title: Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy?
abstract: OBJECTIVE
  This study was designed to evaluate possible social and geographic factors that could have an impact on quality of life in patients after abdominoperineal excision of the rectum. Although the number of patients with rectal cancer who need to be treated with abdominoperineal excision of the rectum and construction of permanent colostomy has greatly decreased in the past, there is still controversy about the influence on quality of life caused by this procedure.
  
  
  METHODS
  In a prospective trial, patients operated on for low rectal cancer by abdominoperineal excision of the rectum were evaluated by a quality of life questionnaire, modified from The American Society of Colon and Rectal Surgeons questionnaire, to assess fecal incontinence. The results for the four domains of quality of life (lifestyle, coping behavior, embarrassment, depression), as well as for subjective general health, were evaluated with regard to age, gender, education, and geographic origin in univariate and multivariate analyses.
  
  
  RESULTS
  Thirteen institutions in 11 countries included data from 257 patients. Although the analysis of general health did not reveal any significant differences, the analysis of the four quality of life domains showed the significant influence of geographic origin. The presence of a permanent colostomy showed a consistently negative impact on patients in southern Europe as well as for patients of Arabic (Islamic) origin. On the other hand, age, gender, and educational status did not reveal a statistically significant influence.
  
  
  CONCLUSIONS
  This is the first study to show the influence of geographic origin on quality of life of patients with a permanent colostomy. Possible factors that may influence the outcome of patients after surgical treatment of rectal cancer, such as weather, religion, or culture, should be taken into account when quality of life evaluations are considered.
authors.affiliation: Department of Surgery, Ludwig Boltzmann Research Institute for Surgical Oncology, Danube Hospital, Vienna, Austria.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Holzer
authors.forename: Klaus
authors.initials: K
authors.lastname: Matzel
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiedeck
authors.forename: Jon
authors.initials: J
authors.lastname: Christiansen
authors.forename: Peter
authors.initials: P
authors.lastname: Christensen
authors.forename: Josep
authors.initials: J
authors.lastname: Rius
authors.forename: Piotr
authors.initials: P
authors.lastname: Richter
authors.forename: Paul Antoine
authors.initials: PA
authors.lastname: Lehur
authors.forename: Alessandra
authors.initials: A
authors.lastname: Masin
authors.forename: Mehmet Ayhan
authors.initials: MA
authors.lastname: Kuzu
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hussein
authors.forename: Tom
authors.initials: T
authors.lastname: Oresland
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Harald Rainer
authors.initials: HR
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy / Q000523:psychology*; D003466:Cultural Characteristics; D004493:Education; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000523:psychology* / Q000601:surgery