Authors (including presenting author) :
Yeung YK(1), lo HY(1), Ng SW(1), Yip HS(1), Leung RWC(1), Brigitte Fung(1), Lee KY(2), Wong MK(2), Lee WS(2), Kwok SY(2)
Affiliation :
(1)Physiotherapy Department, Kwong Wah Hospital, (2)Department of Surgery, Kwong Wah Hospital
Introduction :
According to Hong Kong Cancer Statistics of 2020, rectal cancer(14.9%) is the second commonest cancer in Hong Kong. Up to 80% of rectal cancer patients suffered from faecal incontinence(FI) and impaired bowel function after low anterior resection(LAR) of rectum with total mesorectal excision(TME). This multidisciplinary rehabilitation program was established for all rectal cancer patients in Kwong Wah Hospital. It is the only one existing in Hong Kong which acknowledge this problem in this population and provides rehabilitation accordingly.
Objectives :
To evaluate the efficacy of the enhanced rehabilitative program with multidisciplinary approach for rectal cancer patients.
Methodology :
After LAR of rectum, colorectal nurses and physiotherapists jointly consult post-operative patients at out-patient setting. They were assessed and educated on pelvic floor exercise, bowel management, perianal skin care and stoma care. Following the second operation to close the ileostomy, the joint consultation service was continued on a monthly basis for six months. Data analyzed were recorded at the first session and the sixth session post closure of ileostomy. Outcome measures were:(1)Faecal incontinence frequency per month(times), (2)Wexner score-severity of fecal incontinence, (3)Low anterior resection syndrome score(LARS)-bowel dysfunction after lower anterior resection for rectal cancer, (4)Pelvic floor muscle(PFM) strength-Oxford Scale(Grade 1-5), (5)Bowel opening(BO) frequency per week(times), (6)Bristol stool scale-form of human faeces into 7 categories, (7)Numeric Global Rating of Change Scale(NGRCS)-subjective improvement(0-10). Wilcoxon Signed Ranks test and McNermar test were used on the data. All the statistical analyzes were performed by using the Statistical Package for Social Sciences with p<0.05 deemed significant.
Result & Outcome :
Ninety patients underwent the program from 2017 to 2022. Sixty-nine patients completed the program. Fifty-four sets of completed data were collected with 40 patients male(74%) and 14 females(26%). The mean age was 63.6+/-7.8 years. FI frequency significantly improved from 18.6+/-30.6 to 5.5+/-10.1(p=0.001). PFM strength was significantly improved from grade 2.3+/-0.7 to 2.6+/-0.7 on discharge(p=0.002). PFM strength was significantly improved with 16/54(29.6%) achieved grade 3 or above upon closure of the stoma to 29/54(53.7%) on discharge. BO frequency significantly reduced from 44.5+/-27.1 to 23.3+/-16.9(p<0.001). LARS score significantly reduced from 30.3+/-10.6 to 23.3+/-13.7(p<0.001). The number of patients categorized with mild LARS score of 0-20 improved from 10/54(18.5%) to 21/54(38.9%) whereas severe LARS score of 30-42 reduced from 35/54(64.8%) to 19/54(35.2%). Wexner score significantly decreased from 10.3+/-6.0 to 7.6+/-5.7(p<0.001). The change in Bristol score scale could not reach statistical significance(p=0.056). Patient reported subjective improvement(NGRCS) was 6.7+/-1.9 on discharge. The collaborative rehabilitation program was demonstrated effective to improve the bowel dysfunction of colorectal cancer patients.
