title: Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors.
abstract: BACKGROUND
  Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis.
  
  
  METHODS
  This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction.
  
  
  RESULTS
  CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use.
  
  
  CONCLUSIONS
  CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.
authors.affiliation: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA, USA. vsun@coh.org.
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.affiliation: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA, USA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.affiliation: Southern Arizona Veterans Affairs Health Care System, University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wendel
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Bulkley
authors.affiliation: Kaiser Permanente Medical Care Program, Oakland, CA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.affiliation: University of the Sciences, Philadelphia, PA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ramirez
authors.affiliation: Arizona State University College of Nursing & Health Innovation, Phoenix, AZ, USA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Baldwin
authors.affiliation: Kaiser Permanente Medical Care Program, Oakland, CA, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.affiliation: Southern Arizona Veterans Affairs Health Care System, University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Krouse
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery; D004032:Diet; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010030:Ostomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*