Self-reported wellbeing and body image after abdominoperineal excision for rectal cancer.

Elisabeth González,Eva Angenete,Kajsa Holm,Eva Haglind,Berith Wennström

doi:10.1007/s00384-016-2628-0

Abstract

PurposePatients with low rectal cancer are often operated with an abdominoperineal excision (APE) rendering them a permanent stoma. The surgical procedure itself, the cancer diagnosis, and the permanent stoma might all affect quality of life. The aim of this study was to explore wellbeing and body image 3 years after APE in a population-based cohort of patients.MethodsAll patients with rectal cancer operated with an APE between 2007 and 2009 were identified using the Swedish ColoRectal Cancer Registry. A total of 545 patients answered a questionnaire 3 years after surgery. Two open-ended questions were analyzed with a mixed method design using both qualitative and quantitative content analysis. Main themes and sub-themes on wellbeing and body image were identified.ResultsThree main themes were identified: bodily limitations, mental suffering, and acceptance. Bodily limitations included other symptoms than stoma-related problems. A majority of patients expressed acceptance to their situation regardless of bodily limitations and mental suffering. However, 18 % did not describe any acceptance of their current situation.ConclusionsMost patients expressed acceptance reflecting wellbeing 3 years after APE for rectal cancer. There is, however, a subset of patients (18 %) who describe bodily limitations and mental suffering without acceptance and who require further support. Many aspects of the portrayed bodily limitations and mental suffering could be prevented or treated.Trial registrationNCT01296984.

Highlights

Rectal cancer is common and surgery with curative intent is the main treatment, sometimes with the addition of radiotherapy [1]
The surgical procedure itself is associated with morbidity that both in the short and long term may affect quality of life (QoL) [2, 3]
It is not fully known if the colostomy has a negative effect on quality of life and results have been divergent [4,5,6,7,8,9]

Summary

Introduction

Rectal cancer is common and surgery with curative intent is the main treatment, sometimes with the addition of (chemo) radiotherapy [1]. The surgical procedure itself is associated with morbidity that both in the short and long term may affect quality of life (QoL) [2, 3] It is not fully known if the colostomy has a negative effect on quality of life and results have been divergent [4,5,6,7,8,9]. We recently reported that most patients did not feel limited by their stoma 3 years after surgery [10]. This is supported by Feddern et al, but patients with symptoms from their stoma may have problems with acceptance [11]

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