Symptom Distress, Depression, Lower Social Support Found in Younger Patients With CRC and Stoma

Depression and anxiety, symptom distress, lower social support, and higher supportive care needs were seen among younger patients with colorectal cancer (CRC) who also had a stoma, according to a study published in Supportive Care in Cancer. Improving patients’ quality of life can start by addressing these issues, according to the study authors.

CRC is the second leading cause of cancer death globally, and many patients experience adverse effects outside of the cancer treatment itself, including fatigue, insomnia, loss of appetite, and diarrhea. Supportive care needs have been used as an indicator for evaluating outcomes in cancer patients worldwide, and this study aimed to assess the status of supportive care needs in patients with CRC after ostomy surgery.

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Patients aged 18 years and older with normal cognitive and communication skills and were able to participate in the investigation were eligible for the study, which recruited from the Department of Colorectal Surgery at Sun Yat-sen University Cancer Hospital between September 2020 and January 2021. Sociodemographic factors, disease factors, symptom distress, psychological factors, and social support factors were all collected from patient data. The Supportive Care Need Survey Short Form (SCNS-SF34) was used to evaluate supportive care needs.

There were 175 patients included in the study, all of whom had colorectal cancer and a stoma. The mean (SD) age of participants was 56.51 (13.24) years, with 18.9% being youth-aged and 38.9% being middle-aged. The mean score for SCNS-SF34 was 87.75 (17.34) with the highest scores of each dimension being psychological and daily life needs (2.83 [0.79]).

Patients who had higher supportive care needs were younger (18-45 years, 2.70 [0.48] vs 60-92 years, 2.48 [0.51]), more educated (6 years or less, 2.46 [0.43] vs more than 12 years, 2.62 [0.50]), and more likely to live in urban areas (urban, 2.65 [0.53] vs rural, 2.48 [0.47]). Participants who had later clinicopathological stages, shorter post-ostomy periods, had Miles operation, had postoperative adjuvant chemotherapy, and had permanent stoma showed higher supportive care needs.

A total of 94.3% of patients had at least 1 symptom with the incidence of symptoms in CRC stoma ranging from 8.0% to 89.7%; fatigue was the most frequent symptom. Symptomatic distress had an incidence of 8.6%. Symptom severity and distress were positively correlated with supportive care needs and other dimensions. There were 4 participants determined to be anxious and 11 who were determined to be depressed. The anxiety (0.525) and depression (0.560) subscales were positively correlated with supportive care needs and other dimensions.

A multivariable linear regression model found that a higher total score on symptom distress, depression, and anxiety at a younger age were risk factors for supportive care needs. Other risk factors, such as education level, place of residence, and time after ostomy surgery, were not associated with supportive care needs.

There was a limitation to this study. The study used a cross-sectional design which prevented the researchers from drawing a causal relationship.

The researchers concluded that patients with CRC and a stoma who are younger have “more symptom distress, are depressed and anxious, and have lower social support and higher supportive care needs.” The researchers wrote that health care personnel can use these data to identify patients who will need more supportive care early.

Reference

Xiangting Y, Meichun Z, Huiying Q. Supportive care needs and related factors mong colorectal cancer patients with stoma in the postoperative rehabilitation period from a bio-psycho-social perspective: a cross sectional study. Support Care Cancer. 2023;31:599. doi:10.1007/s00520-023-08067-w