Functional recovery and rehabilitation for low anterior resection syndrome and supportive care for people with colorectal cancer

Abstract

Low anterior resection syndrome (LARS) is a common but under-recognised complication in colorectal cancer survivors. The healthcare system lacks standardised screening, preoperative prep, rehab, and support pathways, leaving survivors with inadequate support. This thesis explores LARS’s prevalence, experiences, and management through a biopsychosocial lens. It evaluates multimodal rehab strategies and their broader impact on returning to work via a mixed-methods, multi-phase study. Seven chapters cover LARS burden, unmet survivor needs, preoperative video education, pelvic floor rehab, and work outcomes. Initial longitudinal study assessed LARS’s impact among Australian CRC survivors, aligning with global data and noting bladder and sexual issues. Improvements occurred over time, but progress was slow after 12 months. Further chapters examined intervention feasibility pre- and post-surgery. Preoperative video education was feasible and acceptable. The systematic review suggested pelvic floor rehab might reduce bowel frequency and incontinence, though heterogeneity limited certainty. A pelvic floor rehab program was feasible and showed potential benefits, improving bowel function and quality of life. Qualitative interviews highlighted that delayed information hindered recovery, emphasising the need for structured guidance. The Empowered Behavioural Adaptation Process (EBAP) is introduced, focusing on routine screening and behavioural change to enhance management. The thesis concludes by examining the return-to-work outcome as a key survivorship indicator. This research demonstrates that LARS is prevalent, persistent, and under-recognised. Structured interventions like preoperative education and pelvic floor rehab are feasible and potentially beneficial. Incorporating these into routine care can improve outcomes. EBAP offers a behaviour-change framework for self-management. Implementing these strategies at a service level is essential to support survivors’ recovery.