Abstract
BACKGROUND: Many colorectal cancer (CRC) patients require stoma creation following surgical resection. Stomas can significantly impact health-related quality of life (HRQOL), yet prospective longitudinal studies exploring this are limited. This study aimed to assess HRQOL among CRC patients comparing between those with and without stomas, and examining differences between subgroups. METHODS: This prospective longitudinal study was conducted across five hospitals in Singapore from 2018 to 2023. CRC patients undergoing surgical resection were assessed at six timepoints from diagnosis to 12-month post-surgery. HRQOL was measured using the EORTC QLQ-C30 instrument. Multilevel mixed-effects tobit regression models were used to evaluate HRQOL changes over time and identify significant predictors of HRQOL outcomes. RESULTS: Among 240 patients, 91 (37.9%) underwent stoma creation. Stoma patients reported significantly poorer HRQOL, particularly in global health status and functional domains at 1 month post-surgery, which persisted into the 3-month timepoint for role (77.43 vs. 86.67, p < 0.05) and emotional (82.11 vs. 90.20, p < 0.05) functioning. Stoma creation predicted reduced physical (β = -10.39, 95% CI: -15.80, -4.97) and role functioning (β = -12.24, 95% CI: -24.38, -0.10). Subgroup differences were mostly non-significant, except for consistently lower cognitive functioning scores in patients with permanent as opposed to temporary stomas (e.g., 1 month; 73.08 vs. 91.19, p < 0.025). CONCLUSIONS: Stoma creation adversely affects HRQOL, particularly in the early postoperative period. Comprehensive post-surgical support addressing physical, psychological, and financial challenges may be crucial to enhance overall HRQOL for stoma patients. Further research should explore tailored support strategies and the effect of early versus delayed stoma closure on HRQOL outcomes.