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1.
World J Surg Oncol ; 18(1): 28, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013992

RESUMO

BACKGROUND: To assess postoperative anal function and quality of life of ultra-low rectal cancer patients treated by laparoscopic modified Parks surgery. METHODS: From February 2017 to March 2019, 114 patients with ultra-low rectal cancer above T2 were treated respectively with ultra-low anterior resection (Dixon), modified coloanal anastomosis (modified Parks), and Miles according to the preoperative stage and anastomotic position. The postoperative anal function and Fecal Incontinence Quality of Life Scale (FIQL) of each patient were collected and synthetically analyzed. RESULTS: Compared with the Dixon group, the postoperative anal function and FIQL in the Parks group were poor at the early stage. However, from 6 to 12 months after surgery, the scores of anal function and FIQL in the Parks group were similar to those in the Dixon group (P > 0.05). Compared with the Miles group, the FIQL of the two groups were similar in the early postoperative stage. However, with the passage of time, from 3 to 9 months after surgery, the four domains of FIQL in the Parks group were higher than those in the Miles group successively (P < 0.05). CONCLUSIONS: Laparoscopic modified Parks is a safe, effective, and economical anus-preserving surgery. Although its early anal function and FIQL were poor, it could gradually recover to the similar level as Dixon. Moreover, it can save the anus and obtain a better postoperative quality of life for some patients who previously could only undergo Miles.


Assuntos
Canal Anal/cirurgia , Anastomose Cirúrgica/métodos , Incontinência Fecal/prevenção & controle , Laparoscopia/métodos , Qualidade de Vida , Neoplasias Retais/psicologia , Neoplasias Retais/cirurgia , Canal Anal/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/patologia
2.
J Surg Oncol ; 121(6): 990-1000, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32090341

RESUMO

BACKGROUND AND OBJECTIVES: Surgical resection is a cornerstone in the management of patients with rectal cancer. Patients may refuse surgical treatment for several reasons although the rate of refusal is currently unknown. METHODS: The National Cancer Database was utilized to identify patients with stage I-III rectal cancer. Patients who refused surgical resection were compared to patients who underwent curative resection. RESULTS: A total of 509 (2.6%) patients with stage I and 2082 (3.5%) patients with stage II/III rectal cancer refused surgery. In multivariable analysis for stage I disease, older age, Black race, and Medicaid/no insurance were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had a higher income or lived further distances from the treatment facility. In multivariable analysis for stage II/III disease, older age, Black race, insurance other than private, and rural county were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had higher Charlson comorbidity scores, lived further distances from the treatment facility, or underwent chemoradiation. There was a significant decrease in survival for patients refusing surgery compared to patients undergoing recommended surgery. CONCLUSIONS: A small proportion of patients refuse surgery for rectal cancer, and this treatment decision significantly affects survival.


Assuntos
Neoplasias Retais/cirurgia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/psicologia , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Neoplasias Retais/psicologia , Recusa do Paciente ao Tratamento/psicologia , Estados Unidos/epidemiologia
3.
Cancer ; 126(8): 1766-1775, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31972054

RESUMO

BACKGROUND: We evaluated associations between perceived social support, social integration, living alone, and colorectal cancer (CRC) outcomes in postmenopausal women. METHODS: The study included 1431 women from the Women's Health Initiative who were diagnosed from 1993 through 2017 with stage I through IV CRC and who responded to the Medical Outcomes Study Social Support survey before their CRC diagnosis. We used proportional hazards regression to evaluate associations of social support (tertiles) and types of support, assessed up to 6 years before diagnosis, with overall and CRC-specific mortality. We also assessed associations of social integration and living alone with outcomes also in a subset of 1141 women who had information available on social ties (marital/partner status, community and religious participation) and living situation. RESULTS: In multivariable analyses, women with low (hazard ratio [HR], 1.52; 95% CI, 1.23-1.88) and moderate (HR, 1.21; 95% CI, 0.98-1.50) perceived social support had significantly higher overall mortality than those with high support (P [continuous] < .001). Similarly, women with low (HR, 1.42; 95% CI, 1.07-1.88) and moderate (HR, 1.28; 95% CI, 0.96-1.70) perceived social support had higher CRC mortality than those with high social support (P [continuous] = .007). Emotional, informational, and tangible support and positive interaction were all significantly associated with outcomes, whereas affection was not. In main-effects analyses, the level of social integration was related to overall mortality (P for trend = .02), but not CRC mortality (P for trend = .25), and living alone was not associated with mortality outcomes. However, both the level of social integration and living alone were related to outcomes in patients with rectal cancer. CONCLUSIONS: Women with low perceived social support before diagnosis have higher overall and CRC-specific mortality.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/psicologia , Pós-Menopausa/psicologia , Neoplasias Retais/mortalidade , Neoplasias Retais/psicologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Fatores de Risco , Integração Social , Apoio Social , Saúde da Mulher
4.
Support Care Cancer ; 28(7): 3219-3226, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31720804

RESUMO

PURPOSE: Both off-topic discussions and exchanges of social support are important to the success of online health support groups. Analyzing their relationship could enhance our understanding of the nature of helpful interactions in online cancer support groups and ways promoting their success. METHODS: A total of 15,284 messages were collected and analyzed from an online support group for rectal cancer. Two coders coded and categorized the messages into 211 threads using directed content analysis and a social support classification system. The relationship between off-topic discussions and social support was explored using the quadratic assignment procedure. RESULTS: There are 91 threads of off-topic discussions, 83 threads of informational support, 22 threads of emotional support, seven threads of tangible support, five threads of network support, and three threads of esteem support. More of the off-topic discussions are associated with more emotional and tangible support. Both off-topic discussions and informational support are mutually influenced by the mediating role of emotional support. In addition, off-topic discussions and network support are mutually influenced by the mediating role of emotional and tangible support, and off-topic discussions and esteem support are mutually influenced by the mediating role of tangible support. CONCLUSIONS: Off-topic discussions directly or indirectly promote different types of social support in an online rectal cancer support group.


Assuntos
Redes Sociais Online , Neoplasias Retais/psicologia , Grupos de Autoajuda/organização & administração , Emoções , Humanos , Comportamento de Busca de Informação , Internet , Resolução de Problemas , Sistemas de Apoio Psicossocial , Apoio Social
5.
Support Care Cancer ; 28(4): 1551-1554, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31720825

RESUMO

PURPOSE: An ostomy poses significant health-related quality of life (HRQOL) issues for cancer survivors. Survivors must learn to manage pouching appliances and adjust to the psychosocial consequences of living with an ostomy. We explored, through qualitative analysis, the challenges with self-management and ostomy appliances reported by cancer survivors. METHODS: Pooled data from two studies with a question on the greatest challenge of living with an ostomy and intervention session notes were analyzed using content analysis approach. The themes were reviewed and agreed upon by the research team, and counts were tallied for each theme based on the number of times they were mentioned by participants. RESULTS: Of the 928 greatest challenge responses and session notes, a total of 106 mentions (11%) were focused on ostomy appliances, associated repercussions, and time taken for ostomy care. Eight themes emerged: bleeding, pain, leakage, skin problems/irritation/rash, wafer-related issues, materials getting under the wafer, time to care for ostomy, and solutions to clean the stoma. Challenges described included poor wafer adherence, allergic reactions to adhesives, and pain around the stoma site. These challenges resulted in anxiety related to leakage, odor, and/or skin irritation, which negatively impacted on participation in social activities and self-confidence with ostomy care. CONCLUSIONS: Cancer survivors living with an ostomy experience multiple obstacles with ostomy appliances and caring for their ostomy. Continued innovation in ostomy appliance design and technology is needed to help cancer survivors with successfully managing ostomy care.


Assuntos
Sobreviventes de Câncer/psicologia , Estomia/psicologia , Estomia/reabilitação , Neoplasias Retais/reabilitação , Humanos , Estomia/efeitos adversos , Estomia/instrumentação , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/psicologia , Neoplasias Retais/cirurgia , Autogestão/métodos , Autogestão/psicologia
6.
BMC Gastroenterol ; 19(1): 209, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31805871

RESUMO

BACKGROUND: Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. METHODS: A decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. RESULTS: The most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG. CONCLUSIONS: Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.


Assuntos
Neoplasias do Colo/diagnóstico , Neoplasias Retais/diagnóstico , Adulto , Idoso , Áustria , Neoplasias do Colo/prevenção & controle , Neoplasias do Colo/psicologia , Colonoscopia/efeitos adversos , Análise Custo-Benefício , Guaiaco , Humanos , Indicadores e Reagentes , Cadeias de Markov , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Sangue Oculto , Anos de Vida Ajustados por Qualidade de Vida , Neoplasias Retais/prevenção & controle , Neoplasias Retais/psicologia , Sensibilidade e Especificidade
7.
J Clin Nurs ; 28(19-20): 3547-3555, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31162866

RESUMO

AIMS AND OBJECTIVES: To compare the differences in psychosocial behaviour reactions, psychosocial needs, anxiety and depression before and after colostomy surgery and to explore the predictors of psychosocial behaviour reactions. BACKGROUND: Colorectal cancer is increasing worldwide. Abdominoperineal resection accompanied by permanent colostomy can cause complicated psychosocial reactions and needs. However, colostomy patients' trajectories of psychosocial adjustment at different time points must be discussed. DESIGN: A longitudinal study. METHODS: Using a convenience sampling method, 67 patients planning to undergo colostomy surgery were recruited from a tertiary cancer centre in southern China from January 2013-January 2014. Data collection consisted of two phases, conducted 1-2 days before surgery and 1-2 days prior to discharge. The Ostomy Psychosocial Behaviour Reaction Questionnaire, the Ostomy Psychosocial Needs Questionnaire, the Hospital Anxiety and Depression Scale and a self-designed demographic questionnaire were used to collect data. STROBE guidelines were followed. RESULTS: The participants had a moderate level of psychosocial behaviour reactions, a deep and wide range of psychosocial needs and a high incidence of anxiety and depression before and after surgery. Anxiety before surgery was significantly higher than that after surgery. Psychosocial needs and anxiety were significant predictors of psychosocial behaviour reactions. CONCLUSIONS: Patients' anxiety was alleviated after surgery. The combination of ascertaining and meeting various psychosocial needs and managing negative emotions was helpful in alleviating patients' stress responses before and after surgery. RELEVANCE TO CLINICAL PRACTICE: An increased focus on the relationships among psychosocial behaviour reactions, psychosocial needs, anxiety and depression at different time points in colostomy patients is necessary for future research and practice.


Assuntos
Colostomia/psicologia , Neoplasias Retais/psicologia , Adulto , Idoso , Ansiedade/complicações , China , Neoplasias Colorretais , Depressão/complicações , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Perioperatório/psicologia , Neoplasias Retais/complicações , Neoplasias Retais/cirurgia , Projetos de Pesquisa , Inquéritos e Questionários
8.
Clin Transl Oncol ; 21(10): 1390-1397, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31006088

RESUMO

BACKGROUND: Miles procedure is often necessary for patients with low rectal carcinoma. However, this operation often affects the quality of life of patients, to evaluate the advantages of improved operation (anal reconstruction), the quality of life and survival between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection were analyzed. METHODS: The clinical data of 43 patients with low situated rectal carcinoma were retrospectively analyzed. 23 patients with left lower abdominal stoma after radical resection (Miles procedure) were divided into group A, and 20 patients with reconstruction of the anus in situ after radical resection were in group B. All patients were investigated by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaire, the clinical data are recorded. Independent sample T test was used to analyze the difference in quality of life between group A and group B at 3, 6, and 12 months after surgery, and Kaplan-Meier was used to compare the difference in overall survival between group A and group B. RESULTS: The results of T test showed that there were statistical significance in global health status and physical functioning between group A and group B at 3 and 6 months, but no statistical significance at 12 months (P = 0.024, P = 0.019, P = 0.115 for global health status; P = 0.004, P = 0.006, P = 0.065 for physical functioning, respectively). Emotional functioning and social functioning were also statistically significant between group A and group B at 3, 6, and 12 months (P = 0.041, P = 0.040, P = 0.034 for Emotional functioning; P = 0.020, P = 0.009, P = 0.032 for social functioning, respectively). This study also found that there was no statistical significance in body image and sexual functioning between group A and group B at 3 months, but there was statistical significance at 6 and 12 months(P = 0.098, P = 0.035, P = 0.045 for body image; P = 0.110, P = 0.048, P = 0.047 for sexual functioning, respectively). There were statistically significant about sexual enjoyment and defecation problems at 3, 6, and 12 months (P = 0.023, P = 0.028, P = 0.050 for sexual enjoyment; P = 0.013, P = 0.011, P = 0.050 for defecation problems, respectively).The results of Kaplan-Meier showed that the overall survival (OS) between group A and group B was not statistically significant (χ2 = 0.600, P = 0.439). CONCLUSIONS: There was no difference in survival time between group A and group B, but compared with the patients with left lower abdominal stoma(group A), the quality of life was better in patients with reconstruction of the anus in situ (group B). It is significant to improve the traditional lower abdominal stoma operation.


Assuntos
Canal Anal/cirurgia , Enterostomia/mortalidade , Qualidade de Vida , Neoplasias Retais/mortalidade , Neoplasias Retais/cirurgia , Imagem Corporal , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/psicologia , Neoplasias Retais/psicologia , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo
9.
Bull Cancer ; 106(5): 447-460, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31010631

RESUMO

The impact of rectal cancer on patient quality of life has been investigated but no research has yet examined the impact of time perspective in the assessment of quality of life of rectal cancer patients. Our goal is to explore the links between quality of life and time perspective and the role of time perspective as a determinant of quality of life. Data were collected from 69 patients who completed a questionnaire comprising a specific measure of quality of life (FACT-C), a measure of time perspective (ZTPI), a measure of emotional distress (HADS) and a collection of socio-demographic and medical data. Regression analyses revealed that present fatalist, past positive and future time perspective predicted quality of life. Present fatalist time perspective seemed to have a deleterious impact on specific measure of rectal cancer quality of life. Present fatalist and future time perspective predicted a better emotional quality of life whereas past positive predicted a worse emotional quality of life. These results suggest the importance of considering time perspective as a determinant of psychological quality of life in order to improve the QoL of patients.


Assuntos
Atitude Frente a Saúde , Qualidade de Vida , Neoplasias Retais/psicologia , Idoso , Feminino , Humanos , Masculino , Neoplasias Retais/cirurgia , Fatores de Tempo , Percepção do Tempo
10.
Acta Oncol ; 58(5): 627-633, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30836806

RESUMO

Background: The ongoing multi-center randomized FURCA-trial investigates the effect of patient-led follow-up after rectal cancer, aiming at improving management of late effects and survivorship care. The purpose of this present sub-study was to identify potential systematic differences between participants and non-participants in the FURCA-trial, in regard to demographic and clinical factors at baseline, and in quality of life (QoL) and fear of cancer recurrence (FCR) after one year. Material and methods: The population comprised patients invited to the FURCA-trial during the first 13 months' recruitment. Clinical and demographic data was obtained at baseline and differences were significance tested. Non-participants were requested to fill in a short survey one year after primary surgery, while participants received the questionnaires as part of more comprehensive one-year follow-up. Results: In the first 13 months of the trial, 113 out of the 262 patients invited, declined to participate. The main reason reported for this was lack of energy surplus. Participants were younger than non-participants (p < .01), and nonparticipation was particularly evident among patients ≥ 80 years. More than half of the invited females declined to participate. Good WHO Performance status was associated with participation (p = .01), yet there were no statistically significant differences in Charlson Comorbidity Index, type of surgery, oncological treatment or UICC stages between participants and non-participants. By one year after surgery, there was no difference in FCR-level (p = .92) and QoL (p = .25) between the non-participants and control group participants. Conclusion: The sub-study found that participants and non-participants differed at baseline in regard to age, gender and performance status, which is supported by results from other studies. No between-group differences were found in psychological factors after one year. These findings are important for the generalisability of the upcoming results from the trial.


Assuntos
Participação do Paciente/psicologia , Neoplasias Retais/psicologia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Autocuidado/psicologia
11.
Sex Med Rev ; 7(2): 202-222, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30655196

RESUMO

BACKGROUND: Treatments for colorectal and anal cancers can have a detrimental impact on sexual function. Type of treatment, which may include surgery, radiation, and/or chemotherapy, varies by disease site and severity. Treatment and long-term side effects can impact sexual function and intimacy for patients and their partners. AIM: To review the literature regarding treatment for colorectal/anal cancer and its impact on female sexual function, and to provide an assessment of medical outcomes and patient-reported outcomes (PROs) of women with a history of colon, rectal, or anal cancer seeking sexual health treatment. METHODS: We performed a PubMed search to identify peer-reviewed, English-language articles published between 2008 to 2018, using the following search terms: "colorectal cancer," or "rectal cancer," or "anal cancer" and "sexual function," or "sexual dysfunction." We also assessed the medical outcomes and PROs from our recent cross-sectional cohort study of 99 women with a history of colon, rectal, or anal cancer seeking sexual health treatment. MAIN OUTCOME MEASURES: Sexual function, quality of life, and PROs after colorectal/anal cancer. RESULTS: A total of 23 studies were identified. Study designs included 15 cross-sectional survey studies, 5 longitudinal studies, 2 psychoeducational interventions, and 1 pilot study. 10 studies included only women, and 13 included both men and women. The literature and our cohort confirmed that women with colorectal/anal cancer experience changes in sexual function after diagnosis and throughout the continuum of care; however, the scarcity of data in this area indicates a need for additional intervention trials and longitudinal studies. CONCLUSIONS: Research studies with large sample sizes and long study durations are needed to help us better understand the needs of female survivors of colorectal/anal cancer. Women with colorectal/anal cancer need simple strategies and resources to address concerns of sexual function after cancer treatment. Such interventions have been shown to enhance survivorship and quality of life. Canty J, Stabile C, Milli L, et al. Sexual Function in Women with Colorectal/Anal Cancer. Sex Med Rev 2019;7:202-222.


Assuntos
Neoplasias do Ânus/complicações , Neoplasias do Colo/complicações , Neoplasias Retais/complicações , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Neoplasias do Ânus/psicologia , Neoplasias do Colo/psicologia , Feminino , Humanos , Neoplasias Retais/psicologia
12.
J Gastrointest Surg ; 23(8): 1623-1630, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30603861

RESUMO

BACKGROUND: The aim in rectal cancer surgery is to cure with minimal impact on the quality of life. Transanal total mesorectal excision (TaTME) seems to be a safe and feasible alternative to laparoscopic TME (LaTME). However, limited data are available on the functional outcomes after TaTME. We aimed to study the quality of life (QoL), through questionnaires, comparing different functional outcomes after TaTME and LaTME. METHODS: Consecutive patients who underwent TME between 2010 and 2017 at Slagelse Hospital, Denmark, were included based on certain criteria. Patients were divided according to the surgical technique (TaTME vs LaTME). The study was based on telephone interviews using the questionnaires: EORTC-QLQ C30, EORTC-QLQ C29, Low Anterior Resection Syndrome (LARS) score, and International Prostate Symptom Score (IPSS) for male patients. Patients in this study had a follow-up time of at least 8 months. RESULTS: Overall, global health status was similar between the groups (p = 0.625). Anorectal symptoms were significantly in disfavor of TaTME including buttock pain (p = 0.011), diarrhea (p = 0.009), clustering of stools (p = 0.017), and urgency (p = 0.032), yet total LARS score was comparable (p = 0.054). We found comparable sexual results and an overall higher satisfaction with urinary status in TaTME group (p = 0.010), yet no difference in IPSS symptoms (p = 0.236). CONCLUSIONS: Anorectal dysfunction may occur after total mesorectal excision (TME) regardless of surgical technique, frequently more in after TaTME. The LARS symptoms and the overall quality of life status were however comparable. TaTME had a positive impact on the reported QoL, related to urinary symptoms.


Assuntos
Defecação/fisiologia , Laparoscopia/métodos , Qualidade de Vida , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Neoplasias Retais/fisiopatologia , Neoplasias Retais/psicologia , Reto , Inquéritos e Questionários , Resultado do Tratamento
13.
Surg Endosc ; 33(1): 79-87, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29967994

RESUMO

BACKGROUND: Transanal total mesorectal excision (TaTME) is a safe alternative to laparoscopic TME for mid and low rectal cancer. TaTME allows improved visualization of the surgical planes and margins, and may potentially improve oncological outcomes. However, functional results after total mesorectal excision (TME) are variable and there are currently only a few published studies that include functional data related to the outcomes of TaTME. METHODS: Fifty-four consecutive patients were included in this study: one group included 27 patients who underwent laparoscopic low anterior and the other included 27 patients who underwent TaTME. All patients were asked to complete five questionnaires related to quality of life (QOL) and function [EQ-5D-3L, EORTC-QLQ C30, EORTC-QLQ C29, Low Anterior Resection Syndrome score (LARS), and International Prostate Symptom Score IPSS]. All TaTME patients were operated on at The Gelderse Vallei Hospital by a single surgeon and had a follow-up of at least 6.6 months. RESULTS: The EORTC-QLQ C30 and EQ-5D-3L questionnaires showed comparable outcomes in terms of QOL between the two groups. Almost all items evaluated by the EORTC-QLQ C29, including sexual outcomes, were similar between the two groups. One item concerning fecal incontinence, however, was scored worse for TaTME. There were no significant differences between the groups in terms of LARS symptoms or urinary function. CONCLUSIONS: Patients undergoing laparoscopic or transanal TME showed comparable functional and QOL outcomes. Although the TaTME technique is still evolving, this study indicates that this technique is a safe alternative to laparoscopic surgery in terms of functional outcomes for mid and low rectal cancers.


Assuntos
Laparoscopia/métodos , Qualidade de Vida , Neoplasias Retais/psicologia , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos , Idoso , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reto/cirurgia
14.
Nutr Cancer ; 71(1): 89-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30572723

RESUMO

BACKGROUND: Rectal cancer (RC) survivors experience significant bowel function issues after treatment. We aimed to describe self-reported dietary and behavioral modifications among long-term (≥5 yr) RC survivors to manage bowel dysfunction. METHODS: RC survivors from Kaiser Permanente Northern California and Northwest regions completed surveys either via postage-paid return mail or telephone. Summary statistics on diet/behavioral modifications data were tabulated by proportion of responses. Modifications and frequency of bowel symptoms cited and were compared by ostomy status. RESULTS: A total of 575 respondents were included (overall response rate = 60.5%). Fruits and vegetables were troublesome for symptoms, but was also helpful in mitigating constipation, obstruction, and frequency, as well as improving predictability. Many respondents attributed red meat (17.7%), fried foods (13.9%), spicy foods (13.1%), carbonated beverages (8.0%), and sweets (7.6%) to increased diarrhea, gas, and urgency. Common behavioral modifications included controlling meal portions (50.6%), timing regularity (25.3%), and refraining from late night eating (13.8%). Permanent ostomy survivors were more likely to report symptoms of obstruction, while anastomosis survivors were more likely to report urgency. CONCLUSION: Multiple modifications were attempted by RC survivors to manage bowel symptoms. Identifying diet changes among RC survivors can improve symptom management and survivorship care.


Assuntos
Terapia Comportamental , Sobreviventes de Câncer/psicologia , Constipação Intestinal/dietoterapia , Dieta , Neoplasias Retais/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Support Care Cancer ; 27(4): 1481-1489, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30368673

RESUMO

PURPOSE: Many adults must cope with the adverse effects of cancer and adjuvant therapies, which may limit their engagement in health-enhancing behaviors such as physical activity (PA). Furthermore, the placement of a stoma during surgery for rectal cancer may cause additional challenges to being physically active. The aim of this study was to explore the experiences of rectal cancer survivors who were living with a stoma and the impact on their engagement in PA. METHODS: Interpretive phenomenological analysis was used as the approach for this qualitative study. Fifteen rectal cancer survivors took part in a semi-structured interview post-chemotherapy, and thematic analysis was used to identify themes within their accounts. RESULTS: Three themes captured participants' personal lived experience: (1) reasons for engaging in PA, (2) deterrents to engaging in PA, and (3) practical implications. CONCLUSIONS: Participants' accounts offered insight into both their cancer and stoma-related experiences, highlighting both reasons for and deterrents to engaging in PA. Further, findings helped to identify tangible strategies that those learning to be physically active with a stoma may find useful.


Assuntos
Exercício Físico/fisiologia , Neoplasias Retais/reabilitação , Neoplasias Retais/cirurgia , Estomas Cirúrgicos/fisiologia , Adaptação Psicológica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colostomia/efeitos adversos , Colostomia/psicologia , Colostomia/reabilitação , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Neoplasias Retais/psicologia , Reto/cirurgia , Estomas Cirúrgicos/efeitos adversos , Sobreviventes/psicologia
16.
Dis Colon Rectum ; 61(11): 1281-1289, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30239397

RESUMO

BACKGROUND: Although the body of evidence supporting nonoperative management for rectal cancer has been accumulating, there has been little systematic investigation to explore how physicians and patients value the tradeoffs between oncologic and functional outcomes after abdominal perineal resection and nonoperative management. OBJECTIVE: The purpose of this study was to elicit patient and physician preferences for nonoperative management relative to abdominal perineal resection in the setting of low rectal cancer. DESIGN: We conducted a standardized interviews of patients and a cross-sectional survey of physicians. SETTINGS: Patients from 1 tertiary care center and physicians from across Canada were included. PATIENTS: The study involved 50 patients who were previously treated for rectal cancer and 363 physicians who treat rectal cancer. INTERVENTIONS: Interventions included standardized interviews using the threshold technique with patients and surveys mailed to physicians. MAIN OUTCOMES MEASURES: We measured absolute increase risk in local regrowth and absolute decrease in overall survival that patients and physicians would accept with nonoperative management relative to abdominal perineal resection. RESULTS: Patients were willing to accept a 20% absolute increase for local regrowth (ie, from 0% to 20%) and a 20% absolute decrease in overall survival (ie, from 80% to 60%) with nonoperative management relative to abdominal perineal resection, whereas physicians were willing to accept a 5% absolute increase for local regrowth (ie, from 0% to 5%) and a 5% absolute decrease in overall survival (ie, from 80% to 75%) with nonoperative management relative to abdominal perineal resection. LIMITATIONS: Data were subject to response bias and generalizable to only a select group of patients with low rectal cancer. CONCLUSIONS: Offering nonoperative management as an option to patients, even if oncologic outcomes are not equivalent, may be more consistent with the values of patients in this setting. See Video Abstract at http://links.lww.com/DCR/A688.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Colectomia , Tratamento Conservador , Neoplasias Retais , Canadá/epidemiologia , Colectomia/efeitos adversos , Colectomia/psicologia , Colectomia/estatística & dados numéricos , Tratamento Conservador/efeitos adversos , Tratamento Conservador/psicologia , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Seleção de Pacientes , Médicos/psicologia , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Neoplasias Retais/epidemiologia , Neoplasias Retais/psicologia , Neoplasias Retais/terapia , Análise de Sobrevida
17.
Arq Gastroenterol ; 55(2): 154-159, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30043865

RESUMO

BACKGROUND: The treatment of median and distal rectal cancer has evolved a lot in the last decades due to the dissemination of the technique of total mesortal excision and the use of neoadjuvant chemotherapy and radiotherapy. However, this multidisciplinary approach can affect patients' quality of life in a number of ways that deserve to be adequately assessed. OBJECTIVE: To evaluate immediate and late health related quality of life in patients with rectal cancer treated with curative intent. METHODS: Prospective study including patients with non-metastatic mid or low rectal cancer. EORTC QLQ-C30 and EORTC-CR38 questionnaires were applied before, 3 months and 12 months after treatment. The mean scores of the questionnaires were stratified into 4 categories for the purpose of comparing the results at different moments. RESULTS: Twenty nine patients completed the 1st and 2nd questionnaires and 12 completed the three questionaries. Patient´s mean age was 50.8 years and 62% were female. Sphincter preservation was possible in 89.6%. Overall health scores and quality of life improved after three months after 12 months. After three months, sexual satisfaction, female sexual problems and future perspective were worsen, but gastrointestinal symptoms, sphincter problems, and weight loss were improved. After 12 months the Future Perspective deteriorated, but there was improvement of the problems related to stoma, sphincter problems and body image. CONCLUSION: Despite the complexity of the treatment of rectal cancer within a specialized service, quality of life was preserved and was satisfactory in most of the studied aspects.


Assuntos
Qualidade de Vida/psicologia , Neoplasias Retais/cirurgia , Adolescente , Adulto , Canal Anal , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Estudos Prospectivos , Neoplasias Retais/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
18.
Oncol Nurs Forum ; 45(4): 469-482, 2018 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-29947348

RESUMO

PROBLEM IDENTIFICATION: Treatments for cancer in the lower pelvis often cause lasting effects on women's sexual well-being. The purpose of this review is to describe interventions to improve sexual well-being in gynecologic, anal, or rectal cancer survivors. LITERATURE SEARCH: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 checklist and guidelines. A literature search was conducted using PubMed, CINAHL®, PsycINFO, and Cochrane Library. DATA EVALUATION: Articles were original intervention research studies of women treated for gynecologic, anal, or rectal cancer and included sexual well-being outcomes. Study characteristics were extracted and compared in a table for analysis and synthesis. SYNTHESIS: Of the 16 included studies, 1 focused on genitourinary rehabilitation, 12 focused on psychoeducational interventions, and 3 focused on combination interventions. Most interventions reported at least one positive sexual well-being outcome. Intervention format, delivery, dose, and outcome variables varied widely. IMPLICATIONS FOR RESEARCH: Preliminary efficacy and feasibility of interventions are promising, but larger studies designed to discern optimal content, delivery format, dose, and timing are needed.


Assuntos
Neoplasias do Ânus/psicologia , Sobreviventes de Câncer/psicologia , Neoplasias dos Genitais Femininos/psicologia , Neoplasias Retais/psicologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estados Unidos
19.
Dis Colon Rectum ; 61(6): 667-672, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29722725

RESUMO

BACKGROUND: Total mesorectal excision and preoperative radiotherapy in mid and low rectal cancer allow us to achieve very good oncological results. However, major and refractory low anterior resection syndrome and fecal incontinence alter the quality of life of patients with a long expected life span. OBJECTIVE: We assessed the functional results of patients treated by antegrade enema for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision. DESIGN: This is a prospective monocentric study from 2012 to 2016. PATIENTS: Patients who underwent percutaneous endoscopic cecostomy for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision were prospectively analyzed. MAIN OUTCOME MEASURES: We assessed the morbidity of the procedure and compared low anterior resection syndrome score, Wexner score, and Gastrointestinal Quality of Life Index before and after the use of antegrade enema. RESULTS: Of 25 patients treated by antegrade enema over the study period, 6 (24%) had a low anterior resection, 18 (72%) had a coloanal anastomosis, and 1 (4%) had a perineal colostomy. Postoperatively, the rate of local abscess was 8%, all treated by antibiotics. Low anterior resection syndrome score (33 vs 4, p < 0.001), Wexner score (16 vs 4, p <0.001), and Gastrointestinal Quality of Life Index (73 vs 104, p < 0.001) were all significantly improved after antegrade enema. The 2 main symptoms reported by patients were sweating (28%) and local pain (36%). At the end of the follow-up, 16% (n = 4) catheters were removed, and the rate of definitive colostomy was 12% (n = 3). LIMITATIONS: The main limitations of this study are the monocentric features and the sample size. CONCLUSION: Antegrade enema for major and refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision appears to be a promising treatment to avoid definitive colostomy. See Video Abstract at http://links.lww.com/DCR/A608.


Assuntos
Colostomia/psicologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Enema/métodos , Incontinência Fecal/prevenção & controle , Neoplasias Retais/cirurgia , Adulto , Idoso , Incontinência Fecal/psicologia , Incontinência Fecal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Qualidade de Vida , Neoplasias Retais/psicologia , Neoplasias Retais/radioterapia
20.
Support Care Cancer ; 26(11): 3933-3939, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29845420

RESUMO

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.


Assuntos
Sobreviventes de Câncer , Estomia , Neoplasias Retais/reabilitação , Neoplasias Retais/cirurgia , Autocuidado , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Estomia/psicologia , Estomia/estatística & dados numéricos , Qualidade de Vida/psicologia , Neoplasias Retais/psicologia , Autocuidado/métodos , Autocuidado/psicologia , Autocuidado/normas , Autorrelato , Inquéritos e Questionários , Washington/epidemiologia
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