Korean J Adult Nurs.  2019 Oct;31(5):487-495. 10.7475/kjan.2019.31.5.487.

Predictors of Quality of Life and Social Support as a Mediator between Defecation Function and Quality of Life among Rectal Cancer Patients

• Kim JR
• Hwang SY

• KMID: 2461064
• DOI: http://doi.org/10.7475/kjan.2019.31.5.487

Abstract

PURPOSE
To identify the factors influencing Quality of Life (QoL) in rectal cancer patients and to examine whether perceived social support mediates the relationship between defecation function and QoL.
METHODS
Using self-report questionnaires, a descriptive survey was conducted with 131 rectal cancer patients who underwent anal sphincter-saving resection, in a large medical center in Korea. Data were collected between September and November, 2014, using research instruments validated in the Korean language. The data were analyzed using SPSS/WIN 21.0 and AMOS 21.0.
RESULTS
The mean age and post-surgical follow-up period of the participants were 59.0±10.2 years and 15.9±9.8 months, respectively. Multiple linear regression analysis revealed that, after adjusting for age and gender, defecation function, perceived social support, and employment status predicted QoL. Path analysis showed that perceived social support partially mediated the relationship between defecation function and QoL with a significant indirect effect.
CONCLUSION
These results suggest that a positive perception of social support from family and healthcare providers is necessary to improve the QoL of patients experiencing defecation dysfunction after rectal cancer surgery. To this end, periodic counseling and education from outpatient healthcare providers, during the postoperative follow-up period, could encourage patients to perceive higher social support.

MeSH Terms

Counseling
Defecation*
Education
Employment
Follow-Up Studies
Health Personnel
Humans
Korea
Linear Models
Outpatients
Quality of Life*
Rectal Neoplasms*

Figure

• 

  Figure 1 Path diagram of the model.

Reference

1. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Research Treatment. 2017; 49(2):292–305. DOI: 10.4143/crt.2017.118.

2. Kim DH. Colorectal cancer epidemic in Korea. Annals of Coloproctology. 2013; 29(1):1–4. DOI: 10.3393/ac.2013.29.1.1.

3. Kinoshita Y, Nokes KM, Kawamoto R, Kanaoka M, Miyazono M, Nakao H, et al. Health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a prospective 6-month follow-up study. European Journal of Cancer Care. 2017; 26(4):e12417. DOI: 10.1111/ecc.12417.

4. Scheer AS, Boushey RP, Liang S, Doucette S, O'Connor AM, Moher D. The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis. Diseases of the Colonand Rectum. 2011; 54(12):1589–1597. DOI: 10.1097/DCR.0b013e3182214f11.

5. Bregendahl S, Emmertsen KJ, Lous J, Laurberg S. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based crosssectional study. Colorectal Disease. 2013; 15(9):1130–1139. DOI: 10.1111/codi.12244.

6. Knowles G, Haigh R, McLean C, Phillips HA, Dunlop MG, Din FVN. Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life. European Journal of Oncology Nursing. 2013; 17(5):570–577. DOI: 10.1016/j.ejon.2013.01.010.

7. Deng M, Lan Y, Luo S. Quality of life estimate in stomach, colon, and rectal cancer patients in a hospital in China. Tumor Biology. 2013; 34(5):2809–2815. DOI: 10.1007/s13277-013-0839-3.

8. Lee E, Kim KS. Relationships between anxiety, depression, low anterior resection syndrome, and quality of life following lower anterior resection for rectal cancer. Perspectives in Nursing Science. 2014; 11(1):74–85. DOI: 10.16952/pns.2014.11.1.74.

9. Kim HJ, Chu SH, Yoo JS, Kim NK. Nutritional risk and physical activity on quality of life in patients with colorectal cancer. Asian Oncology Nursing. 2014; 14(2):66–73. DOI: 10.5388/aon.2014.14.2.66.

10. Costa ALS, Heitkemper MM, Alencar GP, Damiani LP, da Silva RM, Jarrett ME. Social support is a predictor of lower stress and higher quality of life and resilience in Brazilian patients with colorectal cancer. Cancer Nursing. 2017; 40(5):52–60. DOI: 10.1097/NCC.0000000000000388.

11. Simon AE, Thompson MR, Flashman K, Wardle J. Disease stage and psychosocial outcomes in colorectal cancer. Colorectal Disease. 2009; 11(1):19–25. DOI: 10.1111/j.1463-1318.2008.01501.x.

12. Gonzalez-Saenz de, Bilbao A, Baré M, Briones E, Sarasqueta C, Quintana JM, et al. Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer. Psycho-Oncology. 2016; 25(8):891–897. DOI: 10.1002/pon.4022.

13. Haviland J, Sodergren S, Calman L, Corner J, Din A, Fenlon D, et al. Social support following diagnosis and treatment for colorectal cancer and associations with health-related quality of life: results from the UK ColoREctal Wellbeing (CREW) cohort study. Psycho-Oncology. 2017; 26(12):2276–2284. DOI: 10.1002/pon.4556.

14. Kotronoulas G, Papadopoulou C, Burns-Cunningham K, Simpson M, Maguire R. A systematic review of the supportive care needs of people living with and beyond cancer of the colon and/or rectum. European Journal of Oncology Nursing. 2017; 29:60–70. DOI: 10.1016/j.ejon.2017.05.004.

15. van der, Thomas G, Caers F, van Dijk WA, Slooter GD, Maaskant-Braat AJG. What you should know about the low anterior resection syndrome-clinical recommendations from a patient perspective. European Journal of Surgical Oncology. 2018; 44(9):1331–1337. DOI: 10.1016/j.ejso.2018.05.010.

16. Kim YS, Tae YS, Nam GH. Distress and quality of life among elderly patients with gastric cancer: the mediating effect of social support. Korean Journal of Adult Nursing. 2017; 29(5):536–546. DOI: 10.7475/kjan.2017.29.5.536.

17. Bennis M, Parc Y, Lefevre JH, Chafai N, Attal E, Tiret E. Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: A retrospective series of 483 patients. Annals of Surgery. 2012; 255(3):504–510. DOI: 10.1097/SLA.0b013e31824485c4.

18. Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Diseases of the Colon and Rectum. 2005; 48(7):1353–1365. DOI: 10.1007/s10350-004-0942-z.

19. Lim SM. The relationships among bowel function, health locus of control, anxiety and depression in patient with rectal cancer. [master's thesis]. Seoul: Ewha Womans University;2013. 15.

20. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. Journal of Personality Assessment. 1988; 52(1):30–41. DOI: 10.1207/s15327752jpa5201_2.

21. Shin JS, Lee YB. The effects of social support on the psychosocial well-being of the unemployed. Korean Journal of Social Welfare. 1999; 37:241–269.

22. Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Quality of Life Research. 1999; 8(3):181–195. DOI: 10.1023/A:1008821826499.

23. Kim H, Yoo HJ, Kim YJ, Han OS, Lee KH, Lee JH, et al. Development and validation of Korean Functional Assessment Cancer Therapy-General (FACT-G). Korean Journal of Clinical Psychology. 2003; 22(1):215–229.

24. Mahalingam S, Seshadri RA, Veeraiah S. Long-term functional and oncological outcomes following intersphincteric resection for low rectal cancers. Indian Journal of Surgical Oncology. 2017; 8(4):457–461. DOI: 10.1007/s13193-016-0571-8.

25. Emmertsen KJ, Laurberg S. TheRectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. British Journal of Surgery Society. 2013; 100(10):1377–1387. DOI: 10.1002/bjs.9223.

26. Juul T, Ahlberg M, Biondo S, Espin E, Jimenez LM, Matzel KE, et al. Low anterior resection syndrome and quality of life: an international multicenter study. Diseases of the Colon and Rectum. 2014; 57(5):585–591. DOI: 10.1097/DCR.0000000000000116.

27. Oh PJ, Lim SY. Change of cancer symptom, depression and quality of life based on phases of chemotherapy in patients with colorectal or stomach cancer: a prospective study. Korean Journal of Adult Nursing. 2017; 29(3):313–322. DOI: 10.7475/kjan.2017.29.3.313.

28. Andersson J, Angenete E, Gellerstedt M, Angerås U, Jess P, Rosenberg J, et al. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. British Journal of Surgery Society. 2013; 100(7):941–949. DOI: 10.1002/bjs.9144.

29. Eom CS, Shin DW, Kim SY, Yang HK, Jo HS, Kweon SS, et al. Impact of perceived social support on the mental health and health-related quality of life in cancer patients: Results from a nationwide, multicenter survey in South Korea. Psycho-Oncology. 2013; 22(6):1283–1290. DOI: 10.1002/pon.3133.

30. Kim JI, Byeon YS. A study on the factors affecting resilience in patients with colon cancer. Asian Oncology Nursing. 2013; 13(4):256–264. DOI: 10.5388/aon.2013.13.4.256.

31. Duijts SFA, Kieffer JM, van Muijen P, van der Beek AJ. Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis. Acta Oncologica. 2017; 56(2):174–182. DOI: 10.1080/0284186X.2016.1266083.

32. Kwoun HJ, Shin YH. Impact of bowel function, anxiety and depression on quality of life in patients with sphincter-preserving resection for rectal cancer. Journal of Korean Academy of Nursing. 2015; 45(5):733–741. DOI: 10.4040/jkan.2015.45.5.733.