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01.02.2014 | Original Article

Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status

verfasst von: J. B. Reese, P. H. Finan, J. A. Haythornthwaite, M. Kadan, K. R. Regan, J. M. Herman, J. Efron, L. A. Diaz Jr., N. S. Azad

Erschienen in: Supportive Care in Cancer | Ausgabe 2/2014

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Abstract

Purpose

Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined.

Methods

Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N = 141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale—Short Form). Clinical information was obtained through patient validated self-report measures and medical records.

Results

Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p < .001), female sexual function (p = .01), and body image (p < .001). The current and past ostomy groups reported worse impact on sexual function than those who never had an ostomy (p < .001); similar differences were found for female sexual function. The current ostomy group reported worse body image distress than those who never had an ostomy (p < .001). No differences were found across the groups for depressive symptoms (p = .33) or male sexual or erectile function (p values ≥ .59).

Conclusions

Colorectal cancer treatment puts patients at risk for sexual difficulties and some difficulties may be more pronounced for patients with ostomies as part of their treatment. Clinical information and support should be offered.

To examine the role of partnered status in influencing sexual outcomes in the current sample, we compared partnered vs. unpartnered participants on sexual outcomes using general linear models. Most partnered women completed the SFQ (40/46) and the FSFI (38/46). Most partnered men completed the SFQ (69/75) and the IIEF (72/75). A few unpartnered women (1/13) and men (3/7) completed the SFQ, the FSFI (4/13), and the IIEF (4/7). On the SFQ, partnered patients reported higher impact on sexual function (M = 2.54; SD = 1.06) than unpartnered patients (M = 1.49; SD = .35; p = .05). Partnered and unpartnered participants did not differ on body image, depression, or male sexual function or erectile function (p values ≥ .12). On the FSFI, partnered patients reported marginally higher sexual function (M = 16.63; SD = 10.94) than unpartnered patients (M = 6.68; SD = 9.09; p = .09).

Data were analyzed on the following number of patients within the never had ostomy, past ostomy, and current ostomy groups, respectively: medical impact on sexual function—78/98, 15/18, and 20/25; female sexual function—28/40, 4/7, and 10/12; male sexual function and erectile function—53/58, 11/11, and 12/13.

Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds) (2013) SEER Cancer Statistics Review, 1975–2010, National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission, posted to the SEER Website, April 2013. Available from http://seer.cancer.gov/csr/1975_2010/

Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. JAMA 273(1):59–65PubMedCrossRef

Traa MJ, De Vries J, Roukema JA, Den Oudsten BL (2012) Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 23(1):19–27. doi:10.1093/annonc/mdr133 PubMedCrossRef

Ameda K, Kakizaki H, Koyanagi T, Hirakawa K, Kusumi T, Hosokawa M (2005) The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer. Int J Urol 12(3):256–263. doi:10.1111/j.1442-2042.2005.01026.x PubMedCrossRef

Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B (2005) Ten-year historic cohort of quality of life and sexuality in patients with rectal cancer. Dis Colon Rectum 48(3):483–492PubMedCrossRef

Di Fabio F, Koller M, Nascimbeni R, Talarico C, Salerni B (2008) Long-term outcome after colorectal cancer resection. Patients’ self-reported quality of life, sexual dysfunction and surgeons’ awareness of patients’ needs. Tumori 94(1):30–35PubMed

Reese JB, Shelby RA, Keefe FJ, Porter LS, Abernethy AP (2010) Sexual concerns in cancer patients: a comparison of GI and breast cancer patients. Support Care Cancer 18(9):1179–1189. doi:10.1007/s00520-009-0738-8 PubMedCentralPubMedCrossRef

Sprangers MA, Taal BG, Aaronson NK, te Velde A (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38(4):361–369PubMedCrossRef

Tekkis PP, Cornish JA, Remzi FH, Tilney HS, Strong SA, Church JM, Lavery IC, Fazio VW (2009) Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum 52(1):46–54. doi:10.1007/DCR.0b013e318197551e PubMedCrossRef

10.

Nordstrom GM, Nyman CR (1991) Living with a urostomy. A follow up with special regard to the peristomal-skin complications, psychosocial and sexual life. Scand J Urol Nephrol Suppl 138:247–251PubMed

11.

Ross L, Abild-Nielsen AG, Thomsen BL, Karlsen RV, Boesen EH, Johansen C (2007) Quality of life of Danish colorectal cancer patients with and without a stoma. Support Care Cancer 15(5):505–513. doi:10.1007/s00520-006-0177-8 PubMedCrossRef

12.

Sideris L, Zenasni F, Vernerey D, Dauchy S, Lasser P, Pignon JP, Elias D, Di Palma M, Pocard M (2005) Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum 48(12):2180–2191. doi:10.1007/s10350-005-0155-0 PubMedCrossRef

13.

Manderson L (2005) Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med 61(2):405–415PubMedCrossRef

14.

Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, Baldwin CM, McMullen CK, Rawl SM, Matayoshi E, Coons SJ, Hornbrook MC (2009) Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol 27(28):4664–4670PubMedCrossRef

15.

Kasparek MS, Hassan I, Cima RR, Larson DR, Gullerud RE, Wolff BG (2012) Long-term Quality of Life and Sexual and Urinary Function After Abdominoperineal Resection for Distal Rectal Cancer. Dis Colon Rectum 55 (2):147–154, doi: 110.1097/DCR.1090b1013e31823d32606

16.

Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I (2010) Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev 5:CD006878. doi:10.1002/14651858.CD006878.pub2 PubMed

17.

Milbury K, Cohen L, Jenkins R, Skibber JM, Schover L (2012) The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer 21(3):1–10. doi:10.1007/s00520-012-1582-9

18.

Sharpe L, Patel D, Clarke S (2011) The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psychosom Res 70(5):395–402PubMedCrossRef

19.

Ramirez M, McMullen C, Grant M, Altschuler A, Hornbrook MC, Krouse RS (2009) Figuring out sex in a reconfigured body: experiences of female colorectal cancer survivors with ostomies. Women Health 49(8):608–624. doi:10.1080/03630240903496093 PubMedCentralPubMedCrossRef

20.

Bossema ER, Seuntiëns MWM, Marijnen CAM, Baas-Thijssen MCM, van de Velde CJH, Stiggelbout AM (2011) The relation between illness cognitions and quality of life in people with and without a stoma following rectal cancer treatment. Psychooncology 20(4):428–434. doi:10.1002/pon.1758 PubMedCrossRef

21.

Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15(4):1099–1106. doi:10.1245/s10434-007-9748-2 PubMedCrossRef

22.

Den Oudsten BL, Traa MJ, Thong MSY, Martijn H, De Hingh IHJT, Bosscha K, van de Poll-Franse LV (2012) Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: a population-based study. Eur J Cancer 48(17):3161–3170CrossRef

23.

Syrjala KL, Schroeder TC, Abrams JR, Atkins TZ, Brown WS, Sanders JE, Schubert MA, Heiman JR (2000) Sexual function measurement and outcomes in cancer survivors and matched controls. J Sex Res 37(3):213–225. doi:10.1080/00224490009552042 CrossRef

24.

Brotto LA, Heiman JR, Goff B, Greer B, Lentz GM, Swisher E, Tamimi H, Van Blaricom A (2008) A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Arch Sex Behav 37(2):317–329PubMedCrossRef

25.

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208PubMedCrossRef

26.

Alder J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J (2008) Sexual dysfunction after premenopausal stage i and ii breast cancer: do androgens play a role? J Sex Med 5(8):1898–1906PubMedCrossRef

27.

Speer JJ, Hillenberg B, Sugrue DP, Blacker C, Kresge CL, Decker VB, Zakalik D, Decker DA (2005) Study of sexual functioning determinants in breast cancer survivors. Breast J 11(6):440–447. doi:10.1111/j.1075-122X.2005.00131.x PubMedCrossRef

28.

Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242(2):212–223PubMedCrossRef

29.

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830PubMedCrossRef

30.

Canada AL, Neese LE, Sui D, Schover LR (2005) Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma. Cancer 104(12):2689–2700. doi:10.1002/cncr.21537 PubMedCrossRef

31.

Rosen RC, Cappelleri JC, Gendrano N 3rd (2002) The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res 14(4):226–244PubMedCrossRef

32.

Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. Eur J Cancer 37(2):189–197PubMedCrossRef

33.

Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 10(2):77–84PubMed

34.

Jess P, Christiansen J, Bech P (2002) Quality of life after anterior resection versus abdominoperineal extirpation for rectal cancer. Scand J Gastroenterol 37(10):1201–1204PubMedCrossRef

35.

Grant M, McMullen CK, Altschuler A, Mohler MJ, Hornbrook MC, Herrinton LJ, Wendel CS, Baldwin CM, Krouse RS (2011) Gender differences in quality of life among long-term colorectal cancer survivors with ostomies. Oncol Nurs Forum 38(5):587–596PubMedCentralPubMedCrossRef

36.

Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31(1):1–20PubMedCrossRef

37.

Annon J (1976) The PLISSIT Model. Journal of Sex Education Therapy 2:1–15

38.

Ayaz S, Kubilay G (2009) Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma. J Clin Nurs 18(1):89–98. doi:10.1111/j.1365-2702.2008.02282.x PubMedCrossRef

39.

Sprunk E, Alteneder RR (2000) The impact of an ostomy on sexuality. Clin J Oncol Nurs 4(2):85–88PubMed

40.

Schover LR (1999) Counseling cancer patients about changes in sexual function. Oncology (Williston Park) 13(11):1585–1591, discussion 1591–1582, 1595–1586

41.

Reese JB, Porter LS, Somers TJ, Keefe FJ (2012) Pilot feasibility study of a telephone-based couples intervention for physical intimacy and sexual concerns in colorectal cancer. J Sex Marital Ther 38:402–417PubMedCentralPubMedCrossRef

Titel: Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status
verfasst von: J. B. Reese
P. H. Finan
J. A. Haythornthwaite
M. Kadan
K. R. Regan
J. M. Herman
J. Efron
L. A. Diaz Jr.
N. S. Azad
Publikationsdatum: 01.02.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 2/2014
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1998-x

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Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status