Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries

Helle Kristensen*, Anne Thyø, Katrine J. Emmertsen, Neil J. Smart, Thomas Pinkney, Andrea M. Warwick, Dong Pang, Hossam Elfeki, Mostafa Shalaby, Sameh H. Emile, Mohamed Abdelkhalek, Mohammad Zuhdy, Tomas Poskus, Audrius Dulskas, Nir Horesh, Edgar J.B. Furnée, Sanne J. Verkuijl, Nuno José Rama, Hugo Domingos, João MacIelAlejandro Solis-Peña, Eloy Espín-Basany, Marta Hidalgo-Pujol, Sebastiano Biondo, Annika Sjövall, Peter Christensen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Colorectal cancer management may require an ostomy formation; however, a stoma may negatively impact health-related quality of life (HRQoL). This study aimed to compare generic and stoma-specific HRQoL in patients with a permanent colostomy after rectal cancer across different countries. Method: A cross-sectional cohorts of patients with a colostomy after rectal cancer in Denmark, Sweden, Spain, the Netherlands, China, Portugal, Australia, Lithuania, Egypt, and Israel were invited to complete questionnaires regarding demographic and socioeconomic factors along with the Colostomy Impact (CI) score, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and five anchor questions assessing colostomy impact on HRQoL. The background characteristics of the cohorts from each country were compared and generic HRQoL was measured with the EORTC QLQ-C30 presented for the total cohort. Results were compared with normative data of reference European populations. The predictors of reduced HRQoL were investigated by multivariable logistic regression, including demographic and socioeconomic factors and stoma-related problems. Results: A total of 2557 patients were included. Response rates varied between 51-93 per cent. Mean time from stoma creation was 2.5-6.2 (range 1.1-39.2) years. A total of 25.8 per cent of patients reported that their colostomy impairs their HRQoL 'some'/'a lot'. This group had significantly unfavourable scores across all EORTC subscales compared with patients reporting 'no'/'a little' impaired HRQoL. Generic HRQoL differed significantly between countries, but resembled the HRQoL of reference populations. Multivariable logistic regression showed that stoma dysfunction, including high CI score (OR 3.32), financial burden from the stoma (OR 1.98), unemployment (OR 2.74), being single/widowed (OR 1.35) and young age (OR 1.01 per year) predicted reduced stoma-related HRQoL. Conclusion: Overall HRQoL is preserved in patients with a colostomy after rectal cancer, but a quarter of the patients interviewed reported impaired HRQoL. Differences among several countries were reported and socioeconomic factors correlated with reduced quality of life.

Original languageEnglish
Article numberzrac085
JournalBJS open
Issue number6
StatePublished - 1 Dec 2022
Externally publishedYes


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