The evaluation of the consequences of diseases and treatments on patient-reported outcomes, such as QoL, has gained extensive attention [1–5, 17]. In fact, the diagnosis of cancer and the associated treatment process have considerable social, physical, psychological, and sexual impacts for both patients and their spouses. Little information is available regarding spouses’ QoL following colorectal cancer surgery. Depending on the localization of the colorectal carcinoma, either sphincter-saving or sphincter-sacrificing radical surgery can be performed. All procedures have a significant impact on patients’ QoL. The stoma itself can disrupt rectal function owing to the presence of a low anastomosis. Moreover, significant sexual and urological dysfunction has also been reported, mainly due to damage to the autonomic pelvic nerve plexus [18]. Colorectal cancer diagnosis and treatment are not isolated experiences [19]. Spouses are the most frequent providers of support to patients with colorectal cancer. Patients with cancer and their caregivers (e.g., spouses) experience emotional distress, physical problems, psychological difficulties, and sexual problems related to changes in their life [20, 21]. The present study aimed to evaluate the QoL following surgery for colorectal cancer, namely, AR, LAR, and APR, in both patients and their spouses during the same time frame.
The present study revealed a significant relationship between the disability levels of patients and their spouses in terms of both the total score and subscales (self-care, life activities, and participation in society) of the WHODAS-II. There were also positive correlations between the QoL of patients and their spouses for most of the subscales (bodily pain, general health, vitality, social function, emotional role, mental health, and MCS) of the SF-36. When the evaluations were conducted separately for each surgical procedure, there was an increase in postoperative disability levels in patients for all surgery types; however, the level of disability was minimal in patients following AR when compared with patients who underwent LAR or APR. Similarly, there was a decrease in the patient QoL for all surgery types during the postoperative period as measured by all subscales of the SF-36. However, this deterioration was minimal in the AR group when compared with the LAR and APR groups.
As hypothesized, we found decreases in the QoL scores over time in the spouses of patients with colorectal cancer when measured with the SF-36, specifically in the “vitality,” “social function,” “emotional role,” “mental health,” and MCS subscales. Additionally, we found an increase in spousal disability over time for the “life activity” and “participation in society” subscales and the total score of the WHODAS-II. Similarly, Badger et al. [22] showed that 25% of partners often suffer the same or higher levels of emotional distress compared with cancer survivors. In fact, cancer treatment, with its collateral side effects, produces physical and emotional disturbances that influence QoL. A study by Pereira et al. [23], which compared different modes of treatment (i.e., surgery, surgery plus chemotherapy, or surgery followed by radiotherapy) in colorectal cancer, demonstrated that patients who received only surgery had lower levels of depression, anxiety, and traumatic stress symptoms when compared with patients who received surgery plus chemotherapy or surgery plus radiotherapy. Similar results were found for the spouses of patients undergoing these treatments.
Previous studies on changes in the QoL of spouses of patients with breast and prostate cancer have not explored gender-related differences in QoL, as doing a gender-based comparison is only meaningful in gender nonspecific cancers such as colorectal cancer [6–8]. In the present study, there was an increase in postoperative disability for all subscales of the WHODAS-II for both genders, but these increases were not statistically significant except for the “life activities” subscale, which showed a significant increase the score among female patients and male patients’ spouses. The “participation in society” subscale also showed a significant increase among female patients’ spouses.
The results of the Ankara University Life Standards Questionnaire show that patients’ and spouses’ perceptions of their own general health and general QoL significantly decreased following patients’ surgeries. Many studies in the literature have compared patients who underwent LAR with patients who underwent APR, and the general consensus in these publications is that there exists a possibility of LAR syndrome in patients with very low-level anastomosis, which has a negative effect on QoL. In these patients, constipation, diarrhea, frequent stools, and the development of fecal incontinence is a major problem that decreases QoL [24–26]. In our study, when the types of surgery were compared, there was a distinct deterioration in the LAR group. However, there were no gender differences between the patients and spouses. We found that patients and their spouses tended to spend more time together and at home following surgery, especially in the LAR and APR groups. Interestingly, we found that male patients’ spouses spent significantly more time with their husbands and spent more time at home than female patients’ spouses. This situation significantly impacts the lifestyle of male patients’ spouses. As mentioned previously by Cakmak et al. [27], this may be because male patients are more willing to have their colostomy care managed by their wives. Changes in sex life were significantly more common following LAR and APR than in the AR group.
With regard to the religious attitudes of patients, the literature suggests that religion is an important factor in coping with cancer [28, 29]. Shaheen et al. [29] found that religiosity is associated with fewer depressive symptoms and fewer suicidal thoughts in Muslim patients with colorectal cancer. We found that religious activities, such as praying and fasting, decreased significantly in the LAR and APR groups when compared with the AR group, whereas there were no changes in praying and fasting in spouses. This is probably because of the importance of cleanliness and the desire to be free of any fecal material, especially when praying in Islam. We also found that fulfillment of religious duties decreased more among male patients than among female patients.
In conclusion, colorectal cancer surgery has a significant effect on the QoL of both patients and their spouses, with a greater impact on male patients’ spouses. Preoperative counseling regarding potential problems should therefore collectively address the patient and their spouse as a couple rather than the patient alone, particularly for patients undergoing LAR and APR procedures.