Nurse‐led standardized intervention for low anterior resection syndrome. A population‐based pilot study

Abstract

Aim Our aim was to study the implementation of the low anterior resection syndrome (LARS) score in a clinical setting and to evaluate a nurse‐led standardized intervention for bowel dysfunction following rectal cancer surgery. Method All patients who underwent curatively intended, restorative rectal cancer resection in a single centre between 2012 and 2016 were screened using the LARS score. At clinical follow‐up, patients with major LARS were offered treatment in a nurse‐led clinic. Data were retrospectively collected from patients' electronic medical records. Results In total, 190 out of 286 (66%) patients were screened with the LARS score of whom 89 had major LARS. A total of 86 patients requested treatment for their bowel dysfunction and the majority obtained acceptable function after nurse‐led optimized conservative treatment. Seventeen patients went on to transanal irrigation, and seven patients were treated with biofeedback. Five patients were referred for surgery, three for gastroenterological evaluation. After treatment in the clinic, patients achieved a statistically significant decrease in median LARS score from 37 (interquartile range 34–39) to 31 (interquartile range 23–34) (P < 0.001), and the prevalence of major LARS fell from 95% to 53% (P < 0.001). Conclusion Screening for LARS was not optimal as one‐third of patients were not screened. The majority of patients with major LARS requested treatment for their symptoms and could be successfully treated with standardized interventions managed in a nurse‐led setting.

The Risk Factors of Low Anterior Resection Syndrome After Colorectal Cancer Surgery Compared with the Last Decade Studies

“…Every item has three options with a de ned scoring system used for evaluating the severity. The patients were divided into the no (0-20), minor (21)(22)(23)(24)(25)(26)(27)(28)(29), and major (30-42) LARS groups depending on their total score (Table 2). We used the Chinese version of the questionnaire.…”

“…However, this scoring system was not universally applicable and could not be widely used [1,16,24]. The second LARS scoring system is a veitem validated questionnaire created in 2012 for the Danish population that evaluates the bowel function after CRC surgery (Table 1) [5,25,26]. In recent years, this questionnaire has been used to evaluate LARS worldwide.…”

Long‐term gastrointestinal sequelae in colon cancer survivors: prospective pilot study on identification, the need for clinical evaluation and effects of treatment

“…Since April 2018, patients treated for colon cancer have prospectively received questionnaires 12, 24 and 36 months after surgery. At the time of initiation of the screening survey, patients who had undergone resection in the past 3 years (April 2015 to April 2018) were invited to participate when they reached one of the relevant time points (12,24, 36 months after surgery). The questionnaires were designed to screen patients for late complications of treatment for colon cancer and contained questions regarding bowel function and quality of life.…”

“…In the case of intractable symptoms, doctors evaluated patients for treatment with sacral nerve stimulation or a permanent stoma(Figure 1). The treatment algorithm is explained in more detail elsewhere[12].…”

Systematic screening for late sequelae after colorectal cancer—a feasibility study

“…In collaboration with the Clinic for Treatment of LS after Pelvic Organ Cancer at Aarhus and Aalborg University Hospitals, the study group developed a well-defined referral and treatment strategy for LS. The treatments offered are non-experimental standard treatments, some of which are described in detail elsewhere [33,34] All completed surveys were evaluated by a healthcare professional, i.e. a specialized nurse or a doctor.…”