title: Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex.
abstract: OBJECTIVE
  Intestinal stomas can pose significant challenges for long-term (> or = 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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Southern Arizona Veterans Affairs Health Care System, Tucson, AZ 85723, USA. robert.krouse@va.gov
authors.forename: Robert S
authors.initials: RS
authors.lastname: Krouse
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wendel
authors.forename: Sylvan B
authors.initials: SB
authors.lastname: Green
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Mohler
authors.forename: Carol M
authors.initials: CM
authors.lastname: Baldwin
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rawl
authors.forename: Eric
authors.initials: E
authors.lastname: Matayoshi
authors.forename: Stephen Joel
authors.initials: SJ
authors.lastname: Coons
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000379:methods / Q000706:statistics & numerical data*; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000523:psychology / Q000601:surgery*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*