title: Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery.
abstract: For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.
authors.affiliation: Senior Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.affiliation: Senior Consultant, Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.affiliation: Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.affiliation: Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Bulkley
authors.affiliation: Chief Scientist, Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.affiliation: Assistant Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.affiliation: Research Instructor, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wendel
authors.affiliation: Distinguished Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.affiliation: Professor Emerita and Southwest Borderlands Scholar, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Baldwin
authors.affiliation: Professor and Webb Endowed Chair of Nutrition Sciences, Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
authors.affiliation: Colorectal Surgical Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Larissa K F
authors.initials: LK
authors.lastname: Temple
authors.affiliation: Staff General and Oncologic Surgeon, Professor of Surgery, Southern Arizona Veterans Affairs Health Care System and University of Arizona College of Medicine, Tucson, AZ.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Krouse
mesh_terms: D001003:Anal Canal; D003082:Colectomy / Q000379:methods / Q000523:psychology*; D006801:Humans; D059351:Organ Sparing Treatments / Q000523:psychology*; D010030:Ostomy / Q000379:methods / Q000523:psychology*; D057240:Patient Preference; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000523:psychology* / Q000601:surgery*
keywords: anastomosis; cancer survivors; health communication; ostomy; patient-centered care; quality of life; rectal cancer