Abstract
Background/Aims Rectal cancer surgery includes a colostomy (or ileostomy) or, more frequently, anastomosis of the rectum. Both surgery types may create long-term after-effects. We examined differences reported between survivors with ostomies versus anastomoses regarding levels of work, volunteering, and financial burdens, and how much they perceived their cancer operations affected these experiences.
Methods We mailed questionnaires to 1,063 rectal cancer survivors (5+ years post-diagnosis) in Kaiser Permanente (Northern California, Northwest) during 2010–2011. We asked about current employment status and the impact of their cancers on labor force participation, demotions, job discrimination, forced retirement, volunteering, social activities, and marital status. Our overall response rate was 60.5% (578/955). We analyzed usable responses from 390 survivors with anastomoses (69%) and 178 survivors with ostomies (31%) for differences in self-reported functional health status, work, volunteer, and perceived financial burden.
Results Survivorship ranged from 5 to 25 years. Mean ages for both groups were significantly beyond retirement age (anastomoses = 72 years, colostomies = 74 years) (NS). 56% of patients with anastomoses were male compared to 66% of ostomates (P <0.03). About 35% of all survivors were not married or partnered at time of survey. Survivors with anastomoses were more likely to be currently working (FT+PT=33% (128/383)) than survivors with colostomies (FT+PT=20% (35/178)), while survivors with ostomies were more likely to be retired or homemakers (77% (137/178) vs. 64% (247/383) or on Disability (ostomies = 3.4% (6/178), anastomoses = 2.1% (8/383)) (P <0.01). Stage at diagnosis was not associated with employment or volunteer activities among survivors, but employed survivors had significantly shorter survivorship periods than non-working survivors (P <0.05). Compared to survivors with anastomoses, survivors with ostomies reported significantly higher perceived financial burden from their cancer and its treatment (P <0.001). Permanently disabled survivors reported even higher perceived financial burden than non-disabled survivors, with no differences by ostomy and anastomosis status.
Conclusions Compared to survivors with ostomies, survivors with anastomoses were more likely to report being currently employed/working in the home and having lesser financial burdens from their illness. Interventions are needed to support survivors with ostomies to participate in work and volunteer activities, to manage their personal finances, and to maintain their social networks and personal relationships.
