ObjectiveTo evaluate the quality of life (QoL) in patients undergoing anterior resection (AR) or abdominoperineal extirpation (APE) for rectal cancer in a sample of patients recruited from a field trial. Summary Background DataAbdominoperineal resection has been reported to put patients at higher risk of disruption to QoL than sphincter-preserving surgery. MethodsFifty patients treated with AR and 23 patients treated with APE were prospectively followed up. All patients were treated in curative attempt and were disease-free throughout the study. QoL was assessed before surgery and 6 to 9 and 12 to 15 months after surgery. ResultsMultivariate analysis of variance and subsequent post hoc comparisons revealed a main effect for time (role function, emotional function, body image, future perspective, and micturition-related problems) and group in favor of APE (sleeping problems, constipation, diarrhea), and a time-by-group interaction (role function). No significant results were obtained for the remaining scores, but patients undergoing APE consistently had more favorable QoL scores than those undergoing AR. Multivariate analysis and post hoc comparisons revealed a particularly poor QoL for patients undergoing low AR. They had a significantly lower total QoL, role function, social function, body image, and future perspective, and more gastrointestinal and defecation-related symptoms than patients undergoing high AR. ConclusionPatients undergoing APE do not have a poorer QoL than patients undergoing AR. Patients undergoing low AR have a lower QoL than those undergoing APE. Attention should be paid to QoL concerns expressed by patients undergoing low AR.It is the state of the art that whenever feasible, rectal cancer should be treated with sphincter-preserving surgical techniques. A vast body of literature suggests that patients who have a colostomy have a worse quality of life (QoL) than those without a stoma.1-11 However, any interpretation of the seemingly unequivocal results on this issue must take into account the major drawbacks of many of the investigations focusing on QoL aspects in patients with rectal cancer. A main problem is related to general disagreement among QoL researchers as to which method and instrument are most appropriate for accrual of QoL information. An abundance of techniques can be used to collect QoL data, including structured, semistructured, or nonstructured interviews, standardized and nonstandardized questionnaires, and ad hoc questions. This incompatibility in data accrual has resulted in a broad range of inventories used to assess QoL in patients with colorectal cancer and has also contributed to a body of inconsistent findings. In an excellent survey on QoL aspects in patients treated for cancer of the rectum, Camilleri-Brennan and Steele 10 described the current data situation in the field and concluded that "the methodological shortcomings of previous work must be rectified if quality of life studies are to have relevance inpatient management." Of 54 papers on the subject published ...

Despite extensive research on sexual dysfunction after gynecological cancer, uncertainty remains regarding the nature and extent of sexual problems following surgery for early cervical cancer. This study investigated whether radical hysterectomy for stage IB cancer of the cervix without adjuvant treatment entails short- or long-term sexual difficulties. Twenty patients with stage IB cervical cancer undergoing radical hysterectomy (CG), 18 women treated with hysterectomy for a benign gynecological condition (BG), and 20 gynecologically healthy women (HG) were studied. At 0, 4, and 8 months postoperatively, data were prospectively gathered using standardized questionnaires and specifically developed scales. Sexual functioning was covered in 15 specifically designed items and analyzed using Fisher's exact tests. For all other variables, group comparisons were computed using analysis of variance (ANOVA) or nonparametric statistical equivalents. Nonsignificant trends, consistent across time and groups, resulted for most of the sexual variables. Preoperatively, cancer patients exhibited slightly better sexual functioning than the other two groups, but over time this decreased slightly. Conversely, sexual functioning among the patients with benign disease showed steady improvement. These results indicate that radical hysterectomy for stage IB cervical cancer does not entail major sexual sequelae. Because of the limited sample size of our study, conclusions must be drawn cautiously.

Over the past two decades, quality of life (QoL) research has become an integral endpoint in clinical trials, yet, regarding its implementation in daily clinical work, much hesitation still abounds. This article discusses how complex psychological processes at work within a patient along with environmental factors act upon each other to form what is finally measured in a QoL score. An extended model of QoL is suggested which comprehensively describes the contribution of factors such as common psychological reactions to cancer, coping mechanisms, traits, and socioeconomic conditions to the final outcome in a QoL inventory. In order to avoid disappointment at the utility of results gained in QoL assessment both in clinical trials and daily routine, the choice of appropriate QoL instruments, their goal-directed implementation, and suitable expectations towards the anticipated aims are pivotal aspects to be ensured. Competent utilization of QoL assessment contributes to an enhanced standard of patient-centered care in oncology.

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