Research On Quality Of Life Of Permanent Colostomy Patients With Rectal Cancer In Xi’an

ObjectiveThe aim of this study is to investigate the quality of life（QOL）andinfluencing factors of permanent colostomy patients with rectal cancer in Xi’anthrough the prevalence study, and to observe the QOL of permanent colostomypatients with rectal cancer in different periods after Miles operation through theprospective study, analyze the variation of QOL, to provide the basis forproposing effective interventions and developping the health education program.Method1. The prevalence study156permanent colostomy patients of continuity case who operated fromJuly2009to December2010in five hospitals in Xi’an were selected as subjects.The respondent were investigated with the demographic informationquestionnaire, the European Organization for Research and Treatment of Cancer Quality-of-life Questionaire-C30(EORTC QLQ-C30), the European Organizationfor Research and Treatment of Cancer Colorectal Cancer-Specific Quality-of-LifeQuestionnaire Module(EORTC QLQ-CR38). Data collected by telephonefollow-up methods. Data was recorded and constructed with Epidata-3.0software,analysised with SPSS17.0software. The descriptive analysis, one sample t-test,pearson correlation analysis and multiple stepwise regression analysis were used.2. The prospective study51permanent colostomy patients of continuity case who operated from aprilto august2011in five hospitals in Xi’an were selected as subjects. The survey’stool was the same with the prevalence study. Data collected throughquestionnaire survey method with patients in the preoperative, and throughtelephone follow-up method with patients in the postoperative1,3,6month.Data was recorded and constructed with Epidata-3.0software, and analysisedwith SPSS17.0software. The descriptive analysis, ANOVA of repeatedmeasurement data analysis, LSD-t and one sample t-test were used.Result1. The current state QOL of permanent colostomy patients with rectalcancer145QOL questionnaires of permanent colostomy patients were effective.Mean score of the overall QOL was60.31±23.19, lower than the reference value,the difference was not statistically significant (P>0.05). Compared with referencevalue, the difference in role function, social function, diarrhea, financialdifficulties, fatigue, shortness of breath, loss of appetite was statisticallysignificant (P <0.05). Mean score of the sexual function was only25±21.82andthe future perspective was53.79±25.82. Mean score of the male and femalesexual problems, stoma-related symptoms was higher, respectively was50.31± 24.12,48.76±23.80,30.31±16.79. Multiple stepwise regression analysisshowed the psychological condition, postoperative time, stoma complicationwere factors into the regression equation of the overall QOL. Correlation analysisshowed that psychological condition was positively correlated with the QOL andeach functional field, stoma complication was negatively with the QOL and eachfunctional field.2. The dynamic changes of permanent colostomy patients’ QOL in differentperiods of operation49QOL questionnaires of permanent colostomy patients in4time periodswere effective, the ANOVA of repeated measurement data showed that exceptconstipation and diarrhea, the difference in the overall QOL and othersdimensions was statistically significant (P <0.05). Mean Score of the overall QOLin preoperative and postoperative the1,3,6month respectively was71.77±13.16,28.70±11.92,54.42±10.31,74.21±10.17. The difference inconstipation and diarrhea was no statistically significant (P>0.05). Comparedwith the baseline level, the difference in emotional function，cognitive function,fatigue, gastrointestinal symptoms and shortness of breath was not statisticallysignificant in the postoperative3month (P>0.05)，the difference in socialfunction, body image, chemotherapy side effects and financial difficulties wasstatistically significant in the postoperative6month (P <0.05).Conclusion1. The QOL of permanent colostomy patients with rectal cancerThe QOL of permanent colostomy patients in Xi’an were affected, the rolefunction, social function, sexual function, future perspective were affectedsignificantly. Symptoms were severe in diarrhea, male and female sexualproblems, stoma-related symptoms and financial difficulties. Symptoms were mild in fatigue, shortness of breath and loss of appetite. The variation of QOL indifferent periods was "v" type. The baseline level in the preoperative was higher.During the postoperative1month, mean score was the lowest in the overall QOL,each function was affected significantly, symptoms were severe. During thepostoperative3month, the overall QOL and each functional field improvedsignificant, symptoms were relieved, the emotional function, cognitive function,fatigue, gastrointestinal symptoms and shortness of breath had been restored tothe preoperative level. During the postoperative6month, the overall QOL hadbeen restored and beyond to the preoperative level, but the social function, bodyimage, chemotherapy side effects and financial difficulties had not restored to thebaseline level.2. Influencing factors of permanent colostomy patients’ QOLInfluencing factors of permanent colostomy patients’ QOL werepsychological condition, postoperative time and stoma complication. Relevantrelations existed between each functional field and psychological condition,stoma complication.3. Intervention recommendationsThe postoperative1month was the stage that medical staff should focus on.Medical staff should focus on the psychological condition of patients. Takeeffective psychological intervention measures to promote their mental health. Toreduce stoma complications, medical staff should instruct patients with stomacomplications knowledge on identifying, preventing, and handling. And they alsoshould focus on colonic irrigation methods and diet-related knowledge topromote regular bowel movement of patients. To reduce the economic burden ofpatients, government relevant departments should include ostomy care suppliesinto the scope of Medicare reimbursement.