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Zentralbl Chir 2005; 130(5): 393-399
DOI: 10.1055/s-2005-836878
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© Georg Thieme Verlag Stuttgart · New York

Sexualität und Lebensqualität bei Patienten mit Rektumkarzinomen

Quality of Life and Sexuality after Surgery for Rectal Cancer - A Follow-up StudyC. Schmidt1 , B. Bestmann2 , H. Lindemann3 , T. Küchler2 , M. Löhnert4 , B. Kremer1
  • 1Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • 2Referenzzentrum Lebensqualität in der Onkologie, Universitätsklinikum Schleswig Holstein, Campus Kiel
  • 3Städtisches Krankenhaus Kiel, Abteilung für Chirurgie, Kiel
  • 4Städtisches Klinikum Bielefeld Rosenhöhe, Bielefeld
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Publication Date:
11 October 2005 (online)

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Zusammenfassung

Studien zur Lebensqualität (LQ) bei Patienten mit Rektumkarzinom haben gezeigt, dass die Sexualfunktion nach Operation bei Frauen besser ist als bei Männern und stark vom Operationsverfahren abhängt. Die Mehrzahl der Studien konnte jedoch wegen kleiner Fallzahlen und fehlender Adjustierung von Störgrößen keine konsistenten Aussagen treffen. Ziel der vorliegenden Studie war es, Sexualfunktion und geschlechtsspezifische Unterschiede bei Patienten mit Rektumkarzinomen zu untersuchen. Eingeschlossen wurden 570 Patienten, die von Januar 1992 bis Januar 1999 operiert worden waren. Nach Feststellung des Überlebensstatus konnten 325 Patienten postalisch mit dem EORTC-QLQ-C-30 und einem tumorspezifischen Modul befragt werden. 245 Patienten waren tumorassoziiert verstorben, 51 (15,6 %) Patienten lehnten die Teilnahme ab, 215 Fragebogen konnten ausgewertet werden. Von den Patienten waren 103 weiblich, 112 männlich, das Durchschnittsalter lag bei 63,71 (± 10,1) Jahren, die durchschnittliche Überlebenszeit nach zwei Jahren bei 81,3 % und nach fünf Jahren bei 77,5 %. Die zu untersuchenden Kollektive waren vergleichbar. Patienten nach abdomino-perinealer Rektumresektion waren stärker in ihrer Sexualfunktion eingeschränkt als Patienten mit anderen OP-Verfahren. Männer werden durch die OP signifikant stärker in ihrer Sexualfunktion eingeschränkt als Frauen und fühlen sich dadurch stärkerem Stress ausgesetzt. Frauen fühlen sich hingegen durch die medizinische Behandlung insgesamt stärker belastet, was sich in höheren Skalenwerten für Fatigue und Schlaflosigkeit widerspiegelt. Es bestehen geschlechtsspezifische Unterschiede in der Wahrnehmung der postoperativen LQ bei Patienten mit Rektumkarzinom. Die Art des Operationsverfahrens beeinflusst die Sexualfunktion signifikant. Aufgrund des retrospektiven Designs muss die Studie jedoch prospektiv wiederholt werden, um verlässliche Aussagen zur postoperativen LQ machen zu können. Dies wird zur Zeit in einem Modellvorhaben in Kiel umgesetzt.

Abstract

Background: Previous studies have suggested that sexuality following surgery for rectal cancer is better in women than in men and differs with type of surgery in terms of impact on Quality of Life. However, the findings were inconsistent. The aim of the presented study was to address these issues. Methods: 570 patients that had undergone surgery for rectal cancer in our department from 1992 to 1999 were included. After determination of survival status questionnaires on Quality of Life were sent to 370 patients one to two years post surgery. We analysed data from 215 patients of which 103 were female and 112 male. 248 patients died during the time observed. Statistical analysis was done with descriptive methods, Kaplan-Meier analysis (log rank test), T-test and analysis of variance using SPSS 11.0 for Windows. Results: Significant differences were seen in symptom scales between men and women. Women scored higher for distress through medical treatment and had higher values for insomnia, fatigue and constipation. Both sexes had impaired sexual life but men had significantly higher values and felt more distressed by the impairment of sexuality than women. For patients receiving abdominoperineal resection sexuality was most impaired. Anterior resection with pouch had a detrimental effect on diarrhoea and treatment strain. Conclusion: The study showed that sexuality is influenced by gender and type of surgery and impacts Quality of Life after surgery for rectal cancer. Assessing quality of life with generic and specific instruments is helpful to determine differences between surgical procedures, age, gender, and adjuvant therapy where standard parameters such as survival have their limitations.

Schlüsselwörter

Lebensqualität - Rektumkarzinom - Sexualität - Geschlechtsunterschiede

Key words

rectal cancer - sexuality - gender - quality of life - outcome

Literatur

  • 1 Aaronson N K, Ahmedzai S, Bergman B. The European Organization for Research and Treatment of Cancer. QLQ C-30: A Quality of Life instrument for use in international clinical trials in oncology.  J Natl Cancer Inst. 1993;  85 365-376
    CrossrefPubMedGoogle Scholar
  • 2 Alley P G, McNee R K. Age and sex differences in right colon cancer.  Dis Colon Rectum. 1986;  29 227-229
    PubMedGoogle Scholar
  • 3 Anthony T, Hynan L S, Rosen D. et al . The association of pretreatment health-related quality of life with surgical complications for patients undergoing open surgical resection for colorectal cancer.  Ann Surg. 2003;  238 690-696
    PubMedGoogle Scholar
  • 4 Balslev I, Harling H. Sexual dysfunction following operation for carcinoma of the rectum.  Dis Colon Rectum. 1983;  26 785-788
    PubMedGoogle Scholar
  • 5 Becker N, Muscat J E, Wynder E L. Cancer mortality in the United States and Germany.  J Cancer Res Clin Oncol. 2001;  127 293-300
    CrossrefPubMedGoogle Scholar
  • 6 Bortz J, Döring N. Forschungsmethoden und Evaluation für Sozialwissenschaftler. Springer, Berlin, Heidelberg, New York 1995
    Google Scholar
  • 7 Camilleri-Brennan J, Steele R JC. Prospective analysis of Quality of Life and survival following mesorectal excision for rectal cancer.  Br J Surg. 2001;  88 1617-1622
    CrossrefPubMedGoogle Scholar
  • 8 Chatwin N A, Ribordy M, Givel J C. Clinical outcomes and quality of life after low anterior resection for rectal cancer.  Eur J Surg.. 2002;  168 297-301
    CrossrefPubMedGoogle Scholar
  • 9 Chorost M I, Weber T K, Lee J, Rodriguez-Bigas M A, Petrelli N J. Sexual dysfunction, informed consent and multimodality therapy for rectal cancer.  Am J Surg. 2000;  179 271-274
    CrossrefPubMedGoogle Scholar
  • 10 Coates A, Porzsold F, Osoba D. Quality of Life in oncology practice: prognostic value of EORTC QLQ-C-30 scores in patients with advanced malignancies.  Eur J Cancer. 1997;  33 1025-1030
    CrossrefPubMedGoogle Scholar
  • 11 Cramer J A, Spilker B. Quality of Life and Pharmacoeconomics - An Introduction. Lippincott-Raven, Phildelphia 1997; 95-149
    Google Scholar
  • 12 Curran D, Fayers P M, Molenberg G, Machin D. Analysis of incomplete Quality of Life data in clinical trials. In: Staquet MJ, Hays RD, Fayers MP (eds). Quality of Life Assessment in Clinical Trials - Methods and Practice. Oxford University Press, Oxford, New York, Tokyo 1998; 249-280
    Google Scholar
  • 13 Danzi M, Ferulano G P, Abate S, Califano G. Male sexual function after abdominoperineal resection for rectal cancer.  Dis Colon Rectum. 1983;  26 665-668
    PubMedGoogle Scholar
  • 14 Davidson-Homewood J, Norman A, Küchler T, Cunningham D, Watson M. Development of a disease specific questionnaire to supplement a generic tool for QoL in colorectal cancer.  Psychooncology. 2003;  12 675-685
    CrossrefPubMedGoogle Scholar
  • 15 DeCosse J J, Ngoi S S, Jacobson J S, Cennerazzo W J. Gender and colorectal cancer.  Eur J Cancer Prev. 1993;  2 105-115
    PubMedGoogle Scholar
  • 16 Dew M A, Simmons R G. The advantage of multiple measures of quality of life.  Scand J Urol Nephrol. 1990;  131 23-30
    PubMedGoogle Scholar
  • 17 Dibble S L, Padilla G V, Dodd M J, Miaskowski C. Gender differences in the dimensions of quality of life.  Oncol Nurs Forum. 1998;  25 577-583
    PubMedGoogle Scholar
  • 18 Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H J, Hölzel D. Quality of Life in rectal cancer patients: A four-year prospective study.  Ann Surg. 2003;  238 203-213
    CrossrefPubMedGoogle Scholar
  • 19 Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D. Comparison of breast and rectal cancer patients' quality of life: results of a four year prospective field study.  Eur J Cancer Care. 2003;  2 215-223
    PubMedGoogle Scholar
  • 20 Enker W E. Potency, cure, and local control in the operative treatment of rectal cancer.  Arch Surg. 1992;  127 1396-1402
    PubMedGoogle Scholar
  • 21 EORTC study group .EORTC study group on quality of Life. EORTC Quality of life questionnaires. Verfügbar unter: http://www.eortc.be/home/qol/modules.htm. Letzter Zugriff: 15. November 2003
    Google Scholar
  • 22 Fayers P, Aaronson N, Bjordal K, Sullivan M. EORTC QLQ-C30 Scoring Manual. EORTC Quality of Life Study Group, Brussels 1995
    Google Scholar
  • 23 Fazio V W, Fletcher J, Montague D. Prospective study of the effect of resection of the rectum on male sexual function.  World J Surg. 1980;  4 149-152
    PubMedGoogle Scholar
  • 24 Ganz P A, Lee J J, Siau J. Quality of life assessment. An independent prognostic variable for survival in lung cancer.  Cancer. 1991;  67 3131-3135
    CrossrefPubMedGoogle Scholar
  • 25 Gott M, Hinchliff S. How important is sex in later life? The views of older people.  Soc Sci Med. 2003;  56 1617-1628
    CrossrefPubMedGoogle Scholar
  • 26 Heald R J, Ryall R DH. Recurrence and survival after total mesorectal excision for rectal cancer.  Lancet. 1986;  28 1479-1482
    PubMedGoogle Scholar
  • 27 Henne-Bruns D, Vogel I, Marxen J, Papachrysanthou A, Förster J, Rüschmann H, Buschmann P, Baxmann M, Kremer B. Operative Onkologie: Mögliche Wege zur Finanzierung komplexer onkologischer Therapieverfahren.  Langenbecks Archiv of Surg. 1997;  2 345-364
    PubMedGoogle Scholar
  • 28 Hjermstad M J, Fayers P M, Bjorndal K, Kaasa S. Using reference data on quality of life - the importance of adjusting for age and gender, exemplified by the EORTC-C30 [+ 3].  Eur J Cancer. 1998;  34 1381-1389
    CrossrefPubMedGoogle Scholar
  • 29 Hjortrup A, Kirkegaard P, Friis J, Sanders S, Andersen F. Sexual dysfunction after low anterior resection for midrectal cancer.  Acta Chir Scand. 1984;  150 687-688
    PubMedGoogle Scholar
  • 30 Holm T, Singnomklao T, Rutquist L -E, Cedermark B. Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long-term follow-up of two randomized trials.  Cancer. 1996;  78 968-976
    CrossrefPubMedGoogle Scholar
  • 31 Kaasa S, Mastekaasa A, Lund E. Prognostic factors for patients with inoperable non-small cell lung cancer, limited disease. The importance of patients' subjective experience of disease and psychosocial well-being.  Radiother Oncol. 1989;  15 235-242
    PubMedGoogle Scholar
  • 32 Kim N K, Aahn T W, Park J K, Lee K Y, Lee W H, Sohn S K, Min J S. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer.  Dis Colon Rectum. 2002;  45 1178-1185
    CrossrefPubMedGoogle Scholar
  • 33 Koller M, Lorenz W. Quality of life research in patients with rectal cancer: traditional approaches versus a problem-solving oriented perspective.  Langenbecks Arch Surg. 1998;  383 427-436
    CrossrefPubMedGoogle Scholar
  • 34 Küchler T, Bullinger M. Onkologie. In: Ravens-Sieberer U, Cieza A (Hrsg). Lebensqualität und Gesundheitsökonomie in der Medizin. Konzepte - Methoden - Anwendungen. Ecomed, Landsberg 2000; 144-158
    Google Scholar
  • 35 Küchler T, Henne-Bruns D, Rappat S, Graul J, Holst K, Williams J I, Wood-Dauphinee S. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: “Survival results of a trial”.  Hepatogastronenterology. 1999;  46 322-325
    PubMedGoogle Scholar
  • 36 Law W L, Chu K W. Impact of total mesorectal excision on the results of surgery of distal rectal cancer.  Br J Surg. 2001;  88 1607-1612
    CrossrefPubMedGoogle Scholar
  • 37 Maas C P, Moriya Y, Steup W H, Klein Kranenbarg E, de Velde C J van. A prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands.  Eur J Surg Oncol. 2000;  26 751-757
    CrossrefPubMedGoogle Scholar
  • 38 Maisey N R, Norman A, Watson M, Allen M J, Hill M E, Cunningham D. Baseline Quality of Life predicts survival with advanced colorectal cancer.  Eur J Cancer. 2002;  38 1351-1357
    CrossrefPubMedGoogle Scholar
  • 39 Mak A C, Rich T A, Schultheiss T E, Kavanagh B, Ota D M, Romsdahl M M. Late complications of postoperative radiation therapy for cancer of the rectum and recto-sigmoid.  Int J Radiat Oncol Biol Phys. 1994;  28 597-603
    PubMedGoogle Scholar
  • 40 Mannaerts G H, Schijven M P, Hendrikx A, Martijn H, Rutten H J, Wiggers T. Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer.  Eur J Surg Oncol. 2001;  27 265-272
    CrossrefPubMedGoogle Scholar
  • 41 Maurer C A, Z'Graggen K, Renzulli P, Schilling M K, Netzer P, Buchler M W. Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery.  Br J Surg. 2001;  88 1501-1505
    PubMedGoogle Scholar
  • 42 McArdle C S, McMillan D C, Hole D J. Male gender adversely affects survival following surgery for colorectal cancer.  Br J Surg. 2003;  90 711-715
    CrossrefPubMedGoogle Scholar
  • 43 Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri L M. Bladder and sexual dysfunction after mesorectal excision for rectal cancer.  Br J Surg. 2000;  87 206-210
    CrossrefPubMedGoogle Scholar
  • 44 Olschewski M, Schulgen G, Schumacher M, Altmann D G. Quality of Life assessment in clinical cancer research.  Br J Cancer. 1994;  70 1-5
    PubMedGoogle Scholar
  • 45 Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E. A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer.  Surgery. 2002;  131 368-372
    CrossrefPubMedGoogle Scholar
  • 46 Quah H M, Jayne D G, Eu K W, Seow-Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer.  Br J Surg. 2002;  89 1551-1556
    CrossrefPubMedGoogle Scholar
  • 47 Ramsey S D, Berry K, Mooinpur C, Giedzinska A, Andersen M R. Quality of Life in long term survivors of colorectal cancer.  Am J Gastroenterol. 2002;  97 1228-1234
    CrossrefPubMedGoogle Scholar
  • 48 Renner K, Rosen H R, Novi G, Holbling N, Schiessel R. Quality of Life after surgery for colorectal cancer: do we still need a permanent colostomy?.  Dis Colon Rectum. 1999;  42 1160-1167
    PubMedGoogle Scholar
  • 49 Santangelo M L, Romano G, Sassaroli C. Sexual function after resection for rectal cancer.  Am J Surg. 1987;  154 502-504
    CrossrefPubMedGoogle Scholar
  • 50 Sapp A L, Trentham-Dietz A, Newcomb P A, Hampton J M, Moinpour C M, Remington P L. Social networks and Quality of Life among female long-term colorectal cancer survivors.  Cancer. 2003;  98 1749-1758
    CrossrefPubMedGoogle Scholar
  • 51 Schmidt C E, Bestmann B, Longo W E, Küchler T, Kremer B. Prospective evaluation of quality of life of patients receiving either abdominoperineal resection or sphincter preserving procedure for rectal cancer.  Ann Surg Oncol. 2005;  12 117-123
    CrossrefPubMedGoogle Scholar
  • 52 Schmidt C E, Bestmann B, Küchler T, Kremer B. Factors influencing sexual function in patients with rectal cancer.  International Journal of Impotence Research. 2005;  17 231-238
    CrossrefPubMedGoogle Scholar
  • 53 Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC-QLQ-C-30 in general German population.  Eur J Cancer. 2001;  37 1345-1351
    CrossrefPubMedGoogle Scholar
  • 54 Slors F J, Zuijlen P P van, Dijk G J van. Sexual and bladder dysfunction after total mesorectal excision for benign diseases.  Scand J Gastroenterol. 2000;  232 (Suppl) 48-51
    PubMedGoogle Scholar
  • 55 Smith M M, Schmall V L. Knowledge and attitudes toward sexuality and sex education of a select group of older people.  Gerontol Geriatr Educ. 1983;  3 259-269
    PubMedGoogle Scholar
  • 56 Spilker B. Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd edition. Lippencott-Raven, Philadelphia 1996
    Google Scholar
  • 57 Sprangers M A, Cull A, Groenvold M, Bjordal K, Blazeby J, Aaronson N K. EORTC Quality of Life Study Group . The European Organization for Research and Treatment of Cancer approach to developing questionnaire modules: An update and overview.  Qual Life Res. 1998;  7 291-300
    CrossrefPubMedGoogle Scholar
  • 58 Sprangers M A, te Velde A, Aaronson N K. European Organization for research and Treatment of Cancer Study Group on Quality of Life . The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module [QLQ-CR38].  Eur J Cancer. 1999;  35 238-247
    CrossrefPubMedGoogle Scholar
  • 59 Thybusch A, Schmidt C, Küchler T, Henne-Bruns D, Kremer B. Quality of Life of gastric cancer patients following gastrectomy.  World J Surg. 1999;  23 503-508
    PubMedGoogle Scholar
  • 60 Ware J E, Snow K K, Kosinski M, Gandek B. SF 26 Health Survey: Manual and Interpretetation Guide. Oxford University Press, Oxford, New York 1989
    Google Scholar
  • 61 Weir H K, Thun M J, Hankey B F, Ries L A, Howe H L, Wingo P A, Jemal A, Ward E, Anderson R N, Edwards B K. Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control.  Natl Cancer Inst. 2003;  95 1276-1299
    CrossrefPubMedGoogle Scholar
  • 62 Wichmann M W, Muller C, Hornung H M, Lau-Werner U, Schildberg F W. Colorectal Cancer Study Group . Gender differences in long-term survival of patients with colorectal cancer.  Br J Surg. 2001;  88 1092-1098
    CrossrefPubMedGoogle Scholar
  • 63 Wood-Dauphinee S. Assessing quality of life in clinical research: from where have we come and where are we going?.  J Clin Epidemiol. 1999;  52 355-363
    CrossrefPubMedGoogle Scholar
  • 64 World Health Organization .The first ten years of the World Health Organization. World Health Organization, Genf 1958
    Google Scholar

Priv.-Doz. Dr. med. Christian E. SchmidtMPH 

Klinik für Allgemeine Chirurgie und Thoraxchirurgie · Universitätsklinikum Schleswig-Holstein · Campus Kiel

Arnold-Heller-Str. 7

24105 Kiel

Phone: 49/4 31/5 97 73 00

Fax: 49/4 31/5 97 73 73

Email: christian.schmidt@uk-sh.de

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