Virginia Sun1, Marcia Grant2, Christopher S Wendel3, Carmit K McMullen4, Joanna E Bulkley4, Andrea Altschuler5, Michelle Ramirez6, Carol M Baldwin7, Lisa J Herrinton5, Mark C Hornbrook4, Robert S Krouse3. 1. Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA, USA. vsun@coh.org. 2. Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA, USA. 3. Southern Arizona Veterans Affairs Health Care System, University of Arizona College of Medicine, Tucson, AZ, USA. 4. The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. 5. Kaiser Permanente Medical Care Program, Oakland, CA, USA. 6. University of the Sciences, Philadelphia, PA, USA. 7. Arizona State University College of Nursing & Health Innovation, Phoenix, AZ, USA.
Abstract
BACKGROUND: Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS: This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS: CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS: CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.
BACKGROUND:Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS: This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS: CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS: CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.
Authors: David J Horner; Christopher S Wendel; Raymond Skeps; Susan M Rawl; Marcia Grant; C Max Schmidt; Clifford Y Ko; Robert S Krouse Journal: Am J Surg Date: 2010-11 Impact factor: 2.565
Authors: Marcia Grant; Carmit K McMullen; Andrea Altschuler; M Jane Mohler; Mark C Hornbrook; Lisa J Herrinton; Christopher S Wendel; Carol M Baldwin; Robert S Krouse Journal: Oncol Nurs Forum Date: 2011-09 Impact factor: 2.172
Authors: Virginia Sun; Marcia Grant; Carmit K McMullen; Andrea Altschuler; M Jane Mohler; Mark C Hornbrook; Lisa J Herrinton; Carol M Baldwin; Robert S Krouse Journal: J Wound Ostomy Continence Nurs Date: 2013 Jan-Feb Impact factor: 1.741
Authors: Virginia Sun; Christopher S Wendel; Wendy Demark-Wahnefried; Marcia Grant; Carmit K McMullen; Joanna E Bulkley; Lisa J Herrinton; Mark C Hornbrook; Robert S Krouse Journal: Nutr Cancer Date: 2018-12-20 Impact factor: 2.900
Authors: Mubarika Alavi; Christopher S Wendel; Robert S Krouse; Larissa Temple; Mark C Hornbrook; Joanna E Bulkley; Carmit K McMullen; Marcia Grant; Lisa J Herrinton Journal: Ann Surg Oncol Date: 2017-08-07 Impact factor: 5.344
Authors: Mark C Hornbrook; Marcia Grant; Christopher Wendel; Joanna E Bulkley; Carmit K Mcmullen; Andrea Altschuler; Larissa Kf Temple; Lisa J Herrinton; Robert S Krouse Journal: Perm J Date: 2018
Authors: Virginia Sun; Tracy E Crane; Samantha D Slack; Angela Yung; Sarah Wright; Stephen Sentovich; Kurt Melstrom; Marwan Fakih; Robert S Krouse; Cynthia A Thomson Journal: Contemp Clin Trials Date: 2018-03-19 Impact factor: 2.226
Authors: F Al-Rashid; S Robitaille; A S Liberman; P Charlebois; B Stein; L S Feldman; J F Fiore; L Lee Journal: Tech Coloproctol Date: 2022-01-18 Impact factor: 3.781
Authors: Robert S Krouse; Christopher S Wendel; David O Garcia; Marcia Grant; Larissa K F Temple; Scott B Going; Mark C Hornbrook; Joanna E Bulkley; Carmit K McMullen; Lisa J Herrinton Journal: Qual Life Res Date: 2017-07-04 Impact factor: 4.147
Authors: Virginia Sun; Tracy E Crane; Kathryn B Arnold; Katherine Guthrie; Sarah Freylersythe; Christa Braun-Inglis; Lee Jones; Stacey A Cohen; Mazin Al-Kasspooles; Robert S Krouse; Cynthia A Thomson Journal: Contemp Clin Trials Commun Date: 2021-04-08