participants explained how cancer changed their outlook on life, often for the better, with many feeling empowered as they progressed through their cancer diagnosis and treatment processes.

Rectal Cancer Survivors' Participation in Productive Activities

CONTEXT

Rectal cancer and its treatment impair survivors' productivity.

OBJECTIVE

To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis.

DESIGN

We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011.

MAIN OUTCOME MEASURES

Productive activities, functional health status, and bowel management at the time of the survey.

RESULTS

Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex.

CONCLUSION

Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors' medical care access, comorbidities, health-related quality of life, and productive activities.

Quality of Life and Characteristics of Colostomy Patients

Introduction: Colostomy imposed multiple impacts on the patient’s life including physical, psychological, social, and spiritual. This study aims to identify the level of quality of life as well as to examine the differences of quality of life among colostomy patients with regards to certain demographic characteristics.Methods: This study used a cross-sectional and descriptive analytical approach. Seventy-one colostomy patients were recruited purposively to participate in the study. The studied variables included quality of life and demographic characteristics. The data was collected by using the WHO Quality of Life – BREF instrument. One-way ANOVA and an independent t-test were employed to analyse the differences in quality of life with regards to certain demographic characteristics.Results: The study found that the majority of subjects perceived that their level of quality of life ranged between very low to moderate (77.4%). Satisfaction with support from friends was rated as the highest item of quality of life, whereas satisfaction with sexual relationships was rated as the lowest item of quality of life. There was no significant difference in the patients’ quality of life with regards to age group, educational background, occupation, length of being ostomate, sex, and other health problems.Conclusions: The study implied that nurses need to realise and pay attention to multiple aspects of stoma patient’s quality of life. Nursing care should not merely focus on stoma care but also holistically consider on meeting sexual needs, as well as the psychological, social, and spiritual needs of the patients.