Discussion:

This study was an evaluation of a subset of survey responses as a part of a larger survey of members of the California United Ostomy Association. 1457 responses were received, 599 of which were from patients who had colostomies. Most were cancer patients (86%) with colorectal cancer as the reason for colostomy. In the remaining 14%, non-cancer related problems included mostly inflammatory bowel disease and diverticular disease. The demographics of the two groups were similar for age and race/ethnicity. Differences included a higher proportion of women in the non-cancer group (76% versus 51%) and the shorter time since their colostomy surgery (8 versus 10 years). The higher proportion of women in the non-cancer group reflected the higher prevalence of inflammatory bowel disease in women compared with men. The authors suggested that the lower numbers of non-cancer patients with colostomies may be a reflection of sphincter-saving procedures and the previously more common ileostomy surgery in non-cancer patients.

 

Quality of life was measured through responses to the City of Hope QOL-Ostomy Questionnaire, which included additional demographic survey items. There were no significant differences between pre and post-colostomy sexual function between the groups, though erectile dysfunction in men and a drop in sexual activity were reported by both groups. Both groups reporting similar levels of support systems and changes in clothing styles from pre to post-colostomy. There were some significant differences in dietary restriction, especially the avoidance of dairy, vegetable, and fruit food groups.

 

Physical quality of life scores that were reported as moderate to severe problems were similar between groups, except for a higher proportion of the non-cancer group reporting fatigue, loss of strength, sleep disruption, aches and pains, and skin irritation around the colostomy. The overall evaluation of physical quality of life suggested that there were 43% of the non-cancer group reporting moderate to severe problems in this category compared with 22% of the cancer group (p<0.001). However, the authors noted that some of the differences could have been attributed more to continung medical problems than to the colostomy.

 

In the psychological well being category a higher proportion of non-cancer patients noted less satisfaction with appearance, problems with feeling useful, anxiety, depression, and difficulty in caring for their ostomy compared to the cancer group. A total of 50% of non-cancer patients reported moderate to severe problems in this category compared to 37% of the cancer group (p=0.04).

 

For social wellbeing, more in the non-cancer group reported problems with family distress, personal relationships, support systems, and financial burden. Overall, 41% of the non-cancer group reported problems in this category compared to 25% of the cancer group (p=0.005). The authors suggested that the increased perception of financial burden in non-cancer patients could have been attributed to issues around health insurance coverage for chronic disease.

 

In the category of spiritual quality of life, less positive change were reported by a larger proportion of cancer patients (58%) compared to non-cancer patients (37%), which was the only item that appeared to be a lower quality of life issue for cancer versus non-cancer patients. Other items in this category, such as uncertainly about the future, feelings of hope, and reason for living were comparable between the groups. There were no overall significant differences for this category between the groups.

 

Data evaluation was adjusted for differences in gender and time since colostomy surgery in patients to find lower psychological quality of life scores in non-cancer patients (adjusted p<0.0001), including lower satisfaction with appearance, depression, and difficulty in self-care.

 

The overall quality of life scores for all categories did differ significantly between groups (p=0.01) with 48% of the non-cancer group reporting moderate to severe challenges while 32% of the cancer group reported moderate to severe challenges across the four categories. The authors suggested that these differences may be a reflection of overall poorer health among non-cancer colostomy patients and the greater potential for the surgical procedures to cure the cancer compared to non-cure rates and ongoing inflammatory bowel disease in non-cancer patients. Both cancer and non-cancer patients commonly belonged to ostomy support groups, which both groups found helpful in improving coping mechanisms.

 

An improved understanding of the impact of colostomy surgery on patients may lead to improved decisions about the types of surgical procedures performed. Instruction and problem-solving with patients may improve coping capacity and quality of life for patients with ostomies. The authors suggested that education and counseling support should begin pre-operatively to speed up recovery and reduce complications, and should be tailored to age groups because of the difference in coping capacity of younger versus older patients. Individualized supportive interventions should also be tailored to the patient’s disease state. Finally, financial counseling and advocacy may be important for discussion and problem solving, particularly in non-cancer patients prior to colostomy surgery.