Understanding Odor-related Challenges for Colorectal Cancer Survivors with Ostomies: Effects on Anxiety, Body Image, and Emotional Wellbeing

Anxiety in colorectal cancer (CRC) survivors with ostomies is associated with increased mortality, disease complications, and treatment non-adherence. Ostomy odor creates anxiety, particularly in public settings. While body image disturbance (BID) affects this population, relationships between odor, BID, and anxiety remain understudied, especially regarding sensory perception interactions. This study examines relationships among ostomy-related issues (leakage, odor, and peristomal skin complications (PSC)), BID, anxiety, and emotional well-being (EWB) in CRC survivors with ostomies. A scoping review was conducted to identify risk factors and consequences of anxiety in CRC survivors. Cross-sectional studies (N = 130) were conducted with Stage I–III CRC survivors with ostomies recruited through online support groups. Participants completed surveys containing single-item measures of ostomy issues and validated scales for anxiety, BID, and EWB. A series of regression analyses with Baron and Kenny's mediation approach examined relationships while controlling for other anxiety risk factors identified in the scoping review. Our scoping review identified ostomy-related issues and BID as anxiety risk factors in CRC survivors. In our cross-sectional studies, leakage predicted odor (β=0.61, p<.001), PSC (β=0.51, p<.001), and anxiety (β=0.23, p=.003). Adding odor to the model made leakage's effect on anxiety non-significant (β=0.11, p=0.249), while odor remained significant (β=0.19, p=0.039), showing full mediation. PSC had no anxiety association. Odor predicted BID (β=0.15, p=.037), anxiety (β=0.25, p<.001), and EWB (β=-0.32, p<.001). BID partially mediated odor and EWB relationship but showed no significant anxiety association (β=0.15, p=.088). This research demonstrates ostomy odor's central role in the psychosocial experiences of CRC survivors with ostomies. These findings enhance our understanding of how olfactory experiences affect psychological outcomes through cross-modal sensory integration.