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Patient responses to bowel disease

Research looks at factors which inform patient preferences for different treatment outcomes.

This is a photo of a doctor and patient

Bowel cancer, also known as colorectal cancer, refers to cancer which starts in the large bowel (colon) and the back passage (rectum). Colorectal cancer is currently the third most common cancer and fourth leading cause of cancer death worldwide. Surgery and radiotherapy can reduce the chance of rectal cancer recurring, however both treatments can adversely affect a person’s bowel function and poor bowel function may result in the need for a permanent stoma- where medical intervention leads to a patient’s bowel movement occurring from an opening in the stomach connecting the bowel to an external pouch.

What we’re researching:

Dr Anne Miles, Reader, Department of Psychological Sciences and a team are one year into a two-year research programme to examine factors which are most important to people in making a decision on the rectal cancer treatments available to them: Reducing their risk of recurrence, avoiding a permanent stoma and/or having good bowel function. Additionally, the research will also be able to see what level of poor bowel function people will put up with in order to avoid needing a permanent stoma and whether this varies by age, gender or disease stage at diagnosis.

The research team will interview rectal cancer patients about what was important to them when making decisions about their cancer treatment and will send questionnaires to patients to assess which factors influence their treatment preferences and identify any treatment-related regret.

Increasing numbers of people are surviving colorectal cancer, and greater attention is now paid to the challenges that cancer survivors face following treatment for a life-threatening condition. One quarter of people diagnosed with colorectal cancer will have rectal cancer and may be offered surgery and/ or radiotherapy, with up to a quarter of patients requiring a permanent stoma.

The potential benefits of both surgery and radiotherapy are the associated reductions in the risk of recurrence. However, both surgery and radiotherapy can cause bowel incontinence, and increase the likelihood of patients requiring a permanent stoma. Current National Institute for Health and Care Excellence (NICE) guidance states that patients with medium-level risk of recurrence should be considered for pre-operative radiotherapy while surgery should only be offered to low risk of recurrence patients.

However, there is evidence of decisional regret among prostate cancer patients following surgery because of the impact of such treatment on sexual and urinary function and rectal cancer survivors may express similar levels of regret following surgery for their cancer.

Fully informing patients of the likelihood of problems following different treatments is therefore important in reducing post-treatment regret, and knowing what level of bowel function patients will tolerate, in exchange for reducing their risk of recurrence following different treatments, is also critical to enabling patients to make decisions about their treatment.

This is a photo of a hospital bed

What the impact will be:

The research will help inform health care professionals about the factors patients find important in making decisions about their treatment. This project will answer the question: “What level of poor function is justified to avoid a permanent stoma?” from the perspective of people with rectal cancer. The research will form the basis of future research into providing information to help patients make informed decisions about their treatment for rectal cancer.

Project Fact-File:

  • Full project title: “The role of risk of recurrence, bowel function and avoidance of a permanent stoma in patient preferences for treatment for rectal cancer”
  • Project funding: £58,142
  • FunderBowel Disease Research Foundation  
  • Length of award: 1 July 2019 to 27 May 2021  
  • People: Principal Investigator: Dr Anne Miles, Reader in Psychology, Birkbeck, University of London; Co-investigators: Professor Robert Steele University of Dundee; Professor Steve Morris, University of Cambridge; Gemma Hutton, Post-Doctoral Researcher, Birkbeck, University of London; Grieg Stanners, Information Services Division, NHS National Services, Scotland.

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