Gender and quality of life for colorectal cancer survivors with an ostomy

Abstract

9525 Background: Intestinal stomas can pose significant challenges for colorectal cancer (CRC) survivors. Specifying common challenges and sub-group differences will further the development of tailored interventions to improve health-related quality of life (HRQOL) for survivors with an ostomy. Methods: This matched cross-sectional study collected survey and medical records data from CRC survivors in three regions of Kaiser Permanente (Northern California, Northwest, and Hawaii). The survey instrument included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and SF-36v2 questionnaires. Eligible colorectal cancer patients were at least five years beyond diagnosis. Two groups of CRC survivors were surveyed: those with a permanent ostomy (cases) and those that did not require an ostomy (controls). Survivors were matched on tumor site (rectum vs. colon), gender, age, and time since diagnosis. To identify differences in HRQOL associated with having an ostomy, outcomes were compared between the two groups using regression analysis with adjustment for tumor site (rectum vs. colon), age, comorbidity score, income, and work status. Results: Our response rate was 52 percent (675/1304). Cases and controls had similar demographic characteristics. Men and women showed significant differences in the relationship between ostomy and HRQOL and are reported separately. Based on the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared to controls, while only female cases showed significantly worse overall HRQOL and psychological well-being. Based on the SF-36v2, statistically significant and clinically meaningful differences between female cases and controls were observed for scores on seven of the eight scales and on the standardized summary scores. For men, mental health was statistically significantly lower for cases than for controls, but the difference did not reach a meaningful level. Conclusions: CRC survivors with an ostomy experience multiple HRQOL challenges compared to persons who never had an ostomy, even five years beyond the diagnosis. Men and women report a different profile of challenges, suggesting the need for targeted or gender-specific interventions to improve HRQOL in this population. [Table: see text]