Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 279
Filtrar
1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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/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
8.
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
9.
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
10.
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
11.
Bull Cancer ; 105(6): 573-580, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29735158

RESUMO

Surgery accounts for an important part of the therapeutic arsenal of colorectal cancer treatment. In digestive cancers, ostomy devices induce the loss of anal function and control. This medical appliance generates changes affecting all aspects of patients' lives. This study explores, on the one hand, the psychological impact of colostomy on colorectal cancer patients' quality of life and on the other hand, it analyzes the correlational links between body image, self-esteem and anxiety during the stoma. Thirty-five patients with colorectal cancer participated in the study, divided into 2 subgroups: 23 were carriers of a definitive stoma and the 12 others with a temporary stoma. All completed the Functional Assessment Cancer Therapy (FACT-C), the Body Image Scale (BIS), the State Trait Anxiety Inventory (STAI-Y) and the Self Esteem Scale (ETES). Analysis revealed the quality of life of temporary ostomates is more affected than that of the definitive ones. All three of them, body image, self-esteem and anxiety negatively affect the quality of life regardless of the type of stoma. This study highlights the prevalence of physical self-esteem for temporary ostomy; the role of a good body image and substantial emotional self-esteem for the permanent ostomy. Future studies are required to explore the underlying causes of the acceptance of this equipment and the mediating role of care devices.


Assuntos
Ansiedade/psicologia , Imagem Corporal , Neoplasias do Colo/cirurgia , Estomia/psicologia , Qualidade de Vida , Neoplasias Retais/cirurgia , Autoimagem , Neoplasias do Ânus/psicologia , Neoplasias do Ânus/cirurgia , Neoplasias do Colo/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/psicologia , Estudos Retrospectivos , Neoplasias do Colo Sigmoide/psicologia , Neoplasias do Colo Sigmoide/cirurgia
12.
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
13.
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
14.
Colorectal Dis ; 20(10): 881-887, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29679514

RESUMO

AIM: The aim of this study was to validate the Dutch translation of the low anterior resection syndrome (LARS) score in a population of Dutch rectal cancer patients. METHOD: Patients who underwent surgery for rectal cancer received the LARS score questionnaire, a single quality of life (QoL) category question and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. A subgroup of patients received the LARS score twice to assess the test-retest reliability. RESULTS: A total of 165 patients were included in the analysis, identified in six Dutch centres. The response rate was 62.0%. The percentage of patients who reported 'major LARS' was 59.4%. There was a high proportion of patients with a perfect or moderate fit between the QoL category question and the LARS score, showing a good convergent validity. The LARS score was able to discriminate between patients with or without neoadjuvant radiotherapy (P = 0.003), between total and partial mesorectal excision (P = 0.008) and between age groups (P = 0.039). There was a statistically significant association between a higher LARS score and an impaired function on the global QoL subscale and the physical, role, emotional and social functioning subscales of the EORTC QLQ-C30 questionnaire. The test-retest reliability of the LARS score was good, with an interclass correlation coefficient of 0.79. CONCLUSION: The good psychometric properties of the Dutch version of the LARS score are comparable overall to the earlier validations in other countries. Therefore, the Dutch translation can be considered to be a valid tool for assessing LARS in Dutch rectal cancer patients.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Doenças Retais/diagnóstico , Neoplasias Retais/psicologia , Inquéritos e Questionários/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Psicometria , Qualidade de Vida , Doenças Retais/etiologia , Doenças Retais/psicologia , Neoplasias Retais/cirurgia , Reprodutibilidade dos Testes , Síndrome , Traduções
15.
J Surg Res ; 226: 140-149, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29661279

RESUMO

BACKGROUND: Distress is common among cancer and surgical patients and can lead to worse outcomes if untreated. The objective of this study was to explore sources of distress among colorectal cancer patients undergoing surgery. MATERIALS AND METHODS: This was a qualitative study using in-depth, semistructured, one-on-one interviews in an academic setting. Patients were recruited if they had a pathologically confirmed diagnosis of colon or rectal cancer. Purposive sampling was used to recruit patients who were about to undergo (preoperative), or had recently undergone (postoperative), curative resection for colorectal cancer. RESULTS: All participants (n = 24) reported experiencing distress during treatment. Participants identified sources of distress preoperatively (negative emotional reaction to diagnosis, distress from preconception of cancer diagnosis, and distress interacting with healthcare system). Sources of distress during in-hospital recovery included negative emotional reaction to having a surgery and negative emotions experienced in the hospital. Postoperative sources of distress included mismatch of expectations and experience of recovery, dealing with distressing physical symptoms and complications after surgery, and distress worrying about recurrence. Participants identified other sources of distress that were not time-specific (distress related to social support network, from disruption of life, and worrying about death). CONCLUSIONS: Our results highlight a potential role for a comprehensive screening program to identify which patients require assistance with addressing sources of distress during the surgical experience. Understanding how sources of distress may vary by time will help us tailor interventions at different time points of the surgical experience.


Assuntos
Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Recidiva Local de Neoplasia/psicologia , Complicações Pós-Operatórias/psicologia , Neoplasias Retais/cirurgia , Estresse Psicológico/etiologia , Adulto , Ansiedade , Estudos de Coortes , Colectomia/psicologia , Colo/cirurgia , Neoplasias do Colo/psicologia , Feminino , Teoria Fundamentada , Humanos , Masculino , Período Perioperatório/psicologia , Complicações Pós-Operatórias/etiologia , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Neoplasias Retais/psicologia , Apoio Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia
16.
Colorectal Dis ; 20(5): O103-O113, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29460997

RESUMO

AIM: Quality of life (QoL) and functional outcomes are at risk of being impaired after rectal surgery, but there has been no large prospective study to thoroughly assess QoL according to surgical approach. We have investigated the impact of laparoscopic and robotic total mesorectal excision (TME) on QoL and functional outcomes. METHOD: Patients undergoing laparoscopic or robotic TME for rectal cancer between 2009 and 2013 were prospectively included in this questionnaire-based survey of QoL together with variations in urinary and sexual function. A propensity score analysis was retrospectively conducted to compare outcomes between groups in a cohort matched 1:1 for age, sex, body mass index, preoperative chemoradiation status and tumour height. The survey was performed preoperatively and 3, 6 and 12 months after surgery. RESULTS: Global health status/QoL was similar between the two groups for 130 matched pairs, but the robotic group showed better role, emotional and social functioning and experienced less fatigue and financial difficulty. International Prostatic Symptom Scores in men increased postoperatively, with significantly less impairment in the robotic group at 6 months. These scores were comparable to preoperative scores at 6 months in the robotic group and at 12 months in the laparoscopic group. Of 48 sexually active men in each group, International Index of Erectile Function-5 scores decreased postoperatively, returning to preoperative levels at 6 months in the robotic group and at 12 months in the laparoscopic groups. CONCLUSION: The robotic approach for TME was associated with less impairment of urinary and sexual function; QoL was comparable to the laparoscopic approach.


Assuntos
Laparoscopia/métodos , Protectomia/métodos , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pontuação de Propensão , Estudos Prospectivos , Qualidade de Vida , Neoplasias Retais/psicologia , Comportamento Sexual , Resultado do Tratamento , Micção
19.
World J Surg ; 42(8): 2660-2667, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29450698

RESUMO

BACKGROUND: The low anterior resection syndrome (LARS) score is a patient-reported outcome measure to evaluate the severity of bowel dysfunction after rectal cancer surgery by scoring the major symptoms of LARS. The aim of this study was to translate the English version of the LARS score into Japanese and to investigate the validity and reliability of the LARS score. METHODS: The LARS score was translated in Japanese following current international recommendations. A total of 149 rectal cancer patients completed the LARS score questionnaire and were also asked a single question assessing the impact of bowel function on quality of life (QoL). A total of 136 patients answered the LARS score questionnaire twice. RESULTS: The Japanese LARS score showed high convergent validity, based on its good correlation between the LARS score and QoL (p < 0.001). The LARS score was able to discriminate between patients according to the tumor distance to anal verge (p < 0.001), type of surgery (p < 0.001), and time since surgery (p = 0.001). Patients after ultra-low anterior resection and intersphincteric resection showed especially high scores. The score also had high test-retest reliability (intraclass correlation coefficient: 0.87). CONCLUSION: The Japanese LARS score is a valid and reliable tool for measuring LARS. The LARS score is appropriate for assessments in postoperative bowel function and international comparison. Using this score, patient-reported outcome measures of LARS in Japanese patients can be shared internationally. Additional validation reports from non-English speaking countries can support the LARS score as a worldwide assessment tool for postoperative bowel dysfunction.


Assuntos
Defecação/fisiologia , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/fisiopatologia , Neoplasias Retais/psicologia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários
20.
Eur J Cancer Care (Engl) ; 27(2): e12829, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29363821

RESUMO

This study describes the most stressful events and coping strategies used by patients with colorectal cancer 4-6 weeks after surgery and whether the coping strategies were considered helpful or not. For the investigation of situational coping, an exploratory design was used. One hundred and five patients from three Swedish hospitals were included to fill in the Daily Coping Assessment. Most stressful event, number and types of pre-defined coping strategies used, and if the coping strategy used was considered helpful or not, were measured for 5 days. Of 523 diary entries, 180 reported no stressful events. The most stressful event, also with worst level of control and expectation, was "Pain," followed by "Nausea/vomiting." The areas causing most stressful events were "Bowel-related" and "Surgery and treatment-related problems." Acceptance and Direct action were the most frequently used coping strategies. There was a wide range of perceived helpfulness if coping strategies were placed in relation to specific areas of events. The conclusion was that patients revealed several strategies for coping with stressful events but needed a higher level of preparedness for what might come and therefore need to be given appropriate support to cope during the early recovery phase. Such support is suggested to be person-centred and oriented towards individually adapting standardised regimens, given the variety of situations to which the stressful events reported in the study were related.


Assuntos
Adaptação Psicológica , Neoplasias do Colo/psicologia , Neoplasias Retais/psicologia , Estresse Psicológico/etiologia , Idoso , Neoplasias do Colo/cirurgia , Feminino , Humanos , Relações Interpessoais , Masculino , Cuidados Pós-Operatórios , Náusea e Vômito Pós-Operatórios/psicologia , Neoplasias Retais/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA