Tempo de cirurgia de estomia e tipo de tratamento são associados às modificações na qualidade de vida em pacientes colostomizados por câncer colorretal

Abstract

Introduction: Colostomy and chemoradiotherapy treatment may affect the quality of life (QoL) in patients with colorectal cancer (CRC). There are still scarce and contradictory studies that investigate the impact ostomy and the type of treatment on QoL, with colostomized patients due to CRC. Objective: To assess the association of colostomy times and type of treatment with QoL after ostomy surgery, as well as evaluate the clinically important difference on QoL domain score changes between times. Methods: A prospective observational study was conducted with 46 patients with CRC on three occasions: T0, which included patients with recent colostomy surgery (0-2 months); T1 (3-5 months after surgery); and T2 (6-8 months after surgery). Treatment types were: surgery alone, chemotherapy or radiotherapy, and chemoradiotherapy. European Cancer Research and Treatment Organization EORTC-QLQ30 and EORTC-QLQ-CR29 questionnaires were used to assess QoL. The generalized estimation equation (GEE) was used to assess the association of colostomy time and type of treatment on QoL. For the clinically significant negative changes, the difference between the scores by time was calculated. Delta ≥ ±9 in the scores for time was estimated through the effect size multiplied by the standard deviation of the sample, considering the score of the global health status. Results: The sample consisted of 53.7% female, 63.4% elderly and chemoradiotherapy was performed in 51.2% of the patients. The ostomy was associated with better T0 to T1 QoL scores and maintained this improvement between T1 to T2 in several functional and symptom domains, such as physical function, loss of appetite, urinary frequency and dry mouth. On the other hand, chemoradiotherapy was associated with worse scores for some domains such as global health status, nausea and vomiting, pain, blood and mucus in the stool, bloating and dry mouth. Even though not observed significant differences in some domains in GEE analysis, the patients had clinically significant negative modifications in various domains such as pain, anxiety, weight concern, flatulence and embarrassement in times. Conclusion: Colostomy improved QoL at 3-5 months in most domains and remained better at 6-8 months after surgery. Still, chemoradiotherapy was associated with worse QoL scores even after 6-8 months of treatment. Therefore, the health teams can make patients aware that ostomy surgery improves QoL in many functional and symptom aspects, bringing more comfort to patients in this condition.