title: Quality of life in patients with a permanent stoma after rectal cancer surgery.
abstract: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.
  
  
  
  711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.
  
  
  
  336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.
  
  
  
  Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.
authors.affiliation: Department of Surgery, Sunderby Hospital/Umeå University, 97180, Luleå, Sweden. pia.nasvall@nll.se.|Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. pia.nasvall@nll.se.
authors.forename: Pia
authors.identifier: 0000-0002-6248-1212
authors.initials: P
authors.lastname: Näsvall
authors.affiliation: Department of Clinical Sciences, Intervention and Technology, CLINITEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Ursula
authors.initials: U
authors.lastname: Dahlstrand
authors.affiliation: Department of Clinical Sciences, Intervention and Technology, CLINITEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Thyra
authors.initials: T
authors.lastname: Löwenmark
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Rutegård
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Strigård
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image / Q000523:psychology*; D003125:Colostomy / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D018434:Sickness Impact Profile; D054047:Surgical Stomas / Q000502:physiology*; D011795:Surveys and Questionnaires
keywords: HRQoL; Hernia; Parastomal; Rectal cancer; Stoma