This application is a request for a 5-year competitive renewal of our ongoing research grant (R01 CA106912), HR-QOL in Colorectal Cancer (CRC) Survivors with Stomas. The study compared 287 CRC survivors (>5 years) with ostomy with 395 CRC survivors without ostomy. Key findings include a greater understanding of the multiple behavioral and dietary adaptations ostomates use to control bowel function;the previously under- reported complications these patients face;and the HR-QOL differences for men and women. The renewal is focused on rectal cancer and has four critical goals: (1) strengthen the evidence base on outcomes following all major rectal cancer procedures, (2) assess the key question of work disability, (3) assess behavioral and dietary adjustments, and (4) increase knowledge of outcomes in minorities.
Specific Aim 1 : To understand the determinants of outcomes in all long-term survivors of invasive rectal cancer and associated treatments, including those with (a) permanent ostomy, (b) anastomosis without temporary ostomy, and (c) anastomosis with temporary ostomy (indicating low cancers with minimal remaining rectum). Outcomes to be measured include bowel function, HR-QOL, work disability, and medical complications.
Specific Aim 2 : From among patients whose initial cancer surgery was anastomosis, to assess the relationships of tumor location, patient age, and co-morbidity on the rate of anastomotic failure and eventual permanent ostomy.
Specific Aim 3 : To better understand the scope of behavioral and dietary adjustments made by rectal cancer survivors with ostomy and anastomosis to control bowel function.
Specific Aim 4 : To collect qualitative data to more fully understand the lived experiences of minority rectal cancer survivors. The study will be set among 2,724 long-term survivors with rectal cancer, of whom 142 are Black/African American, 209 are Hispanic/Latino, and 340 are Asian/Pacific Islander. Data will be collected using patient self-reported information to a mailed questionnaire, linkage to the electronic medical record, focus groups, and in-depth interviews. The study is innovative in identifying the largest group of long-term rectal cancer survivors for study. Through the proposed study, we can better understand the risks and benefits of rectal cancer treatments as well as the adaptations patients make to improve control of their bowel functioning. Public Health Relevance: This competitive renewal to our ongoing research grant (R01 CA106912), """"""""HR-QOL in Colorectal Cancer Survivors with Stomas"""""""" proposes a study of rectal cancer survivors using focus groups and mailed questionnaires. Health-related quality of life, work disability, behavioral and dietary adaptations, healthcare costs and long-term medical complications will be measured. The study will strengthen the evidence base regarding outcomes resulting from the surgical options now available for rectal cancer: permanent ostomy and rectal-sparing surgery. Greater knowledge of outcomes will enable patients and their physicians to be more fully informed at the time they are considering their available surgical options and will also enable development of clinical and self-help interventions and potential quality improvements in the current algorithms for care.

Public Health Relevance

- Relevance to Public Health This competitive renewal to our ongoing research grant (R01 CA106912), HR-QOL in Colorectal Cancer Survivors with Stomas proposes a study of rectal cancer survivors using focus groups and mailed questionnaires. Health-related quality of life, work disability, behavioral and dietary adaptations, healthcare costs and long-term medical complications will be measured. The study will strengthen the evidence base regarding outcomes resulting from the surgical options now available for rectal cancer: permanent ostomy and rectal-sparing surgery. Greater knowledge of outcomes will enable patients and their physicians to be more fully informed at the time they are considering their available surgical options and will also enable development of clinical and self-help interventions and potential quality improvements in the current algorithms for care.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
2R01CA106912-04A1
Application #
7653542
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Aziz, Noreen M
Project Start
2004-09-15
Project End
2014-02-28
Budget Start
2009-05-20
Budget End
2010-02-28
Support Year
4
Fiscal Year
2009
Total Cost
$444,408
Indirect Cost
Name
University of Arizona
Department
Surgery
Type
Schools of Medicine
DUNS #
806345617
City
Tucson
State
AZ
Country
United States
Zip Code
85721
Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia et al. (2018) Ongoing ostomy self-care challenges of long-term rectal cancer survivors. Support Care Cancer 26:3933-3939
Sun, Virginia; Wendel, Christopher S; Demark-Wahnefried, Wendy et al. (2018) Diet and Behavior Modifications by Long-term Rectal Cancer Survivors to Manage Bowel Dysfunction-Associated Symptoms. Nutr Cancer :1-11
Alavi, Mubarika; Wendel, Christopher S; Krouse, Robert S et al. (2017) Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis. Ann Surg Oncol 24:3596-3603
Mcmullen, Carmit; Liu, Liyan; Bulkley, Joanna E et al. (2017) Participation in Activities Associated With Quality of Life for Long-Term Survivors of Rectal Cancer. Perm J 21:
Hornbrook, Mark C; Grant, Marcia; Wendel, Christopher et al. (2017) Rectal Cancer Survivors' Participation in Productive Activities. Perm J 22:
Krouse, Robert S; Wendel, Christopher S; Garcia, David O et al. (2017) Physical activity, bowel function, and quality of life among rectal cancer survivors. Qual Life Res 26:3131-3142
Chongpison, Yuda; Hornbrook, Mark C; Harris, Robin B et al. (2016) Self-reported depression and perceived financial burden among long-term rectal cancer survivors. Psychooncology 25:1350-1356
McMullen, Carmit K; Bulkley, Joanna E; Altschuler, Andrea et al. (2016) Greatest Challenges of Rectal Cancer Survivors: Results of a Population-Based Survey. Dis Colon Rectum 59:1019-1027
Herrinton, Lisa J; Altschuler, Andrea; McMullen, Carmit K et al. (2016) Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery. CA Cancer J Clin 66:387-97
Sun, Virginia; Grant, Marcia; Wendel, Christopher S et al. (2016) Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors. J Sex Med 13:1071-9

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