Quality of life following surgery for colorectal cancer: A literature review

Colorectal cancer patients are faced with the debilitating consequences of either sphincter‐sacrificing or sphincter‐conserving surgery. The question central to the current literature review is: what is the prevalence of physical, psychological, social and sexual dysfunction among colorectal cancer patients with a colostoma (ostomates) compared with those patients whose sphincter function has been conserved (non‐ostomates). Although the extant literature yields some inconsistent findings, a number of clear trends can be identified: (a) both patient groups are troubled by frequent or irregular bowel movements and diarrhea, and consequently often require dietary restrictions; (b) ostomates report higher levels of psychological distress than do non‐ostomates; (c) psychological problems tend to be more frequent among younger patients and among women; (d) while both ostomates and nonostomates report restrictions in their level of social functioning, such problems appear to be more prevalent among patients with a colostoma; (e) the sexual functioning of male colostomists is consistently more impaired than that of patients with intact sphincters; and (f) a considerable number of women whose sphincter function has been sacrificed suffer from dyspareunia. There is need for more methodologically sound studies that: (1) employ well validated quality‐of‐life measures; (2) assess patients' quality of life prospectively in order to examine patients' psychosocial adaptation over time; and (3) identify those subgroups of patients who are at greatest risk to the adverse psychosocial sequalae of the disease and its surgical treatment.