Originally published as JCO Early Release 10.1200/JCO.2008.20.9502 on August 31 2009

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Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex

Robert S. Krouse, Lisa J. Herrinton, Marcia Grant, Christopher S. Wendel, Sylvan B. Green, M. Jane Mohler, Carol M. Baldwin, Carmit K. McMullen, Susan M. Rawl, Eric Matayoshi, Stephen Joel Coons, Mark C. Hornbrook

From the Southern Arizona Veterans Affairs Health Care System; University of Arizona College of Medicine; Arizona Cancer Center; University of Arizona College of Public Health; University of Arizona College of Pharmacy, Tucson; Arizona State University College of Nursing & Health Innovation, Phoenix, AZ; Kaiser Permanente Division of Research, Oakland; City of Hope National Medical Center, Department of Nursing Research and Education, Duarte, CA; Kaiser Permanente Center for Health Research-Northwest, Portland, OR; Kaiser Permanente Center for Health Research-Hawaii; Moanalua Medical, Honolulu, HI; and Indiana University School of Nursing, Indianapolis, IN.

Corresponding author: Robert S. Krouse, MD, FACS, Southern Arizona VA Health Care System, Surgical Care Line, 2-112, 3601 S 6th Ave, Tucson, AZ 85723; email: robert.krouse{at}va.gov.

Purpose Intestinal stomas can pose significant challenges for long-term ( 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL).

Patients and Methods This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status.

Results Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (< age 75 years), ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores.

Conclusion Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

Deceased.

Supported by National Cancer Institute Grant No. R01 CA106912, by an unrestricted donation from the Sun Capital Foundation, and by Arizona Cancer Center Support Grant No. CA023074. Resources and facilities were provided at the Southern Arizona Veterans Affairs Health Care System, Tucson, AZ.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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