Factors influencing quality of life in patients with a colostomy due to rectal cancer: A retrospective cohort study with multivariate and subgroup analyses

Abstract

The quality of life (QOL) of patients with rectal cancer who have undergone colostomy surgery is influenced by various demographic, clinical and socioeconomic factors. Understanding these factors is crucial for improving patient outcomes and guiding clinical interventions. The present study aimed to evaluate the factors associated with QOL in patients with a colostomy following rectal cancer treatment, utilizing multivariate and subgroup analyses to identify key predictors and assess the robustness of the findings. The study was performed as a retrospective cohort study involving 134 patients. Data were collected on demographic character istics, clinical variables and QOL scores using the European Organization for Research and Treatment of Cancer QOL Questionnaire Core 30. Univariate analyses were performed to explore associations between individual factors and QOL. Multivariate linear and logistic regression analyses were also conducted to identify independent predictors of QOL. In addition, subgroup analyses were carried out based on sex, time since stoma surgery and residence, and sensitivity analyses were conducted to assess the impact of different data processing methods on the results. Univariate analysis revealed significant associations of higher educational levels, certain occupations such as government officials and teachers, and higher per capita family income with higher QOL scores. Multivariate regression analysis confirmed that higher educa tion (B=7.89, P=0.001), independent stoma self care (B=9.45, P<0.001) and higher income (B=6.92, P=0.001) were strong independent predictors of improved QOL. Logistic regres sion revealed that patients with a university education or higher [odds ratio (OR)=0.38, P=0.045] and those with higher income (OR=0.36, P=0.027) were less likely to report a low QOL. Subgroup analysis highlighted the consistent impact of education and stoma self care ability across different patient groups, with independent stoma care being the most important factor for both sexes and across all time frames post surgery. Sensitivity analysis demonstrated that the QOL findings were robust across various methods of handling missing data, with no significant changes in outcomes. In summary, educational level, income and stoma self care ability were found to be the key determinants of QOL in patients with a colostomy following rectal cancer treatment. These findings highlight the need for targeted interventions to improve self care abilities and mitigate socioeconomic disparities in this patient population. The results of the study are robust across different analytical approaches, reinforcing the validity of the conclusions.