title: Greatest Challenges of Rectal Cancer Survivors: Results of a Population-Based Survey.
abstract: BACKGROUND
  Eliciting the priorities of cancer survivors is essential to address the specific needs of cancer survivor subgroups.
  
  
  OBJECTIVE
  The purpose of this study was to describe the greatest challenges related to treatment for long-term rectal cancer survivors.
  
  
  METHODS
  This was an observational study with a cross-sectional survey.
  
  
  METHODS
  The study included members of Kaiser Permanente Northern California and Northwest health plans.
  
  
  METHODS
  A survey was mailed to long-term (≥5 years postdiagnosis) survivors of rectal cancer who had an anastomosis, temporary ostomy, or permanent ostomy.
  
  
  METHODS
  The main outcome was measured with an open-ended question about the greatest challenge related to cancer surgery. We categorized responses using a grounded theory approach with double coding for reliability. Bonferroni-adjusted χ values were used to assess differences in the proportions of subgroups who mentioned challenges within each response category.
  
  
  RESULTS
  The survey completion rate was 61% (577/953); 76% (440/577) of participants responded to the greatest challenge question. The greatest challenges for respondents were bowel/ostomy management (reported by 44%), negative psychosocial effects (37%), late effects of treatment (21%), comorbidities and aging (13%), postoperative recovery (5%), and negative healthcare experiences (5%). Survivors with temporary ostomy or anastomosis were more likely than survivors with permanent ostomy to report late effects (p < 0.0001 and p = 0.01). Survivors with anastomosis were less likely than survivors with permanent ostomy to report negative psychosocial impacts (p = 0.0001).
  
  
  CONCLUSIONS
  Generalizability is restricted by the lack of ethnically and racially diverse, uninsured (non-Medicare-eligible population), and non-English-speaking participants. Because the survey was cross-sectional and included respondents at different times since diagnosis, we could not adequately address changes in the greatest challenges over time.
  
  
  CONCLUSIONS
  Our results reveal the need for bowel/ostomy management, psychosocial services, and surveillance for late effects in survivorship and supportive care services for all survivors of rectal cancer, regardless of ostomy status. The perspective of long-term survivors with anastomosis reveals challenges that may not be anticipated during decision making for treatment (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A254).
authors.affiliation: 1 Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 2 Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 3 Southern Arizona Veterans Affairs Health Care System and University of Arizona College of Medicine, Tucson, Arizona 4 Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Bulkley
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wendel
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.forename: Robert S
authors.initials: RS
authors.lastname: Krouse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000379:methods / Q000523:psychology; D057240:Patient Preference / Q000706:statistics & numerical data; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000523:psychology / Q000601:surgery; D017741:Survivors / Q000523:psychology*; D014481:United States