Clin Colon Rectal Surg 2024; 37(04): 256-265
DOI: 10.1055/s-0043-1770720
Review Article

Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients

Srinivas Joga Ivatury
1   Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
,
Pasithorn A. Suwanabol
2   Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
,
Ana C. De Roo
3   Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, Missouri
› Author Affiliations

Abstract

Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better inform patients deliberating treatment options for rectal cancer.

Note

This Agreement between University of Michigan–Pasithorn Suwanabol (“You”) and Wolters Kluwer Health, Inc. (“Wolters Kluwer Health, Inc.”) consists of your license details and the terms and conditions provided by Wolters Kluwer Health, Inc. and Copyright Clearance Center.


All payments must be made in full to CCC. For payment instructions, please see information listed at the bottom of this form.


License Number 5383750106302


License date Sep 07, 2022




Publication History

Article published online:
19 July 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns 2006; 60 (03) 301-312
  • 2 Moumjid N, Gafni A, Brémond A, Carrère MO. Shared decision making in the medical encounter: are we all talking about the same thing?. Med Decis Making 2007; 27 (05) 539-546
  • 3 Elwyn G, Frosch D, Thomson R. et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27 (10) 1361-1367
  • 4 Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49 (05) 651-661
  • 5 Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44 (05) 681-692
  • 6 Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: concepts, evidence, and practice. Patient Educ Couns 2015; 98 (10) 1172-1179
  • 7 Neuhauser D. Ernest Amory Codman MD. Qual Saf Health Care 2002; 11 (01) 104-105
  • 8 Miles WE. The present position of the radical abdomino-perineal operation for cancer of the rectum in regard to mortality and post-operative recurrence. Proc R Soc Med 1931; 24 (07) 989-991
  • 9 Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1 (8496): 1479-1482
  • 10 Marr R, Birbeck K, Garvican J. et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 2005; 242 (01) 74-82
  • 11 Bordeianou L, Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM. Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results. J Gastrointest Surg 2014; 18 (07) 1358-1372
  • 12 Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D. Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene?. Gut 2008; 57 (12) 1690-1697
  • 13 Stelzner S, Hellmich G, Haroske G, Puffer E, Jackisch T, Witzigmann H. Practicability of quality goals for the treatment of rectal cancer. Int J Colorectal Dis 2010; 25 (09) 1093-1102
  • 14 Patwardhan MB, Samsa GP, McCrory DC. et al. Cancer care quality measures: diagnosis and treatment of colorectal cancer. Evid Rep Technol Assess (Full Rep) 2006; (138) 1-116
  • 15 Ludwig KA. Sphincter-sparing resection for rectal cancer. Clin Colon Rectal Surg 2007; 20 (03) 203-212
  • 16 Chambers SKM, Meng X, Youl P, Aitken J, Dunn J, Baade P. A five-year prospective study of quality of life after colorectal cancer. Qual Life Res 2012; 21 (09) 1551-1564
  • 17 Russell MM, Ganz PA, Lopa S. et al. Comparative effectiveness of sphincter-sparing surgery versus abdominoperineal resection in rectal cancer: patient-reported outcomes in National Surgical Adjuvant Breast and Bowel Project randomized trial R-04. Ann Surg 2015; 261 (01) 144-148
  • 18 Tilney HS, Heriot AG, Purkayastha S. et al. A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg 2008; 247 (01) 77-84
  • 19 Almoudaris AM, Clark S, Vincent C, Faiz O. Establishing quality in colorectal surgery. Colorectal Dis 2011; 13 (09) 961-973
  • 20 Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2012; 12 (12) CD004323
  • 21 Lawday S, Flamey N, Fowler GE. et al. Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review. BJS Open 2021; 5 (06) zrab101
  • 22 West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 2008; 26 (21) 3517-3522
  • 23 den Dulk M, Putter H, Collette L. et al. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 2009; 45 (07) 1175-1183
  • 24 How P, Shihab O, Tekkis P. et al. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011; 20 (04) e149-e155
  • 25 van Leersum N, Martijnse I, den Dulk M. et al. Differences in circumferential resection margin involvement after abdominoperineal excision and low anterior resection no longer significant. Ann Surg 2014; 259 (06) 1150-1155
  • 26 Neuhauser D, Provost L, Bergman B. The meaning of variation to healthcare managers, clinical and health-services researchers, and individual patients. BMJ Qual Saf 2011; 20 (Suppl. 01) i36-i40
  • 27 Wexner SD, Rotholtz NA. Surgeon influenced variables in resectional rectal cancer surgery. Dis Colon Rectum 2000; 43 (11) 1606-1627
  • 28 Ricciardi R, Roberts PL, Read TE, Marcello PW, Schoetz DJ, Baxter NN. Variability in reconstructive procedures following rectal cancer surgery in the United States. Dis Colon Rectum 2010; 53 (06) 874-880
  • 29 Etzioni DA, Cannom RR, Madoff RD, Ault GT, Beart Jr RW. Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons?. Dis Colon Rectum 2010; 53 (05) 713-720
  • 30 Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ. Who performs proctectomy for rectal cancer in the United States?. Dis Colon Rectum 2011; 54 (10) 1210-1215
  • 31 Ricciardi R, Virnig BA, Madoff RD, Rothenberger DA, Baxter NN. The status of radical proctectomy and sphincter-sparing surgery in the United States. Dis Colon Rectum 2007; 50 (08) 1119-1127 , discussion 1126–1127
  • 32 Richardson DP, Porter GA, Johnson PM. Population-based use of sphincter-preserving surgery in patients with rectal cancer: is there room for improvement?. Dis Colon Rectum 2013; 56 (06) 704-710
  • 33 Abdelsattar ZM, Wong SL, Birkmeyer NJ. et al. Multi-institutional assessment of sphincter preservation for rectal cancer. Ann Surg Oncol 2014; 21 (13) 4075-4080
  • 34 Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH. Workload and surgeon's specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 2012; (03) CD005391
  • 35 Gérard JP, Conroy T, Bonnetain F. et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006; 24 (28) 4620-4625
  • 36 Hendren S, Abdelsattar Z. Sphincter-preserving surgery for rectal cancer: a controversial measure of quality. Ann Surg Oncol 2015; 22 (01) 9-10
  • 37 Chen TY, Wiltink LM, Nout RA. et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer 2015; 14 (02) 106-114
  • 38 Zedan AH, Hansen TF, Fex Svenningsen A, Vilholm OJ. Oxaliplatin-induced neuropathy in colorectal cancer: many questions with few answers. Clin Colorectal Cancer 2014; 13 (02) 73-80
  • 39 Wan J, Gai Y, Li G, Tao Z, Zhang Z. Incidence of chemotherapy- and chemoradiotherapy-induced amenorrhea in premenopausal women with stage II/III colorectal cancer. Clin Colorectal Cancer 2015; 14 (01) 31-34
  • 40 Schüring AN, Fehm T, Behringer K. et al. Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part I: indications for fertility preservation. Arch Gynecol Obstet 2018; 297 (01) 241-255
  • 41 Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol 2011; 8 (01) 51-57
  • 42 Hendren SK, O'Connor BI, Liu M. et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005; 242 (02) 212-223
  • 43 Sun V, Grant M, Wendel CS. et al. Sexual function and health-related quality of life in long-term rectal cancer survivors. J Sex Med 2016; 13 (07) 1071-1079
  • 44 Hardiman KM, Felder SI, Friedman G, Migaly J, Paquette IM, Feingold DL. Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surveillance and survivorship care of patients after curative treatment of colon and rectal cancer. Dis Colon Rectum 2021; 64 (05) 517-533
  • 45 Pieniowski EHA, Palmer GJ, Juul T. et al. Low anterior resection syndrome and quality of life after sphincter-sparing rectal cancer surgery: a long-term longitudinal follow-up. Dis Colon Rectum 2019; 62 (01) 14-20
  • 46 Jimenez-Gomez LM, Espin-Basany E, Trenti L. et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis 2017; Epub ahead of print DOI: 10.1111/codi.13901.
  • 47 Pucciani F. A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updates Surg 2013; 65 (04) 257-263
  • 48 Sun R, Dai Z, Zhang Y, Lu J, Zhang Y, Xiao Y. The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer: a systematic review and meta-analysis. Support Care Cancer 2021; 29 (12) 7249-7258
  • 49 Keane C, Wells C, O'Grady G, Bissett IP. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis 2017; 19 (08) 713-722
  • 50 Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol 2012; 13 (09) e403-e408
  • 51 Keane C, Fearnhead NS, Bordeianou LG. et al; LARS International Collaborative Group. International consensus definition of low anterior resection syndrome. Dis Colon Rectum 2020; 63 (03) 274-284
  • 52 Habr-Gama A, Perez RO, Nadalin W. et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004; 240 (04) 711-717 , discussion 717–718
  • 53 Maas M, Beets-Tan RG, Lambregts DM. et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 2011; 29 (35) 4633-4640
  • 54 Habr-Gama A, Gama-Rodrigues J, São Julião GP. et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 2014; 88 (04) 822-828
  • 55 Quezada-Diaz FF, Smith JJ, Jimenez-Rodriguez RM. et al. Patient-reported bowel function in patients with rectal cancer managed by a watch-and-wait strategy after neoadjuvant therapy: a case-control study. Dis Colon Rectum 2020; 63 (07) 897-902
  • 56 Hupkens BJP, Martens MH, Stoot JH. et al. Quality of life in rectal cancer patients after chemoradiation: watch-and-wait policy versus standard resection - a matched-controlled study. Dis Colon Rectum 2017; 60 (10) 1032-1040
  • 57 Chen TY, Emmertsen KJ, Laurberg S. What are the best questionnaires to capture anorectal function after surgery in rectal cancer?. Curr Colorectal Cancer Rep 2015; 11 (01) 37-43
  • 58 Veenstra CM, Regenbogen SE, Hawley ST. et al. A composite measure of personal financial burden among patients with stage III colorectal cancer. Med Care 2014; 52 (11) 957-962
  • 59 Veenstra CM, Regenbogen SE, Hawley ST, Abrahamse P, Banerjee M, Morris AM. Association of paid sick leave with job retention and financial burden among working patients with colorectal cancer. JAMA 2015; 314 (24) 2688-2690
  • 60 de Boer AG, Taskila T, Ojajärvi A, van Dijk FJ, Verbeek JH. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA 2009; 301 (07) 753-762
  • 61 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Guideline Survivorship. National Comprehensive Cancer Network, Inc. Accessed September 7, 2022 at: https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf
  • 62 Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw 2009; 7 (08) 883-893 , quiz 894
  • 63 Wexner SD, Taranow DA, Johansen OB. et al. Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum 1993; 36 (04) 349-354
  • 64 Danielsen AK, Soerensen EE, Burcharth K, Rosenberg J. Impact of a temporary stoma on patients' everyday lives: feelings of uncertainty while waiting for closure of the stoma. J Clin Nurs 2013; 22 (9-10): 1343-1352
  • 65 Rondelli F, Reboldi P, Rulli A. et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009; 24 (05) 479-488
  • 66 Rullier E, Le Toux N, Laurent C, Garrelon JL, Parneix M, Saric J. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 2001; 25 (03) 274-277 , discussion 277–278
  • 67 Goldwag JL, Wilson LR, Ivatury SJ, Tsapakos MJ, Wilson MZ. The prevalence of fascial defects at prior stoma sites in patients with colorectal cancer. Int J Abdomin Wall Hernia Surg 2020; 3 (02) 50
  • 68 Allal AS, Bieri S, Pelloni A. et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 2000; 82 (06) 1131-1137
  • 69 Allal AS, Gervaz P, Gertsch P. et al. Assessment of quality of life in patients with rectal cancer treated by preoperative radiotherapy: a longitudinal prospective study. Int J Radiat Oncol Biol Phys 2005; 61 (04) 1129-1135
  • 70 Camilleri-Brennan J, Steele RJ. Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Colorectal Dis 2002; 4 (01) 61-66
  • 71 Campos-Lobato LF, Alves-Ferreira PC, Lavery IC, Kiran RP. Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer. Clinics (São Paulo) 2011; 66 (06) 1035-1040
  • 72 Celasin H, Karakoyun R, Yılmaz S, Elhan AH, Erkek B, Kuzu MA. Quality of life measures in Islamic rectal carcinoma patients receiving counselling. Colorectal Dis 2011; 13 (07) e170-e175
  • 73 Hamashima C. Long-term quality of life of postoperative rectal cancer patients. J Gastroenterol Hepatol 2002; 17 (05) 571-576
  • 74 Rauch P, Miny J, Conroy T, Neyton L, Guillemin F. Quality of life among disease-free survivors of rectal cancer. J Clin Oncol 2004; 22 (02) 354-360
  • 75 Smith-Gagen J, Cress RD, Drake CM, Romano PS, Yost KJ, Ayanian JZ. Quality-of-life and surgical treatments for rectal cancer–a longitudinal analysis using the California Cancer Registry. Psychooncology 2010; 19 (08) 870-878
  • 76 Varpe P, Huhtinen H, Rantala A. et al. Quality of life after surgery for rectal cancer with special reference to pelvic floor dysfunction. Colorectal Dis 2011; 13 (04) 399-405
  • 77 Yoo HJ, Kim JC, Eremenco S, Han OS. Quality of life in colorectal cancer patients with colectomy and the validation of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), Version 4. J Pain Symptom Manage 2005; 30 (01) 24-32
  • 78 Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. ‘Because Everybody is so Different’: a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021; 11 (05) e043245
  • 79 Bloemen JG, Visschers RG, Truin W, Beets GL, Konsten JL. Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma. Dis Colon Rectum 2009; 52 (07) 1251-1258
  • 80 Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 2003; 238 (02) 203-213
  • 81 Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C. Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 2008; 15 (04) 1099-1106
  • 82 Gosselink MP, Busschbach JJ, Dijkhuis CM, Stassen LP, Hop WC, Schouten WR. Quality of life after total mesorectal excision for rectal cancer. Colorectal Dis 2006; 8 (01) 15-22
  • 83 Guren MG, Eriksen MT, Wiig JN. et al; Norwegian Rectal Cancer Group. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 2005; 31 (07) 735-742
  • 84 Kasparek MS, Hassan I, Cima RR, Larson DR, Gullerud RE, Wolff BG. Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life. Colorectal Dis 2011; 13 (08) 872-877
  • 85 Krouse RS, Herrinton LJ, Grant M. et al. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol 2009; 27 (28) 4664-4670
  • 86 Peng J, Shi D, Goodman KA. et al. Early results of quality of life for curatively treated rectal cancers in Chinese patients with EORTC QLQ-CR29. Radiat Oncol 2011; 6: 93
  • 87 Ross L, Abild-Nielsen AG, Thomsen BL, Karlsen RV, Boesen EH, Johansen C. Quality of life of Danish colorectal cancer patients with and without a stoma. Support Care Cancer 2007; 15 (05) 505-513
  • 88 Schmidt CE, Bestmann B, Küchler T, Longo WE, Rohde V, Kremer B. Gender differences in quality of life of patients with rectal cancer. A five-year prospective study. World J Surg 2005; 29 (12) 1630-1641
  • 89 Ito N, Ishiguro M, Uno M. et al. Prospective longitudinal evaluation of quality of life in patients with permanent colostomy after curative resection for rectal cancer: a preliminary study. J Wound Ostomy Continence Nurs 2012; 39 (02) 172-177
  • 90 Williams NS, Johnston D. The quality of life after rectal excision for low rectal cancer. Br J Surg 1983; 70 (08) 460-462
  • 91 Kessels RP. Patients' memory for medical information. J R Soc Med 2003; 96 (05) 219-222
  • 92 Scalia P, Durand MA, Berkowitz JL. et al. The impact and utility of encounter patient decision aids: systematic review, meta-analysis and narrative synthesis. Patient Educ Couns 2019; 102 (05) 817-841
  • 93 Kanters AE, Morris AM, Abrahamse PH, Mody L, Suwanabol PA. The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care. Dis Colon Rectum 2018; 61 (07) 817-823
  • 94 Goldwag JL, Saunders CH, Read JT, Durand MA, Elwyn G, Ivatury SJ. A rectal cancer surgical decision aid is not enough: a qualitative study. Dis Colon Rectum 2022; 65 (12) 1483-1493
  • 95 Kruser JM, Nabozny MJ, Steffens NM. et al. “Best Case/Worst Case”: qualitative evaluation of a novel communication tool for difficult in-the-moment surgical decisions. J Am Geriatr Soc 2015; 63 (09) 1805-1811
  • 96 Kalet AL, Janicik R, Schwartz M, Roses D, Hopkins MA, Riles T. Teaching communication skills on the surgery clerkship. Med Educ Online 2005; 10 (01) 4382
  • 97 Singh Ospina N, Toloza FJK, Barrera F, Bylund CL, Erwin PJ, Montori V. Educational programs to teach shared decision making to medical trainees: a systematic review. Patient Educ Couns 2020; 103 (06) 1082-1094
  • 98 Kapadia MR, Kieran K. Being affable, available, and able is not enough: prioritizing surgeon-patient communication. JAMA Surg 2020; 155 (04) 277-278
  • 99 Adsul P, Wray R, Boyd D, Weaver N, Siddiqui S. Perceptions of urologists about the conversational elements leading to treatment decision-making among newly diagnosed prostate cancer patients. J Cancer Educ 2017; 32 (03) 580-588
  • 100 Charles C, Gafni A, Whelan T. Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach. Health Expect 2004; 7 (04) 338-348
  • 101 Berlin A, Kunac A, Mosenthal AC. Perioperative goal-setting consultations by surgical colleagues: a new model for supporting patients, families, and surgeons in shared decision making. Ann Palliat Med 2017; 6 (02) 178-182
  • 102 Ivatury SJ, Kang R, Goldwag JL, Wilson MZ. Restorative reconstruction after total mesorectal excision for rectal cancer is associated with significant bowel dysfunction from initial presentation. Surg Open Sci 2020; 3: 29-33