Relationships between Anxiety, Depression, Low Anterior Resection Syndrome, and Quality of Life Following Lower Anterior Resection for Rectal Cancer

Eun Lee; Keum Soon Kim

doi:10.16952/pns.2014.11.1.74

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Lee and Kim: Relationships between Anxiety, Depression, Low Anterior Resection Syndrome, and Quality of Life Following Lower Anterior Resection for Rectal Cancer

Original Article

Perspectives in Nursing Science 2014;11(1):74-85.

Published online: 20 April 2014

DOI: https://doi.org/10.16952/pns.2014.11.1.74

Relationships between Anxiety, Depression, Low Anterior Resection Syndrome, and Quality of Life Following Lower Anterior Resection for Rectal Cancer

Eun Lee¹, Keum Soon Kim²

¹RN, Samsung Medical Center, Seoul, Korea

²Professor, Collegeof Nursing, Seoul National University, Seoul, Korea

Corresponding author: Lee, Eun 8th Floor East ward, Cancer Center, Samsung Medical Center, 81 Irwon-ro Gangnam-gu, Seoul 135-710, Korea. Tel: +82-10-9450-0102, Fax: +82-3410-0850, E-mail: 82lefox@naver.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study wastoinvestigatethe relationshipsbetweenanxiety, depression, low anterior resection syndrome, and qualityof life after lower anterior resectionfor rectal cancer.

Methods

Theparticipants ofthisstudy were 105 rectal cancer patientswho visitedtheoutpatient departmentof a hospitalin Seoulfor treatment or follow-up consultations. Data were collected using self-reportedquestionnaires and clinical records. To measurethevariables, theHospital AnxietyandDepressionScale, Low Anterior ResectionSyndromeScore, and Qualityof LifeQuestionnaire-Core 30wereutilized. Dataweresubsequently analyzed usingtheSPSS/WIN 20.0 program.

Results

Low anterior resectionsyndromewas more severeamong patientswhose cancer was located closerto theanus, and had agreater rangeof resectioninthosewhoreceivedneoadjuvant treatment. Whenanxi-ety, depression, and low anterior resection syndrome score were higher, quality of life scores were lower.

Conclusion

These results suggest that low anterior resection syndrome may negatively impact quality of life. Therefore, it is necessary to provide patients with symptom management support/assistance through evidence-basednursinginterventions, andevaluations oflow anterior resection syndrometo relieveanxietyandde-pression, and thus enhance quality of life.

Keywords: Rectal cancer, Anxiety, Depression, Fecal incontinence, Quality of life

References

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Table 1.

General Characteristics of the Participants (N=105)

Characteristics	Categories	n (%)
Age (year)	40 ＜	1 (1.0)
	40∼49	17 (16.2)
	50∼59	46 (43.8)
	60∼69	29 (27.6)
	70 ≥	12 (11.4)
Gender	Male	70 (66.7)
	Female	35 (33.3)
Level of education	None	3 (2.9)
	Elementary school	5 (4.8)
	Middle school	16 (15.2)
	High school	42 (40.0)
	Above college	39 (37.1)
Marital status	Married	100 (95.2)
	Divorce	1 (1.0)
	Separation Separation by deat	h 2 (1.9) 2 (1.9)
Current main caregiver	No (self)	7 (6.7)
	Spouse	95 (90.5)
	Children	3 (2.9)
Religion	No	55 (52.4)
	Protestant	23 (21.9)
	Catholic Buddhist	13 (12.4) 14 (13.3)
Over 4 kg weight	No	101 (96.2)
loss for 1month	Yes	4 (3.8)
Monthly Income	100 ＜	18 (17.1)
(10,000 won)	100∼199	24 (22.9)
	200∼299	38 (36.2)
	300∼399 400∼499	20 (19.0) 4 (3.8)
	500 ≥	1 (1.0)
Job	Full time job	24 (22.9)
	Part time job	26 (24.8)
	Not have	9 (8.6)
	Housewife	27 (25.7)
Cohabitant	Alone Spouse	6 (5.7) 59 (56.2)
	Children	3 (2.9)
	Spouse & children	37 (35.2)

Table 2.

Disease Related Characteristics of the Participants (N=105)

Characteristics	Categories	n (%)	M±SD	Min∼Max
LAR operation method	Laparotomy	42 (40.0)
	Laparoscopic operation	62 (59.0)
	Robot operation	1 (1.0)
Range of resection	TME	99 (94.3)
	PME	6 (5.7)
Stage of cancer	Stage 1	28 (26.7)
	2	29 (27.6)
	3	48 (46.7)
Neoadjuvant therapy	None. Chemotherapy	70 (66.7) 3 (2.9)
	Radiation	1 (1.0)
	CCRT (Chemo+Radiation)	31 (29.5)
Adjuvant therapy	None.	41 (39.0)
	Chemotherapy	47 (44.8)
	CCRT (Chemo+Radiation)	17 (16.2)
Temporary ostomy retention	No Yes	67 (63.8) 38 (36.2)
Current treatment	None	102 (97.1)
	Chemotherapy	1 (1.0)
	CCRT (Chemo+Radiation)	2 (1.9)
Comorbidity	No	80 (76.2)
	yes	25 (23.8)
Smoking history	No smoker	57 (54.3)
	Ex-smoker	46 (43.8)
	Current smoker	2 (1.9)
Alcohol history	No alcoholism	39 (37.1)
	Ex-alcoholism	53 (50.5)
	Current alcoholism	13 (12.4)
Tumor location	0∼5	31 (29.5)	7.72±3.63	1∼15
(distance from AV cm)	6∼10	55 (52.4)
	11∼15	19 (18.1)
Transitional period after surgery	4∼11	15 (14.3)	28.42±16.39	4∼59
(month)	12∼23	34 (32.4)
	24∼35	20 (19.0)
	36∼47	17 (16.2)
	48∼59	19 (18.1)

LAR=low anterior resection; TME=total mesorectal excision; PME=partial mesorectal excision; CCRT=combined chemotherapy and radiation therapy; AV=anal verge.

Table 3.

Descriptive Statistics of the Measured Variables (N=105)

Variables	Categories	n (%)	M±SD	Min-Max
Anxiety	Normal (0∼7)	99 (94.2)	3.26±2.88	0∼9
	Borderline case (8∼10)	5 (4.8)
	Probable case (11) ≥	1 (1.0)
Depression	Normal (0∼7)	95 (90.6)	4.01±2.62	0∼12
	Borderline case (8∼10)	9 (8.6)
	Probable case (11) ≥	1 (1.0)
LARS score	No LARS (0∼20)	46 (43.8)	24.22±11.56	0∼41
	Minor LARS (21∼29)	13 (12.4)
	Major LARS (30∼42)	46 (43.8)
Quality of life	General Health status		68.80±15.15	33∼100
	Functional status		87.12±8.99	56∼100
	Symptom experience		10.31±7.71	0∼30.86

Table 4.

Low Anterior Resection Syndrome Score according to Clinical Characteristics (N=105

Variables	Categories	n (%)	LARS score			Scheffé
Variables	Categories	n (%)	M±SD	F	p	Scheffé
Range of excision	TME	99	25.17±11.05	12.843	.001
	PME	6	8.66±8.68
Tumor location (distance from AV cm)	0∼5^a 6∼10^b 11∼15^c	31 55 19	29.32±11.00 23.80±10.11 17.15±12.86	7.415	.001	a c ＞
Neoadjuvant therapy	Yes	35	29.08±10.10	10.075	.002
	No	70	21.80±11.54
Temporary ostomy retention	Yes	39	29.97±9.74	17.801	.001 ＜
	No	66	20.83±11.26

TME=total mesorectal excision; PME=partial mesorectal excision; AV=anal verge.

Table 5.

Quality of Life According to Clinical Characteristics (N=105)

Variables	Categories	n	Quality of Life
			General health status		Functional status		Symptom experience
			M±SD	F (p)	M±SD	F (p)	M±SD	F (p)
Range of excision	TME PME	99 6	67.92 83.33 ±14.98 ±10.54	6.131 (.015)	86.75 93.16 ±9.02 ±6.16	2.926 (.090) 1	10.58 5.86 ±7.76 ±5.68	2.137 (.147)
Tumor Location (distance from AV; cm)	0∼5^a 6∼10^b 11∼15^c	31 55 19	63.70 68.03 79.38 ±17.15 ±13.49 ±11.23	7.226 (.001) c a, ＞ b	84.64 87.20 90.97 ±10.00 ±8.24 ±8.39	3.008 1 1	12.44 10.16 7.24 ±8.75 ±7.07 ±6.96	2.788 (.066)
Received neoadjuvant	Yes	35	61.66 ±15.81	13.005	85.23 ±8.70	2.337 1	14.33 ±7.70	16.418
therapy	No	70	72.38 ±13.57	(.001) ＜	88.06 ±9.04	(.127)	8.29 ±6.94	(.001) ＜
Temporary ostomy	Yes	39	63.88 ±14.97	6.911	83.64 ±9.13	10.119 1	13.72 ±8.06	13.593
retention	No	66	71.71 ±14.60	(.010)	89.18 ±8.30	(.002)	8.29 ±6.79	(.001) ＜

TME=total mesorectal excision; PME=partial mesorectal excision; AV=anal verge; a, b, c=Scheffe test. ́

Table 6.

Correlations among the Measured Variables

Variables	LARS score	Anxiety	Depression	Quality of Life
Variables	LARS score	Anxiety	Depression	General health status	Functional status	Symptom experience
Tumor location (distance from AV)	) -.454 (.001) ＜
Anxiety	.445 (.001) ＜
Depression	.530 (.001) ＜	.516 (.001 ＜	)
QOL General health status	–.648 (.001) ＜	–.536 (.001 ＜	1) −652 (.001) ＜
Functional status	–.612 (.001) ＜	–.616 (.001 ＜	1) −692 (.001) ＜	.737 (.001) ＜
Symptom experience	.592 (.001) ＜	.517 (.001 ＜	) 653 (.001) ＜	–.713 (.001) ＜	–.686 (.001) ＜

Table 7.

Variables Predicting Quality of Life

Classification	Predicting variables	R²	Adjusted R²	R² change	F	p
General health status	Depression Depression, LARS score Depression, LARS score, anxiety	.425 .553 .576	.419 .544 .563	.425 .128 .023	76.093 62.967 45.745	.001 ＜ .001 ＜ .001 ＜
Functional status	Depression Depression, anxiety Depression, Anxiety LARS score	.478 .570 .620	.473 .561 .609	.478 .092 .050	94.411 67.500 54.955	.001 ＜ .001 ＜ .001 ＜
Symptom experience	Depression Depression, LARS score Depression, LARS score, anxiety	.426 .510 .532	.421 .501 .518	.426 .084 0.22	76.467 53.127 38.213	.001 ＜ .001 ＜ .001 ＜

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