Abstract
Background/Aims Rectal cancer (RC) 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 (O) versus anastomoses (A) regarding bowel function and self-care. This analysis highlights patient-reported changes in daily routines that helped their bowel function, as revealed by responses to a question about post-surgical changes other than diet, exercise, or use of supplements “(such as timing of eating, number of meals, or other changes to your daily routines) that have helped with your bowel function?”
Methods In 2010–2011, we mailed questionnaires to 1,063 long-term rectal cancer survivors (= 5 year’s post-diagnosis) from two Kaiser Permanente (KP) Regions, Northern California (KPNC) and Northwest (KPNW), who had undergone a major intra-abdominal operation as part of their cancer treatment. Potential participants (KP members age 18 years or older with tissue-verified RC diagnoses) were identified through an electronic search of each site’s computerized tumor registry. The overall response rate was 60.5% (577 respondents/953 eligible patients).
Results Survivorship ranged from 5 to 25 years. Mean age at time of survey was 72 years for anastomoses and 74 years for ostomies (P <0.03). About 56% of patients with anastomoses were male compared to 66% of ostomates (P <0.03). The most frequently mentioned strategies to help bowel function for both surgery types were: smaller meals (O = 26%, A = 33%; n = 13/30), regular time of meals (O = 26%, A = 9%; n = 13/8), and not eating dinner too late (O = 8%, A = 9%; n = 4/8). Patients with anastomoses mentioned the following additional strategies: grazing or multiple small meals/snacks (10%, n = 9), and not eating before activity (4%, n = 4). The most frequent bowel symptoms helped by these strategies were: predictability (52%, n = 73), gas (34%, n = 48), constipation (31%, n = 43), diarrhea (26%, n = 37), and bloating (23%, n = 32).
Conclusions Minimal differences were observed between ostomy/anastamosis survivors in bowel self-care strategies beyond diet, exercise, or use of supplements. Clinicians caring for RC survivors should be aware of these bowel self-management strategies both to offer as potential self-care practices and to understand whether these activities pose any risks to specific patients, given their comorbidity burdens and other health practices.
