Coping strategies and considerations regarding low anterior resection syndrome and quality of life among patients with rectal cancer; a qualitative interview study

Abstract

IntroductionLow anterior resection syndrome (LARS) is defined as disordered bowel function following rectal resection, which is detrimental to quality of life (QoL). A recent international consensus definition of LARS stresses the importance of focusing on both the symptoms and the consequences that the symptoms have for the individual patient as studies indicate that LARS has a negative impact on patients’ QoL. However, an ongoing PROM study investigating late sequelae after rectal cancer finds that a minor proportion of patients scoring major LARS experience none or only little impact on quality of lifeAimThe aim of this study was to identify patients’ considerations and coping strategies to establish why the burden caused by major LARS had little or no influence on their QoL.Materials and methodsThis was a qualitative interview study based on 21 semi-structured individual telephone interviews with patients treated for rectal cancer. Data were analysed using a hermeneutic inspired thematic analysis.Results and conclusionThree themes emerged from the analysis; Adapting new life situation, Altering life perception and the Importance of relationships. Major LARS and its consequences following rectal cancer may be managed or altered by adopting problem-focused and emotion-focused coping strategies. Maintaining a positive attitude and having a good network of family and friends constitute a surplus, allowing patients to cope with the need for changed behaviour and appreciate the life that they have been given. Accepting that major LARS and its consequences cause limitations in life allowed patients to change their normality threshold over time.

Patients’ experiences of living with low anterior resection syndrome three to six months after colorectal cancer surgery: A phenomenological study

“…Our participants also expressed desire to join peer support groups, as meeting someone with the same challenges was viewed as useful. These findings are consistent with others [ 17 , 30 ], who reported adaption to LARS by being open about the condition and by getting support from their social environment. Our findings are important because our patients are reporting these coping strategies already three to six months after colorectal surgery, as opposed to one- and three years later [ 15 , 17 , 30 ].…”

“…These findings are consistent with others [ 17 , 30 ], who reported adaption to LARS by being open about the condition and by getting support from their social environment. Our findings are important because our patients are reporting these coping strategies already three to six months after colorectal surgery, as opposed to one- and three years later [ 15 , 17 , 30 ]. This information is valuable for healthcare providers wanting to provide support for patients experiencing major LARS and for their relatives.…”

Care of Post-Operative Altered Bowel Function in Colorectal Cancer Patients

“…Although management of low anterior resection syndrome remains equivocal, some strategies are mentioned [5,[29][30][31][32][33][34]. The strategies involve in three options: self-care strategies, clinician-initiated interventions, and creating a permanent stoma [29][30][31]35].…”

“…In the population, rectal cancer patients had worse long-term quality of life than colon cancer patients, which may relate to severer bowel dysfunction after they received anal-saving surgery [2,4]. Improving the dysfunction in rectal cancer patients may effectively promote the quality of life in colorectal cancer patients [5]. The postoperative altered bowel function in rectal cancer patients with anal-saving surgery was named low anterior resection syndrome [6,7].…”

The effect of implementing a transanal minimally invasive surgical programme for the local excision of early rectal neoplasia on outcomes in a tertiary referral rectal cancer centre

“…Despite providing effective local tumour control, proctectomy with TME is associated with a 3% mortality risk, and the prospect of considerable functional morbidity [3]. Survivors of rectal cancer, are often troubled by a myriad of symptoms including bowel, bladder and sexual dysfunction, all of which can significantly affect quality of life (QOL) [4][5][6].…”