Abstract
Background: Some colorectal cancer (CRC) patients require a permanent ostomy (a surgically created opening on the exterior of the abdomen that allows feces to be eliminated from the body). An ostomy can create psychosocial distress and affect body image, sense of self, and sexual functioning. Few studies have examined health-related quality of life (HR-QOL) relevant to disturbed sleep of CRC survivors with ostomies; moreover, no studies have examined gender differences of ostomates on quality of sleep and fatigue.
Methods: HR-QOL was examined in this cross-sectional study of long-term (>5 years) CRC survivors with ostomies, who receive care at Kaiser Permanente health systems in California, Oregon, Washington, and Hawaii. Participants completed the City of Hope Quality of Life Ostomy questionnaire, which includes demographic and scaled items, and narrative comments for greatest challenges associated with having an ostomy. Two items, ‘fatigue’ and ‘sleep disruption’ (scale from 0 to 10), served as dependent variables. Age, ethnicity, education, partnered status, body mass index (BMI), and time since surgery were included in models. Data were analyzed using t-tests and ordinal logistic regression modeling with significance set at P<0.05.
Results: Women (n=118) compared to men (n=168) were less likely to be partnered (25% vs 55%, P<0.0001). There were no differences for age, ethnicity, education, BMI, or time since surgery. Regression modeling for fatigue showed women to have lower HR-QOL compared to men (0.65 decrease, P<0.01), adjusted for time since surgery (modest positive association, P<0.05). Regression modeling for sleep disruption also showed women to have poorer HR-QOL (0.57 decrease, P<0.01), adjusted for age (modest positive association, P<0.001). CRC surgical controls without ostomy showed no significant gender difference for either HR-QOL item. Qualitative narrative comments suggest sleep disruption is associated with fear of, or actual, leakage during hours of sleep.
Conclusions: Women CRC survivors with ostomies report more fatigue and sleep disruption that may contribute to poorer HR-QOL compared to their male counterparts. Higher rates of fatigue for women are consistent with gender differences in other health conditions. These findings can provide a foundation for gender-specific ostomy interventions to improve sleep quality.
- Received September 11, 2008.
