E114: Insights into Challenges Faced by Cancer Patients Undergoing Fecal Ostomy Surgery

Patients with colorectal cancer often require fecal ostomies. The ostomy can contribute to decreased patient quality of life. This study aims to 1) describe challenges experienced by patients undergoing surgery with an ostomy and 2) explore resources needed to combat these challenges.

Methods:

Colorectal cancer patients 21-90 days after surgery requiring an ostomy were recruited from a single academic hospital. Individual semi-structured interviews were conducted. A hybrid deductive-inductive coding approach was used, and thematic analysis performed. Thematic saturation was reached.

Results:

Fifteen patients (80% male, mean age 59) were interviewed. Preoperatively, many patients reported challenges with thinking about caring for the stoma as they didn’t know what to expect or could not really process what it would entail until after surgery. Most patients also reported preoperative emotional distress, which was often related to the upcoming surgery or their cancer diagnosis, rather than the ostomy itself. Postoperatively, patients frequently described challenges with ostomy care, including appliance leaks, skin irritation/breakdown, obtaining the right appliance, and ordering supplies. Supply issues primarily included changes in products needed the first few weeks after surgery (e.g., stoma evolution). Many patients noted fear or reluctance to go out in public or back to work given concerns about leakage or issues with their ostomy. In addition, many patients experienced embarrassment with having the ostomy and significant anxiety. Some noted difficulty coming to terms with caring for the stoma and returning to their daily lives. Several patients described being given conflicting information by different team members regarding ostomy care. Some patients noted difficulties in reaching the clinical team when they needed advice. A few stated there were miscommunications regarding the likelihood or duration of having a stoma. Needed resources included: opportunity to talk to past patients about their experiences, centralized repository of educational materials, and emphasis on key aspects of stoma care or self-care (e.g., ordering supplies, hydration).

Conclusions:

Patients with colorectal cancer who require ostomy surgery continue to face many challenges related to stoma care, emotional distress, and adapting to daily life. There are significant opportunities to improve education and expectation setting for patients via standardized communication interventions, as well as available resources to help mitigate these challenges.