Stoma Location and Ostomy-Related Quality of Life Among Cancer Survivors with Ostomies: A Pooled Analysis
INTRODUCTION Ostomies have substantial impacts on many aspects of cancer survivors' daily lives. We sought to describe how stoma location may affect clothing style, ostomy appliance leakage, skin irritation around the stoma, weight changes after ostomy surgery, and health-related quality of life (HRQOL). METHODS A pooled dataset was obtained from three multi-site studies that had used the modified City of Hope Quality of Life-Ostomy questionnaire to measure HRQOL and ostomy-specific concerns in
... cancer survivors with ostomies. Questions pertaining to stoma location, clothing issues, weight change since ostomy surgery, and HRQOL were analyzed. Ostomy bag change frequency was assessed in two of the three studies. Respondents were categorized by self-reported stoma location quadrant: lower left side, upper left side, lower right side, or upper right side. Predicted means for HRQOL and individual items were generated for every stoma location, adjusting for sex, ostomy type (fecal or urinary), and body mass index (BMI). RESULTS Of 607 cancer survivors included in this analysis, abdominal quadrant ostomy groups were: 138 (23%) upper left, 298 (49%) lower left, 51 (8%) upper right, and 120 (20%) lower right. The majority of participants (>50%) reported changing their clothing styles due to their ostomies. Cancer survivors with ostomies on the lower right side had significantly more weight gain after ostomy surgery (p=0.02) and reported more frequent ostomy bag changes or emptying over a 24-hour period. Overall HRQOL did not vary by stoma location, with predicted means of 6.90 to 7.18 (out of 10). Survivors with ostomies on the right half of the abdomen reported statistically significantly different QOL scores spiritual well-being (p=0.031), sleep disruptions (p=0.03), satisfaction with appearance (p<0.001) and interference with social activities (p=0.005) compared to survivors with ostomies on the left half of the abdomen. DISCUSSION Stoma location is associated with HRQOL, ostomy bag usage, and difficulties related to adjusting to the ostomy, which may affect long-term survivorship and QOL. Moreover, even after controlling for ostomy type, there were sustained significant differences in ostomy-related QOL associated with stoma location. Our results indicate that stoma location should be considered when designing interventions for cancer survivors with ostomies.