The psychological impact of cancer and cancer surgery.I. Adaptation to the dry colostomy; preliminary report and summary of findings

S have increased the number of cancer survivors.T h e radical surgery necessary for prolongation of life, however, has resulted in severe impairment of function in many instances.T h e medical management of these patients has made evident the importance of psychological factors in invalidism that exceeds the limitations set by surgery.Despite growing awareness, there has been little systematic study of the impact of cancer and the attending surgical procedures to guide the clinician in the practical problem of managing the cancer survivor in his total situation.T h e introduction, in 1908, of the abdominoperineal resection of the rectum with the concomitant permanent dry colostomy brought about the problem of management of bowel function without sphincter control.Regimens of diet and irrigating procedures have been considered the key to colostomy management.New regimens and variations are repeatedly introduced inasmuch as patients still have cmisiderable difficulty in managing the colostomy.T h e invention and continued experimentation with surgical procedures to preserve the sphincter, which many surgeons regard as unsafe, testify to the difficulty of the problem.Regardless of new surgical developments, at least half and perhaps two thirds of all sufferers from ~~~ From the Deparlment of Rehabilitalion and Psychiatry, Memorial Center for Cancer and Allied Diseases, New York, New York.This project has been carried on under the auspices oC the Rehabilitation Commitice and made possible by the generosity of Mr.