title: Quality of life of older rectal cancer patients is not impaired by a permanent stoma.
abstract: BACKGROUND
  The current study was undertaken to investigate the impact of a stoma on the HRQL with a special focus on age.
  
  
  METHODS
  Using the Eindhoven Cancer Registry, rectal cancer patients diagnosed between 1998 and 2007 in 4 hospitals were identified. All patients underwent TME surgery. Survivors were approached to complete the SF-36 and EORTC QLQ-C38 questionnaires. HRQL scores of the four groups, stratified by stoma status (stoma/no stoma) and age at operation (<70 and ≥ 70), were compared. The SF-36 and the QLQ-CR38 sexuality subscale scores of the survivors were compared with an age- and sex-matched Dutch norm population.
  
  
  RESULTS
  Median follow-up of 143 patients was 3.4 years. Elderly had significantly worse physical function (p = 0.0003) compared to younger patients. Elderly (p = 0.005) and patients without a stoma (p = 0.009) had worse sexual functioning compared to younger patients and patients with a stoma. Older males showed more sexual dysfunction (p = 0.01) when compared to younger males. In comparison with the normative population, elderly with a stoma had worse physical function (p < 0.01), but slightly better mental health (p < 0.05). Elderly without a stoma had better emotional role function (p < 0.01), and younger patients had worse sexual functioning and enjoyment (both p < 0.0001).
  
  
  CONCLUSIONS
  Older patients with a stoma have comparable HRQL to older patients without a stoma or the normative population, indicating the feasibility of a permanent stoma for elderly patients with a low situated rectal carcinoma. The negative impact of treatment on sexual functioning as found in the current study calls for further attention to alleviate this problem in sexually active patients.
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Ricardo.orsini@catharina-ziekenhuis.nl
authors.forename: R G
authors.initials: RG
authors.lastname: Orsini
authors.forename: M S Y
authors.initials: MS
authors.lastname: Thong
authors.forename: L V
authors.initials: LV
authors.lastname: van de Poll-Franse
authors.forename: G D
authors.initials: GD
authors.lastname: Slooter
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.forename: I H J T
authors.initials: IH
authors.lastname: de Hingh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000523:psychology; D016022:Case-Control Studies; D003125:Colostomy / Q000009:adverse effects* / Q000523:psychology; D015897:Comorbidity; D004766:Enterostomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000209:etiology; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires