Preoperative and Postoperative Quality of Life in Patients with Familial Adenomatous Polyposis

Purpose  This study was designed to prospectively examine functional outcome, quality of life, and patients’ personal experiences and adjustment to functional changes during the first year after prophylactic surgery. Methods  Twenty-one consecutive patients with familial adenomatous polyposis were examined before proctocolectomy (T0), on ileostomy reversal (T1), and 6 (T2) and 12 months (T3) after surgery by means of standardized questionnaires and interviews. Results  Average physical and mental health declined profoundly after proctocolectomy, followed by a steady improvement after 6 and 12 months. The majority of patients reported the ileostomy period as particularly distressing. After one year, 75 percent of patients reported complete recovery in terms of physical, emotional, and social functioning, whereas one-quarter of patients did not regain their former level of functioning. Despite substantial improvement in pouch functions, functional impairment persists because of frequent bowel movements, resulting mainly in restricted social activities. Ten percent of patients reported impaired sex life, irrespective of gender. Conclusions  The majority of patients with familial adenomatous polyposis were found to adjust favorably to functional impairment while maintaining satisfactory quality of life. Complementing standardized quality of life measures by patients’ personal experiences may help to identify vulnerable patients in need of psychosocial support. Presented at the Consortium for Psychooncology, Cologne, Germany, December 1 to 2, 2005, and at the German Cancer Congress, Berlin, Germany, March 22 to 26, 2006.