Bowel Function Instrument Research Articles

Impact of Bowel Function, Anxiety and Depression on Quality of Life in Patients with Sphincter-preserving Resection for Rectal Cancer

This study was a descriptive survey research to identify the impact of bowel function, anxiety and depression on quality of life in patients with rectal cancer who had a sphincter-preserving resection. Participants were 100 patients who had rectal cancer surgery at W hospital in Korea. Bowel function, anxiety & depression, and quality of life were measured using the BFI (Bowel Function Instrument), HADS (Hospital Anxiety-Depression Scale) and the FACT-C (Functional Assessment of Cancer Therapy-Colorectal). The mean scores were 39.81±5.16 for bowel function, 6.15±3.25 for anxiety, 7.24±3.13 for depression, and 72.50±13.27 for quality of life. There were significant negative correlations between quality of life and anxiety (r=-.59, p<.001) and between quality of life and depression (r=-.53, p<.001). But the correlation between quality of life and bowel function was significantly positive (r=.22, p=.025). The influence of the independent variables on the total quality of life was examined using multiple regression analysis. Anxiety (β=-.38, p=.002), bowel function (β=-.25, p=.028) and occupation (β=.16, p=.048) were identified as factors affecting quality of life. The explanation power of this regression model was 44% and it was statistically significant (F=16.53, p<.001). The results of this study indicate that in order to improve the bowel function of patients after sphincter-preserving resection for rectal cancer, effective nursing interventions should be developed. As psychological problem such as anxiety and depression can relate to quality of life for these patients, nurses should work on improving the situation by providing continuous emotional nursing.

O1-4-6 - A Systematic Review of Measurement Properties of Quality of Life Instruments Used in Patients with Colorectal Cancer

Background: To critically appraise the measurement properties of standardized health-related quality of life (HRQOL) instruments for colorectal cancer (CRC) patients, and to provide recommendations on the use of HRQOL instrument through collective evidence from previous studies.Materials: Systematic review of English-language literature published between January 1985 and December 2011 was conducted through the database search of Pubmed, Web of Science, Embase, and OVID Medline. Methodological quality of each eligible study and overall levels of evidence per measurement property and per HRQOL instrument were rated using a COSMIN checklist.Results: Thirty-nine studies reporting 27 standardized HRQOL instruments for CRC patients were identified. Methodological quality of hypothesis testing and internal consistency was evaluated most frequently. The Functional Assessment of Cancer Therapy-Colorectal (FACT-C) in Functional Assessment of Chronic Illness Therapy (FACIT) was the most extensively evaluated in eight out of nine measurement properties. The highest number of positive sign in the overall level of evidence was obtained in the colorectal cancer-specific quality of life questionnaire module (QLQ-CR38) in European Organisation for Research and Treatment of Cancer (EORTC) module, the FACT-C in FACIT module, Quick-FLIC and MSKCC Bowel Function instruments.Conclusion: For clinical use, the FACT-C was suggested to assess HRQOL in patients with CRC regardless of disease stage whereas the measurement property of MSKCC Bowel Function instrument was satisfactory in measuring HRQOL in rectal cancer patients. To facilitate the proper access to the overall level of evidence of HRQOL instruments, this review emphasized the need for high-quality and standard reporting of measurement properties of the existing and newly-developed HRQOL instruments for CRC patients.

Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery: a prospective study using the Memorial Sloan Kettering Cancer Center bowel function instrument.

Until recently, no studies have prospectively evaluated bowel function after sphincter-preserving surgery for rectal cancer with the use of a validated bowel function scoring system. The aim of this study was to investigate possible risk factors for altered bowel function after sphincter-preserving surgery. This was a prospective study. The study was conducted between January 2006 and May 2012 at the authors' institution. Patients who underwent sphincter-preserving rectal cancer surgery were recruited. Bowel function was assessed 1 day before (baseline) and at 1 year after sphincter-preserving surgery or temporary ileostomy takedown with the use of the Memorial Sloan Kettering Cancer Center questionnaire. Multivariable analysis was performed to identify the factors associated with altered bowel function after surgery. Overall, 266 patients were eligible for the analysis. The tumor was located in the upper, middle, and lower rectum in 68 (25.5%), 113 (42.5%), and 85 (32.0%) patients. Intersphincteric resection and temporary ileostomy were performed in 18 (6.8%) and 129 (48.5%) patients. The mean Memorial Sloan Kettering Cancer Center score was 64.5 ± 7.6 at 1 year after sphincter-preserving surgery or temporary ileostomy takedown. The Memorial Sloan Kettering Cancer Center score decreased in 163/266 patients (61.3%) between baseline and 1 year after surgery. Tumor location (p = 0.01), operative method (p = 0.03), anastomotic type (p = 0.01), and temporary ileostomy (p = 0.01) were associated with altered bowel function after sphincter-preserving surgery in univariate analyses. In multivariable analysis, only tumor location was independently associated with impaired bowel function after sphincter-preserving rectal cancer surgery. This study was limited by its nonrandomized design and the lack of measurement before preoperative chemoradiotherapy. We suggest that preoperative counseling should be implemented to inform patients of the risk of bowel dysfunction, especially in patients with lower rectal cancer, although this study cannot exclude the effect of chemoradiotherapy owing to the limitation of study.

PRM115 - Is between-mode equivalence comparable to test-retest reliability for patient-reported outcome (PRO) measures: A test case of web versus IVRS versus paper for the MSKCC bowel function instrument and LASA QOL

PRM115 - Is between-mode equivalence comparable to test-retest reliability for patient-reported outcome (PRO) measures: A test case of web versus IVRS versus paper for the MSKCC bowel function instrument and LASA QOL

Sigmoidectomy Syndrome? Patients' Perspectives on the Functional Outcomes Following Surgery for Diverticulitis

Bowel function following surgery for diverticulitis has not previously been systematically described. This study aimed to document the frequency, severity, and predictors of suboptimal bowel function in patients who have undergone sigmoid colectomy for diverticulitis. This study is a retrospective analysis. This study was conducted at a large, academic medical center. Three hundred twenty-five patients who underwent laparoscopic or open sigmoid colectomy with restoration of intestinal continuity for diverticulitis were included in the study population. Of these, 249 patients (76.6%) returned a 70-question survey incorporating the Fecal Incontinence Severity Index, the Fecal Incontinence Quality of Life Scale, and the Memorial Bowel Function Instrument. Survey responders and nonresponders were compared with the use of χ and t tests. Responders with suboptimal bowel function (fecal incontinence, urgency and/or incomplete emptying) were then compared with those with good outcomes by the use of logistic regression analysis to determine the predictors of poor function. Of the responders, 24.8% reported clinically relevant fecal incontinence (Fecal Incontinence Severity Index ≥ 24), 19.6% reported fecal urgency (Memorial Bowel Function Instrument Urgency Subscale ≥ 4), and 20.8% reported incomplete emptying (Memorial Bowel Function Instrument Emptying Subscale ≥ 4). On logistic regression analysis, fecal incontinence was predicted by female sex (OR = 2.3, p = 0.008) and the presence of a preoperative abscess (OR = 1.4, p < 0.05). Fecal urgency was associated with female sex (OR = 1.3, p < 0.05) and a diverting ileostomy (OR = 2.1, p < 0.001). Incomplete emptying was associated with female sex (OR = 1.4, p < 0.05) and postoperative sepsis (OR = 1.9, p < 0.05). This study was limited by the fact that we did not use a nondiverticulitis control group and we had limited preoperative data on the history of bowel impairment symptoms. One-fifth of patients reported fecal urgency, fecal incontinence, or incomplete emptying after surgery for diverticulitis. Despite the limitations of our study, these results are concerning and should be investigated further prospectively.

Validity and reliability of the MSKCC Bowel Function instrument in a sample of Italian rectal cancer patients

Aims The purpose of this study was to translate the Memorial Sloan Kettering Cancer Centre (MSKCC) Bowel Function Instrument into Italian and to test its psychometric validity and reliability in a sample of Italian rectal cancer patients. Methods The MSKCC questionnaire was translated into Italian using a standard procedure of double-back translation. Construct validity was tested using a factor analysis and internal reliability was estimated using the Cronbach’s alpha coefficient. Concurrent validity was determined by correlations with European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 quality of life scales. A non-parametric analysis of variance was used to establish the discriminant validity of the questionnaire. Test-retest reliability was assessed using the intra-class correlation coefficient. Results 124 rectal cancer patients participated in the validation study. The number of missing items was 2.2%. The factorial structure was found to be quite similar to the original one and the internal reliability was 0.7 for urgency, 0.6 for frequency, and 0.7 for dietary subscale. The test-retest reliability was acceptable with one exception: the dietary subscale showed a low reproducibility (ICC = 0.4). All three subscales showed a significant correlation with the QLQ-C30 and QLQ-CR38 domains and were able to discriminate several groups of clinical relevance. Conclusions The Italian version of the MSKCC Bowel Function Instrument shows acceptable psychometric properties and can be considered a valuable and specific instrument to assess bowel functions in rectal cancer patients, both for research purposes and in clinical practise.

Bowel dysfunction after sphincter-preserving surgery.

3657 Background: Alterations in bowel function following sphincter-preserving surgery (SPS) for rectal cancer have not been well studied, limiting our ability to effectively counsel patients regarding appropriate surgery. Methods: A prospective single-institution longitudinal study of stage I-III rectal cancer patients undergoing SPS was performed from 1/07-7/09. Patients completed the validated MSKCC Bowel Function Instrument (BFI) and EORTC-QOL30/38. Comparisons between preoperative and 6 month responses were made using paired t test; predictors of 6 month bowel function were assessed with t test. Results: 91 of 117 (78%) rectal cancer patients completed surveys preoperatively and 6 months post restoration of bowel continuity (Table). Significant dysfunction at 6 months was reported; >57% reported >4 bowel movements/day. 15 of 18 BFI items were reported in >75% of patients, many severe. 80% reported altering their activities to compensate for bowel dysfunction. Compared to preoperative scores, 6 month scores were worse on all BFI subscales (frequency (p=0.003), urgency (p<0.001), dietary (p<0.001)), EORTC-CRC38 GI subscale (p=0.002) and total BFI score (p<0.001). Predictors of poor function included male gender, radiation, low tumor, hand-sewn anastomosis (Table). Conclusions: Post SPS bowel function is significantly worse 6 months after restoration of bowel continuity, and is associated with patient and treatment factors. Longer follow-up of this cohort will provide better assessment of long-term bowel function after SPS, enabling us to better counsel rectal cancer patients preoperatively. N 6-mo BFI total score (range 14-70) p Gender Male 55 51 (31-66) 0.016 Female 36 47 (28-64) Median age 54 (25-85) <55 47 (28-66) ≥55 48 (34-65) 0.79 Pre-op atage I/II 30 N/A III 61 Median level of tumor from anal verge (cm) 8 (1-16) <8 cm 46 (28-65) ≥8 cm 48 (37-66) 0.022 Pre-op therapy No RT (18 CT only) 39 50 (36-66) 0.006 Combined CT/RT 52 48 (28-64) Surgery LAR 26 48 (37-66) 0.30 LAR/CAA 63 48 (28-65) TAE 2 Too small LAR and LAR/CAA No. pouch vs straight 20 vs. 59 51 (28-65) vs. 48 (31-66) 0.07 No. hand sewn vs. stapled 24 vs. 65 45 (31-64) vs. 50 (28-66) 0.003 Temp stoma vs. no stoma 67 vs. 24 47 (29-65) vs. 51 (37-66) 0.09 No significant financial relationships to disclose.

Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer

Background Short-course preoperative radiotherapy and total mesorectal excision have decreased local recurrence rates from rectal cancer. However, the effect of this radiotherapy on bowel function and quality of life in these patients is not well understood. Methods Between 1999 and 2004, 34 patients underwent low anterior resection and either short-course preoperative radiation (N = 24) or surgery alone (N = 10). Quality of life and bowel function were assessed using validated instruments: European Organization of Research and Treatment of Cancer Quality of Life questionnaires, Fecal Incontinence Quality of Life Scale, and the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument. Results Patients treated with preoperative radiation had higher rates of fecal incontinence and showed a strong trend toward lower global quality-of-life scores. In addition, there was a trend toward worse bowel function in these patients. Conclusions Patients treated with short-course preoperative radiotherapy had worse continence-related quality of life than patients treated with surgery alone for rectal cancer. Fecal incontinence has a negative effect on quality of life in these patients, causing difficulty with coping, lifestyle, and depression, and limiting daily activities. Validated instruments provide standardized assessment of bowel function and quality of life.

Development of the MSKCC Bowel Function Instrument: Summary of Research Funded by the American Society of Colon and Rectal Surgery Research FoundationLimited Project Grant #070

Development of the MSKCC Bowel Function Instrument: Summary of Research Funded by the American Society of Colon and Rectal Surgery Research FoundationLimited Project Grant #070