Impact of a Patient-centered Program for Low Anterior Resection Syndrome
Richard Garfinkle, Marie Demian, Sarah Sabboobeh, Sahir Bhatnagar, Julie Savard, Sébastien Drolet, Sender Liberman, Carl J. Brown, Jason Park, Jeongyoon Moon, Carmen G. Loiselle, S. D. Wexner, Liliana Bordeianou, Gabriela Ghitulescu, Julio Faria, Nancy Morin, Carol‐Ann Vasilevsky, Marylise Boutros
Abstract
OBJECTIVE: The objective of this study was to evaluate the impact of a low anterior resection syndrome (LARS) patient-centered program (LARS-PCP)-an informational and guided self-management intervention-on global quality of life (QoL) after surgery in comparison to standard care. BACKGROUND: Self-management using conservative measures is the cornerstone of LARS treatment; however, due to the individual and symptom-based nature of LARS, self-management largely consists of unguided troubleshooting with minimal success. METHODS: Adult patients who had undergone a restorative proctectomy with a diverting ostomy and who were scheduled for ostomy closure were randomized in a 1:1 ratio into 1 of 2 arms: LARS-PCP or standard care. The LARS-PCP consisted of an informational tool and nursing support centralized from one institution. Outcomes were measured with the use of patient-reported outcomes measures at various timepoints over the 12-month follow-up period. The primary outcome was global QoL at 6 months after ostomy closure. RESULTS: In total, 160 patients were randomized: 78 to the LARS-PCP and 82 to standard care. At 6 months after ostomy closure, LARS-PCP was associated with a higher mean global QoL (79.7 ±8.7 vs. 67.8 ±9.5, P= 0.001). This association was maintained at 12-month follow-up (82.0 ±9.1 vs. 74.9 ±10.1, P= 0.036). The incidence of major LARS was lower at 1-month (60.0% vs. 81.7%, P =0.008) postoperatively among LARS-PCP participants but was similar at 3, 6, and 12 months. CONCLUSIONS: This was the first multicenter randomized controlled trial to demonstrate that nurse-guided LARS self-management improved QoL after restorative proctectomy.