Conversations for providers caring for patients with rectal cancer: Comparison of long‐term patient‐centered outcomes for patients with low rectal cancer facing ostomy or sphincter‐sparing surgery

Abstract

For some low rectal cancer patients, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients eligible for sphincter-sparing surgery may not be well served by the surgery and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries, or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects following the two surgeries has not been synthesized. We therefore conducted a systematic review to examine this ? This systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. Our goals are: 1) improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) increase the patient’s participation in the decision; (3) alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, improve patients’ long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery, as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient.

Effect of Neoadjuvant Therapy and Rectal Surgery on Health-related Quality of Life in Patients With Rectal Cancer During the First 2 Years After Diagnosis

“…In addition, patient performance status, predicted bowel function and continence, and personal preference play important roles in the decision process. 9 Often a LAR procedure is preferred because of the preserved rectal function and avoidance of a permanent stoma. Nonetheless, LAR has been associated with a substantial risk of acute and chronic anastomotic complications 10 and long-term bowel dysfunction.…”

“…15 It is therefore essential to inform patients of the treatment-related risks and the effect of treatment on QOL to manage patients' expectations and to allow for shared decisionmaking. 9 The QOL of rectal cancer patients has been reported previously but often using a cross-sectional study design, without a reference population or without pretreatment measurements. [16][17][18] In the present longitudinal study, we have described the trends in QOL of patients with rectal cancer to evaluate the effect of neoadjuvant therapy and rectal surgery in the first 2 years after the start of treatment.…”

Physical activity, bowel function, and quality of life among rectal cancer survivors

“…Despite the many benefits of PA, RC survivors often suffer many long-term and late effects of their treatments [2, 23] which may pose barriers to engaging in PA. Examples of problems that can inhibit PA include hernia [24], skin problems [24], fistula [3], neuropathy [25, 26], and pain [26]. Other barriers to PA may include fear of stool leakage, having an ostomy, and persistent fatigue [27].…”

Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis

“…13 Information about long-term outcomes is important for the primary care providers who manage long-term cancer survivor’s health care as well. 13 …”