Patient Experiences of Long-term Pain and Pain Management Following Pelvic Exenteration for Locally Recurrent Rectal Cancer: A Qualitative Study

Mathilde M O'Dell; Kate White; Charlotte S H Johnstone; Michael J Solomon; Killian G M Brown; Daniel Steffens; Cherry E Koh

doi:10.1097/DCR.0000000000003476

Patient Experiences of Long-term Pain and Pain Management Following Pelvic Exenteration for Locally Recurrent Rectal Cancer: A Qualitative Study

Dis Colon Rectum. 2024 Nov 8. doi: 10.1097/DCR.0000000000003476. Online ahead of print.

Authors

Mathilde M O'Dell^{1

2}, Kate White^{3

4}, Charlotte S H Johnstone^{1

2

5}, Michael J Solomon^{1

2

6

7}, Killian G M Brown^{1

2

6

7}, Daniel Steffens^{1

2

7}, Cherry E Koh^{1

2

6

7}

Affiliations

¹ Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, NSW, Australia.
² Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
³ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW.
⁴ Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.
⁶ Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁷ RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.

PMID: 39514291
DOI: 10.1097/DCR.0000000000003476

Abstract

Background: Although pain may persist for patients who undergo pelvic exenteration for treatment of locally recurrent rectal cancer, studies exploring patient experience of postoperative pain and its management remains limited.

Objective: This study aimed to explore patient experiences of postoperative chronic pain and management following pelvic exenteration.

Design: Qualitative cohort study of patients who have undergone pelvic exenteration for locally recurrent rectal cancer.

Settings: The study was conducted through one-on-one semi-structured telephone interviews.

Patients: Seventeen patients with locally recurrent rectal cancer who underwent pelvic exenteration between January 2018 and December 2020 were included.

Main outcome measures: Semi-structured interviews explored participants' experiences of pain including its impact on life and management strategies at six and twelve months following exenteration. Interview transcripts were analyzed by two researchers using inductive thematic analysis.

Results: Participant experiences of pain following exenteration are reflected by three themes identified: 1) adapting to long-term consequences of pelvic exenteration including pain, 2) reluctance to take pain medications, 3) engaging multidisciplinary care team is essential to post-pelvic exenteration chronic pain management. Several participants reported ongoing intermittent pain following surgery that significantly affected various aspects of their lives. This prompted participants to adapt their lifestyle and explore alternative pain relief methods as some were hesitant to rely on analgesics.

Limitations: The small sample size from a single center whereby all patients underwent curative pelvic exenteration for lower recurrent rectal cancer with none undergoing the procedure for palliation limits the generalizability of the results of this study.

Conclusions: While chronic pain following pelvic exenteration for locally recurrent rectal cancer interferes with patient's postoperative quality of life, analgesia use was influenced by pain habituation and fear of dependence on pain medications. Our findings emphasize the further need to investigate a multidisciplinary approach, including non-pharmacological methods, for optimization of pain outcomes following pelvic exenteration. See Video Abstract.