Greatest challenges of rectal cancer survivors

Results of a population-based survey

Carmit K. McMullen, Joanna E. Bulkley, Andrea Altschuler, Christopher S Wendel, Marcia Grant, Mark C. Hornbrook, Virginia Sun, Robert S Krouse

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Eliciting the priorities of cancer survivors is essential to address the specific needs of cancer survivor subgroups. OBJECTIVE: The purpose of this study was to describe the greatest challenges related to treatment for long-term rectal cancer survivors. DESIGN: This was an observational study with a cross-sectional survey. SETTINGS: The study included members of Kaiser Permanente Northern California and Northwest health plans. PATIENTS: A survey was mailed to long-term (≥5 years postdiagnosis) survivors of rectal cancer who had an anastomosis, temporary ostomy, or permanent ostomy. MAIN OUTCOME MEASURES: The main outcome was measured with an open-ended question about the greatest challenge related to cancer surgery. We categorized responses using a grounded theory approach with double coding for reliability. Bonferroni-adjusted χ 2 values were used to assess differences in the proportions of subgroups who mentioned challenges within each response category. RESULTS: The survey completion rate was 61% (577/953); 76% (440/577) of participants responded to the greatest challenge question. The greatest challenges for respondents were bowel/ostomy management (reported by 44%), negative psychosocial effects (37%), late effects of treatment (21%), comorbidities and aging (13%), postoperative recovery (5%), and negative healthcare experiences (5%). Survivors with temporary ostomy or anastomosis were more likely than survivors with permanent ostomy to report late effects (p < 0.0001 and p = 0.01). Survivors with anastomosis were less likely than survivors with permanent ostomy to report negative psychosocial impacts (p = 0.0001). LIMITATIONS: Generalizability is restricted by the lack of ethnically and racially diverse, uninsured (non-Medicare-eligible population), and non-English-speaking participants. Because the survey was cross-sectional and included respondents at different times since diagnosis, we could not adequately address changes in the greatest challenges over time. CONCLUSIONS: Our results reveal the need for bowel/ostomy management, psychosocial services, and surveillance for late effects in survivorship and supportive care services for all survivors of rectal cancer, regardless of ostomy status. The perspective of long-term survivors with anastomosis reveals challenges that may not be anticipated during decision making for treatment (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A254).

Original languageEnglish (US)
Pages (from-to)1019-1027
Number of pages9
JournalDiseases of the Colon and Rectum
Volume59
Issue number11
DOIs
StatePublished - Nov 1 2016

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Ostomy
Rectal Neoplasms
Survivors
Population
Cross-Sectional Studies
Neoplasms
Surveys and Questionnaires
Observational Studies
Comorbidity
Decision Making
Therapeutics
Survival Rate
Delivery of Health Care

Keywords

  • Patient-centered outcomes
  • Rectal cancer
  • Survey
  • Survivors
  • Unmet needs

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Greatest challenges of rectal cancer survivors : Results of a population-based survey. / McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Wendel, Christopher S; Grant, Marcia; Hornbrook, Mark C.; Sun, Virginia; Krouse, Robert S.

In: Diseases of the Colon and Rectum, Vol. 59, No. 11, 01.11.2016, p. 1019-1027.

Research output: Contribution to journalArticle

McMullen, Carmit K. ; Bulkley, Joanna E. ; Altschuler, Andrea ; Wendel, Christopher S ; Grant, Marcia ; Hornbrook, Mark C. ; Sun, Virginia ; Krouse, Robert S. / Greatest challenges of rectal cancer survivors : Results of a population-based survey. In: Diseases of the Colon and Rectum. 2016 ; Vol. 59, No. 11. pp. 1019-1027.
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