Understanding the impact of bowel function on quality of life after rectal cancer surgery

• Published in: Canadian Journal of Surgery 2022-11, Vol.65, p.S79-S79
• Main Authors: Maalouf, Michael Fares, Robitaille, Stephan, Penta, Ruxandra, Pook, Makena, Fiore, Julio Flavio, Feldman, Liane, Lee, Lawrence
• Format: Article
• Language: English
• Subjects: Cancer surgery; Colorectal cancer; Interviews; Patients; Quality of life
• ISSN: 0008-428X; 1488-2310

Background: Bowel dysfunction is an important consequence of rectal cancer surgery; however, the specific quality of life (QoL) domains that are affected remain unaddressed by generic surveys. This study aims to identify QoL domains most affected by rectal cancer surgery. Methods: Adult patients who underwent sphincter-preserving rectal cancer surgery at a single universityaffiliated colorectal referral centre between July 2017 and July 2020 were included. Patients were excluded if their surgery was less than 1 year since recruitment or they developed local recurrence or metastasis. Semistructured interviews were conducted by phone. Patients were asked to identify QoL domains most affected by symptoms. Bowel dysfunction was evaluated via the low anterior resection syndrome (LARS) score. Interviews were coded by 2 independent reviewers. Mixed-methods analysis was used to identify themes and their frequency of occurrence. Results: A total of 54 patient interviews were analyzed. Mean time to interview was 49.5 ± 32.6 months, mean age was 63.7 ± 8.6 years, and 75.9% were male. The proportion of patients with no, minor, and major LARS was 38.9%, 22.2%, and 38.9%, respectively. Interview analysis revealed 5 QoL-related themes impacted by bowel function: 1) experiencing psychological and emotional stress, 2) challenging roles and relationships within society, 3) encountering physical limitations, 4) restricting leisure and recreational activities, and 5) self-empowerment and adapting to change. Patients with minor or major LARS had significantly more disruption to social activities and role as a sexual partner than those with no LARS. Patients with major LARS were significantly more likely to report sleep disturbances than those with no and minor LARS. Conclusion: The impact of bowel dysfunction on QoL after rectal cancer surgery extends beyond traditional QoL measures and varies significantly with LARS score. These results may help support patients in the preoperative setting and contribute to the development of a patient-centred rectal cancer QoL survey.