Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy?
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.
Holzer
Brigitte
B
Department of Surgery, Ludwig Boltzmann Research Institute for Surgical Oncology, Danube Hospital, Vienna, Austria.
Matzel
Klaus
K
Schiedeck
Thomas
T
Christiansen
Jon
J
Christensen
Peter
P
Rius
Josep
J
Richter
Piotr
P
Lehur
Paul Antoine
PA
Masin
Alessandra
A
Kuzu
Mehmet Ayhan
MA
Hussein
Ahmed
A
Oresland
Tom
T
Roche
Bruno
B
Rosen
Harald Rainer
HR
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