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Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis

Annals of Surgical Oncology volume 24, pages 3596–3603 (2017)Cite this article

An Erratum to this article was published on 16 August 2017

This article has been updated

Abstract

Background

Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics.

Methods

The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer survivors with anastomosis. Bowel function was scored using the self-administered, 14-item Memorial Sloan-Kettering Cancer Center Bowel Function Index. Patient, cancer, and treatment variables were collected from the electronic medical chart. We used multiple regression to assess the relationship of patient- and treatment-related variables with the bowel function score.

Results

The study included 381 anastomosis patients surveyed an average 12 years after their rectal cancer surgeries. The total bowel function score averaged 53 (standard deviation, 9; range, 31–70, higher scores represent better function). Independent factors associated with worse total bowel function score included receipt of radiation therapy (yes vs. no: 5.3-unit decrement, p < 0.0001), tumor distance from the anal verge (≤6 cm vs. >6 cm: 3.2-unit decrement, p < 0.01), and history of a temporary ostomy (yes vs. no: 4.0-unit decrement, p < 0.01). One factor measured at time of survey was also associated with worse total bowel function score: ever smoking (2.3-unit decrement, p < 0.05). The regression model explained 20% of the variation in the total bowel function score.

Conclusions

Low tumor location, radiation therapy, temporary ostomy during initial treatment, and history of smoking were linked with decreased long-term bowel function following an anastomosis. These results should improve decision-making about surgical options.

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Fig. 1

Change history

  • 16 August 2017

    An erratum to this article has been published.

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Acknowledgements

The authors thank Mary Wagner, Administrative Assistant, University of Arizona Cancer Center, for help with this work.

Funding

Supported by Grant R01 CA106912, “Health-Related Quality of Life in Colorectal Cancer Survivors With Stomas,” from the National Cancer Institute, National Institutes of Health, in collaboration with resources and the use of facilities provided at the Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona, and Kaiser Permanente.

Disclaimer

The views expressed in this report are those of the authors and do not necessarily represent the views of the University of Arizona or Kaiser Permanente.

Disclosures

Dr. Herrinton has had research contracts in the past 3 years with MedImmune that was unrelated to this study. The other authors have no disclosures.

Ethical Approval

All studies were approved by the Institutional Review Boards of the University of Arizona and Kaiser Permanente.

Author information

Affiliations

  1. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Mubarika Alavi MS & Lisa J. Herrinton PhD

  2. University of Arizona College of Medicine, Tucson, AZ, USA

    Christopher S. Wendel MS

  3. CMC Veterans Affairs Medical Center, Philadelphia, PA, USA

    Robert S. Krouse MD, FACS

  4. University of Rochester Medical Center, Rochester, NY, USA

    Larissa Temple MD, MSc, FACS

  5. Kaiser Permanente Center for Health Research, Portland, OR, USA

    Mark C. Hornbrook PhD, Joanna E. Bulkley PhD & Carmit K. McMullen PhD

  6. City of Hope/Beckman Research Institute, Duarte, CA, USA

    Marcia Grant RN, PhD, FAAN

Authors
  1. Mubarika Alavi MS
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  2. Christopher S. Wendel MS
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  3. Robert S. Krouse MD, FACS
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  4. Larissa Temple MD, MSc, FACS
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  5. Mark C. Hornbrook PhD
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  6. Joanna E. Bulkley PhD
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  7. Carmit K. McMullen PhD
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  8. Marcia Grant RN, PhD, FAAN
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  9. Lisa J. Herrinton PhD
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Corresponding author

Correspondence to Lisa J. Herrinton PhD.

Additional information

The original article has been updated: Mark C. Hornbrook's last name has been corrected as reflected in the erratum.

An erratum to this article is available at https://doi.org/10.1245/s10434-017-6056-3.

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Alavi, M., Wendel, C.S., Krouse, R.S. et al. Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis. Ann Surg Oncol 24, 3596–3603 (2017). https://doi.org/10.1245/s10434-017-6017-x

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  • DOI: https://doi.org/10.1245/s10434-017-6017-x

Keywords

  • Rectal Cancer
  • Long-term Cancer Survivors
  • Temporary Ostomy
  • Bowel Function Index (BFI)
  • Anal Verge