Does the impact of a colostomy on quality of life change with time? - Prospective evaluation in rectal cancer patients.

Abstract

Improved outcomes after treatment for rectal cancer (RC) have resulted in more long-term survivors, some with a permanent colostomy. The challenges associated with a stoma may impact health-related quality of life (HRQoL) and change over time. We report changes in stoma-related sequelae and HRQoL from a prospective follow-up program. Patients were included from a systematic late sequelae screening program using patient-reported outcome measures. Patients undergoing RC surgery with a permanent colostomy were included. Patients completed the colostomy impact (CI) score and EuroQol five-dimensional five-level (EQ-5D-5L) at 3, 12, 24 and 36 months after surgery. CI scores and mean EQ-5D-5L scores were compared, and multivariable regression analysis was performed to explore potential risk factors for major CI at 12 months. A total of 301 patients (34% female) were included, with a mean age of 71.2 years. Median CI scores, EQ-5D-5L index and EQ-5D-5L visual analogue scale scores remained unchanged. However, the distribution of the individual symptoms composing the CI score changed from 3 to 12 months, with more smell and leakage, more parastomal bulging and better self-care. Between 3 and 12 months, 27% of patients shifted CI category and around 20% of patients shifted category at 2 and 3 years post surgery. Logistic regression showed a significantly higher risk of major CI at 12 months in younger patients, patients with higher American Society of Anaesthesiologists scores, preoperative radiotherapy or postoperative complications. Stoma-related sequelae change during the first years after surgery. However, this is not reflected in CI Score or generic HRQoL.