The Cost of Survival: Colorectal Cancer Survivors' Experiences of Bowel Dysfunction

Background Bowel dysfunction is a potential chronic side-effect of surgical excision and irradiation of colorectal cancer (CRC). Survivors of CRC may be predisposed to more frequent bowel movement, faecal incontinence, and... [ view full abstract ]

Background
Bowel dysfunction is a potential chronic side-effect of surgical excision and irradiation of colorectal cancer (CRC). Survivors of CRC may be predisposed to more frequent bowel movement, faecal incontinence, and rectal bleeding, which may have consequent negative impacts on daily activities, and perceived health.

Aims and Objectives of the Study
This mixed methods sequential explanatory design study explores CRC survivors’ quality of life (QOL) and experiences of long-term physical and psychosocial effects in the five years following treatment.

Method
A purposive sample of CRC survivors (n=304) attending hospitals and cancer support centres between September 2014 and January 2016 were recruited. All participants returned a postal questionnaire, which included The Functional Assessment of Therapy–Colorectal (FACT-C) questionnaire, the EUROQOL Self-Rated Health Visual Analogue Scale, and symptom experience items. A sub-sample of participants were followed up using semi-structured interviews to gain further insight about CRC survivors’ QOL and symptom experiences. The study received ethical approval from appropriate bodies.

Findings
160 participants (56.9%) reported difficulties with bowel control. Non-parametric tests indicated that participants who had difficulties with bowel control reported significantly poorer self-rated health, physical well-being, social/family well-being, emotional well-being, functional well-being, CRC specific well-being and overall QOL on the FACT-C scale compared to those who did not report issues with bowel control. Analysis of qualitative interviews revealed bowel dysfunction drastically impacted CRC survivors’ day to day life, with particular effects on the survivors’ diet and social activity.

Conclusions and Implications
Symptoms of bowel dysfunction were experienced by more than half of CRC survivors up to five years following cancer treatment. Development of strategies to improve bowel control in the aftermath of colorectal cancer treatment are necessary, as well as measures to manage chronic bowel dysfunction.

This study is funded by the Health Research Board of Ireland, grant number HPF.2014.715.