## 4 Discussion  
The modern approach of treatment options for patients with CRC leads to the necessity of taking into consideration their QoL after surgical and/or oncological protocol application. QoL should be included in the evaluation of such patients, along with the survival assessment, tumor recurrence, side effects and toxicity of chemoradiation, the physical and psychological effects of wearing a stoma, as well as the cost-effectiveness of procedures. We consider that the main statements of our study are the following: the average level of scores for symptoms did not differ significantly between the sexes, highlighting a moderate impairment of QoL. Men did not feel less masculine, while women felt less feminine as a result of illness and treatment; the correlation matrix of items for emotional function showed strong correlations, statistically significant between the patient's concerns for future health, weight, feelings of dissatisfaction with attractiveness, femininity/masculinity and, generally, with their own body; the symptoms characteristic of discomfort caused by the colostomy bag or unintentional manifestations generated by bowel movement showed correlations that led the patient to reanalyze his/her physical and emotional effects, and greater impairment of physical and emotional functions was noted in men. Scores are transformed linearly, giving a score between zero and 100. The results of our study were compared to the results of other studies that showed that the higher the scores, the better they function on the functioning scales and a higher level of symptoms on the symptoms scale [27]. The results of the present study will be used in the calibration of the Romanian population and the construction of their own standards for patients with CRC with a genetic risk. The physical and emotional changes in patients with stoma varied by gender. In female patients, a lower QoL score was reported for emotional and physical functioning, but in males, we described, just like other studies [28], a decrease in the score. These findings can lead to a gradual reduction in a person's confidence and can change his/her social functioning as well [5]. The impact of colostomy, together with chemoradiation and other therapeutic procedures in patients diagnosed with CRC, could be ameliorated by providing specialized assistance, such as colostomy care programs and psychological counseling [29]. In a study on patients with CRC and their partners, regarding the influence of oncological treatments on psychological functioning, the authors showed significant differences in anxiety, depression and traumatic stress symptoms among patients who underwent surgery, and chemoradiation, as compared to patients treated only surgically. The first group experienced higher anxiety scores, more depressive symptoms and more posttraumatic stress symptoms [30]. Figure 5: Global score histogram. In a prospective longitudinal study, authors demonstrated that the group activities of patients with CRC and colostomy, sharing personal experiences, would decrease the level of isolation and feeling of loneliness caused by the stoma wearing, along with the diagnosis of cancer, and chemoradiation [31]. The increased toxicity of chemotherapeutic substances contributes to smaller or more severe side effects, influencing the QoL of oncological patients. However, these side effects are not only given by the pharmacodynamics of the chemicals, but they can also be influenced by individual perception and other psychological factors related to the patients [32]. The limitations of the QoL studies in patients with CRC could be the lack of accumulation of information by systematic reviews and the lack of a gold standard for QoL measurement. Other limitations of such studies could be due to poor data acquisition, low response rates, a reduced sample size, and different ways of correcting the confounding factors. The role of chemoradiation has been little investigated in patients with a colostomy for CRC.