Image du corps, dépression et anxiété des patients atteints d’un cancer du rectum avec stomie temporaire : une étude exploratoire longitudinale

Abstract

ObjectivesIn 2012, rectal cancer represented 30 % of colorectal cancers. In the case of cancer, three treatments are available, alone or associated: radiotherapy, chemotherapy and surgery. The main treatment for rectal cancer is surgery and more particularly rectal resection. The most important complication of this surgery is fistula. To reduce the risk, surgeons put a temporary stoma who can have repercussions like psychological difficulties, alteration of body image for example. The aims of this research were to explore the evolution of body satisfaction, anxiety and depression in the surgical treatment and study the associations between these variables. Materials and methodsParticipants are recruited in a visceral surgery department of CHU of Bordeaux. On the eve of the operation (T0), one month after the operation (T1) and two months after reversal stoma (T2), the Hospital Anxiety and Depression Scale and the Questionnaire d’Image du Corps were completed by 31 participants (13 women et 18 men, Mage=62.48 years) diagnosed with rectal cancer treated with rectal excision and temporary stoma. ResultsTemporary stoma had an impact on body satisfaction (F (2.58)=6.402, P<0.01) but the alteration of body satisfaction does not persist after reversal stoma. The mean score of body satisfaction at T0 (M=64.16, SD=10.92) was significantly (t (30)=3.075, P<0.01) higher than mean score of body satisfaction at T1 (M=55.97, SD=12.48). The mean score of body satisfaction at T1 was significantly lower (t (30)=2.881, P<0.01) than mean score of body satisfaction at T2 (M=61.51, SD=12.47). There was no significant difference between the average scores of body satisfaction at T0 and T2 (t (30)=1.065, P>0.05). In total, 19.3 % of participants have severe anxiety and 4.3 % severe depression. The mean scores of anxiety at T0, T1 and T2 were not significantly different (F (2,58)=1.163, P>0.05). Temporary stoma had an impact also depression (F (2.60)=6.935, P<0.01) who persist after reversal stoma. The mean score of depression at T0 (M=2.94, SD=2.5) was significantly lower than the mean score of depression at T1 (M=5.14, SD=3.15) and at T2 (M=4.14, SD=3.07). Finally, body satisfaction was negatively correlated with anxiety and depression at T0 and T2 (P<0.05). ConclusionsCancer remains the second leading cause of death in our advanced societies. In France and oncology, patients's psychological distress would be undervalued and insufficiently supported. That is why we focused on this variable and also on body image from a target population, yet little studied: patients with rectal cancer and temporary ostomy. With advances in recent years in the treatment of rectal cancer, sphincter preservation becomes more systematic, to the detriment of the final stoma, but it involves the implementation of a temporary ostomy. As we have seen, surgical treatment with temporary stoma for rectal cancer appears to have psychological repercussions. In a society where the fashion and advertising standards valuing a beautiful body hurt the ostomate person where their suffering is often ignored and little discussed, it seems essential and necessary to set up psychological counseling and measure its effectiveness.