Grant Number:	2R01CA106912-04A1 Interpret this number
Primary Investigator:	Krouse, Robert
Organization:	University Of Arizona
Project Title:	Hr-Qol in Colorectal Cancer Survivors with Stomas
Fiscal Year:	2009

DESCRIPTION (provided by applicant): This application is a request for a 5-year competitive renewal of our ongoing research grant (R01 CA106912), HR-QOL in Colorectal Cancer (CRC) Survivors with Stomas. The study compared 287 CRC survivors (>5 years) with ostomy with 395 CRC survivors without ostomy. Key findings include a greater understanding of the multiple behavioral and dietary adaptations ostomates use to control bowel function; the previously under- reported complications these patients face; and the HR-QOL differences for men and women. The renewal is focused on rectal cancer and has four critical goals: (1) strengthen the evidence base on outcomes following all major rectal cancer procedures, (2) assess the key question of work disability, (3) assess behavioral and dietary adjustments, and (4) increase knowledge of outcomes in minorities. Specific Aim 1: To understand the determinants of outcomes in all long-term survivors of invasive rectal cancer and associated treatments, including those with (a) permanent ostomy, (b) anastomosis without temporary ostomy, and (c) anastomosis with temporary ostomy (indicating low cancers with minimal remaining rectum). Outcomes to be measured include bowel function, HR-QOL, work disability, and medical complications. Specific Aim 2: From among patients whose initial cancer surgery was anastomosis, to assess the relationships of tumor location, patient age, and co-morbidity on the rate of anastomotic failure and eventual permanent ostomy. Specific Aim 3: To better understand the scope of behavioral and dietary adjustments made by rectal cancer survivors with ostomy and anastomosis to control bowel function. Specific Aim 4: To collect qualitative data to more fully understand the lived experiences of minority rectal cancer survivors. The study will be set among 2,724 long-term survivors with rectal cancer, of whom 142 are Black/African American, 209 are Hispanic/Latino, and 340 are Asian/Pacific Islander. Data will be collected using patient self-reported information to a mailed questionnaire, linkage to the electronic medical record, focus groups, and in-depth interviews. The study is innovative in identifying the largest group of long-term rectal cancer survivors for study. Through the proposed study, we can better understand the risks and benefits of rectal cancer treatments as well as the adaptations patients make to improve control of their bowel functioning. Public Health Relevance: This competitive renewal to our ongoing research grant (R01 CA106912), "HR-QOL in Colorectal Cancer Survivors with Stomas" proposes a study of rectal cancer survivors using focus groups and mailed questionnaires. Health-related quality of life, work disability, behavioral and dietary adaptations, healthcare costs and long-term medical complications will be measured. The study will strengthen the evidence base regarding outcomes resulting from the surgical options now available for rectal cancer: permanent ostomy and rectal-sparing surgery. Greater knowledge of outcomes will enable patients and their physicians to be more fully informed at the time they are considering their available surgical options and will also enable development of clinical and self-help interventions and potential quality improvements in the current algorithms for care.




Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Authors: Krouse R.S. , Anderson G.L. , Arnold K.B. , Thomson C.A. , Nfonsam V.N. , Al-Kasspooles M.F. , Walker J.L. , Sun V. , Alvarez Secord A. , Han E.S. , et al. .
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Stoma location and ostomy-related quality of life among cancer survivors with ostomies: A pooled analysis.
Authors: Mo J. , Wendel C.S. , Sloan J.A. , Sun V. , Hornbrook M.C. , Grant M. , Ercolano E. , Malkowicz S.B. , Tallman N.J. , McCorkle R.C. , et al. .
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PMID: 34600739
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Cancer Survivorship at the Intersections of Care and Personhood.
Authors: Ramirez M. , Janke E.A. , Grant M. , Altschuler A. , Hornbrook M. , Krouse R.S. .
Source: Medical Anthropology, 2020 Jan; 39(1), p. 55-68.
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PMID: 31403821
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Cancer survivors' challenges with ostomy appliances and self-management: a qualitative analysis.
Authors: Sun V. , Bojorquez O. , Grant M. , Wendel C.S. , Weinstein R. , Krouse R.S. .
Source: Supportive Care In Cancer : Official Journal Of The Multinational Association Of Supportive Care In Cancer, 2019-11-13 00:00:00.0; , .
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PMID: 31720825
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Diet and Behavior Modifications by Long-term Rectal Cancer Survivors to Manage Bowel Dysfunction-Associated Symptoms.
Authors: Sun V. , Wendel C.S. , Demark-Wahnefried W. , Grant M. , McMullen C.K. , Bulkley J.E. , Herrinton L.J. , Hornbrook M.C. , Krouse R.S. .
Source: Nutrition And Cancer, 2019; 71(1), p. 89-99.
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PMID: 30572723
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Ongoing ostomy self-care challenges of long-term rectal cancer survivors.
Authors: Bulkley J.E. , McMullen C.K. , Grant M. , Wendel C. , Hornbrook M.C. , Krouse R.S. .
Source: Supportive Care In Cancer : Official Journal Of The Multinational Association Of Supportive Care In Cancer, 2018-05-29 00:00:00.0; , .
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PMID: 29845420
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Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis.
Authors: Alavi M. , Wendel C.S. , Krouse R.S. , Temple L. , Hornbook M.C. , Bulkley J.E. , McMullen C.K. , Grant M. , Herrinton L.J. .
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EPub date: 2017-08-07 00:00:00.0.
PMID: 28785900
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Physical activity, bowel function, and quality of life among rectal cancer survivors.
Authors: Krouse R.S. , Wendel C.S. , Garcia D.O. , Grant M. , Temple L.K.F. , Going S.B. , Hornbrook M.C. , Bulkley J.E. , McMullen C.K. , Herrinton L.J. .
Source: Quality Of Life Research : An International Journal Of Quality Of Life Aspects Of Treatment, Care And Rehabilitation, 2017-07-04 00:00:00.0; , .
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PMID: 28677077
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Participation in Activities Associated With Quality of Life for Long-Term Survivors of Rectal Cancer.
Authors: Mcmullen C. , Liu L. , Bulkley J.E. , Hornbrook M.C. , Wendel C. , Grant M. , Altschuler A. , Temple L.K. , Krouse R.S. , Herrinton L. .
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PMID: 28241904
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Rectal Cancer Survivors' Participation in Productive Activities.
Authors: Hornbrook M.C. , Grant M. , Wendel C. , Bulkley J.E. , Mcmullen C.K. , Altschuler A. , Temple L.K. , Herrinton L.J. , Krouse R.S. .
Source: The Permanente Journal, 2017; 22, .
PMID: 29236653
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Self-reported depression and perceived financial burden among long-term rectal cancer survivors.
Authors: Chongpison Y. , Hornbrook M.C. , Harris R.B. , Herrinton L.J. , Gerald J.K. , Grant M. , Bulkley J.E. , Wendel C.S. , Krouse R.S. .
Source: Psycho-oncology, 2016 Nov; 25(11), p. 1350-1356.
PMID: 26365584
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Greatest Challenges Of Rectal Cancer Survivors: Results Of A Population-based Survey
Authors: McMullen C.K. , Bulkley J.E. , Altschuler A. , Wendel C.S. , Grant M. , Hornbrook M.C. , Sun V. , Krouse R.S. .
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PMID: 27749476
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Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery.
Authors: Herrinton L.J. , Altschuler A. , McMullen C.K. , Bulkley J.E. , Hornbrook M.C. , Sun V. , Wendel C.S. , Grant M. , Baldwin C.M. , Demark-Wahnefried W. , et al. .
Source: Ca: A Cancer Journal For Clinicians, 2016 Sep; 66(5), p. 387-97.
PMID: 26999757
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Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors.
Authors: Sun V. , Grant M. , Wendel C.S. , McMullen C.K. , Bulkley J.E. , Herrinton L.J. , Hornbrook M.C. , Krouse R.S. .
Source: The Journal Of Sexual Medicine, 2016 Jul; 13(7), p. 1071-9.
PMID: 27318020
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Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors.
Authors: Sun V. , Grant M. , Wendel C.S. , McMullen C.K. , Bulkley J.E. , Altschuler A. , Ramirez M. , Baldwin C.M. , Herrinton L.J. , Hornbrook M.C. , et al. .
Source: Annals Of Surgical Oncology, 2015 Dec; 22(13), p. 4317-24.
PMID: 26159443
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Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors.
Authors: Wendel C.S. , Grant M. , Herrinton L. , Temple L.K. , Hornbrook M.C. , McMullen C.K. , Bulkley J.E. , Altschuler A. , Krouse R.S. .
Source: Quality Of Life Research : An International Journal Of Quality Of Life Aspects Of Treatment, Care And Rehabilitation, 2014 Dec; 23(10), p. 2831-40.
PMID: 24890826
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From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies.
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Source: Supportive Care In Cancer : Official Journal Of The Multinational Association Of Supportive Care In Cancer, 2014 Jun; 22(6), p. 1563-70.
PMID: 24442998
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"I didn't feel like I was a person anymore": realigning full adult personhood after ostomy surgery.
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Source: Medical Anthropology Quarterly, 2014 Jun; 28(2), p. 242-59.
PMID: 24782269
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Spiritual well-being in long-term colorectal cancer survivors with ostomies.
Authors: Bulkley J. , McMullen C.K. , Hornbrook M.C. , Grant M. , Altschuler A. , Wendel C.S. , Krouse R.S. .
Source: Psycho-oncology, 2013 Nov; 22(11), p. 2513-21.
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Development of a chronic care ostomy self-management program.
Authors: Grant M. , McCorkle R. , Hornbrook M.C. , Wendel C.S. , Krouse R. .
Source: Journal Of Cancer Education : The Official Journal Of The American Association For Cancer Education, 2013 Mar; 28(1), p. 70-8.
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Surviving colorectal cancer: long-term, persistent ostomy-specific concerns and adaptations.
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Source: Journal Of Wound, Ostomy, And Continence Nursing : Official Publication Of The Wound, Ostomy And Continence Nurses Society / Wocn, 2013 Jan-Feb; 40(1), p. 61-72.
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Changes in body mass index and stoma related problems in the elderly.
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Source: Journal Of Geriatric Oncology, 2013 Jan; 4(1), p. 84-9.
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Source: Clinical Journal Of Oncology Nursing, 2012 Oct; 16(5), p. 514-9.
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Source: Oncology Nursing Forum, 2011 Sep; 38(5), p. 587-96.
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Source: Medical Care, 2011 Mar; 49(3), p. 321-6.
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Source: Diseases Of The Colon And Rectum, 2010 Feb; 53(2), p. 200-12.
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Source: Women & Health, 2009 Dec; 49(8), p. 608-24.
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Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex.
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Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2009-10-01 00:00:00.0; 27(28), p. 4664-70.
EPub date: 2009-10-01 00:00:00.0.
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Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies.
Authors: Baldwin C.M. , Grant M. , Wendel C. , Hornbrook M.C. , Herrinton L.J. , McMullen C. , Krouse R.S. .
Source: Journal Of Clinical Sleep Medicine : Jcsm : Official Publication Of The American Academy Of Sleep Medicine, 2009-08-15 00:00:00.0; 5(4), p. 335-43.
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The influence of husbands' or male partners' support on women's psychosocial adjustment to having an ostomy resulting from colorectal cancer.
Authors: Altschuler A. , Ramirez M. , Grant M. , Wendel C. , Hornbrook M.C. , Herrinton L. , Krouse R.S. .
Source: Journal Of Wound, Ostomy, And Continence Nursing : Official Publication Of The Wound, Ostomy And Continence Nurses Society / Wocn, 2009 May-Jun; 36(3), p. 299-305.
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Source: Quality Of Life Research : An International Journal Of Quality Of Life Aspects Of Treatment, Care And Rehabilitation, 2009 Mar; 18(2), p. 157-61.
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Source: Current Medical Research And Opinion, 2008 Jul; 24(7), p. 2059-70.
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Source: The Journal Of Supportive Oncology, 2008 Apr; 6(4), p. 175-82.
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