Functional Bowel Complaints and the Impact on Quality of Life After Colorectal Cancer Surgery in the Elderly

Abstract

BackgroundThe Low Anterior Resection Syndrome (LARS) is commonly reported after colorectal cancer surgery and significantly impairs quality of life. The prevalence and impact of LARS in the elderly after rectal cancer as well as colon cancer surgery is unclear. We aimed to describe the prevalence of LARS complaints and the impact on quality of life in the elderly after colorectal cancer surgery.Materials and MethodsPatients were included from seven Dutch hospitals if they were at least one year after they underwent colorectal cancer surgery between 2008 and 2015. Functional bowel complaints were assessed by the LARS score. Quality of life was assessed by the EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Outcomes in patients ≥70 years were compared to a reference group of patients <70 years.ResultsIn total 440 rectal cancer and 1183 colon cancer patients were eligible for analyses, of whom 133 (30.2%) rectal and 536 (45.3%) colon cancer patients were ≥70 years. Major LARS was reported by 40.6% of rectal cancer and 22.2% of colon cancer patients ≥70 years. In comparison, patients <70 years reported major LARS in 57.3% after rectal cancer surgery (p=0.001) and in 20.4% after colon cancer surgery (p=0.41). Age ≥70 years was independently associated with reduced rates of major LARS after rectal cancer surgery (OR 0.63, p=0.04). Patients with major LARS reported significantly impaired quality of life on almost all domains.ConclusionElderly should not be withheld a restorative colorectal cancer resection based on age alone. However, a substantial part of the elderly colorectal cancer patients develops major LARS after surgery, which often severely impairs quality of life. Since elderly frequently consider quality of life and functional outcomes as one of the most important outcomes after treatment, major LARS and its impact on quality of life should be incorporated in the decision-making process.

The effect of anastomotic leak on postoperative pelvic function and quality of life in rectal cancer patients

“…Quality of life questionnaires are also offered to elderly patients above 70 years of age in a Dutch study by Ketelaers et.al. This study showed that LARS can severely affect their quality of life and it is of paramount importance to describe preoperatively and thoroughly possible bowel dysfunction in their decision making process [ 36 ].…”

Commentary: Functional bowel complaints and the impact on quality of life after colorectal cancer surgery in the elderly

“…We would like to congratulate Ketelaers et al. (2022) ( 1 ) on their article regarding prevalence of low anterior resection syndrome (LARS) complaints and the impact on quality of life in the elderly after colorectal cancer surgery. Their article concerns a population-based study of 1623 older adults who underwent colorectal cancer surgery with primary anastomosis.…”

“…For colon cancer patients, the study showed the prevalence of major LARS symptoms as similar between younger and older patients: 20.4% and 22.2%, respectively. In addition, patients with major LARS presented significantly impaired quality of life ( 1 ). This study used the LARS score questionnaire, which is a very popular tool among clinicians and researchers.…”

“…The Ketelaers et al. (2022) ( 1 ) study included patients with and without LAR. The previously mentioned studies have in common the use of the LARS score questionnaire and the detection of some degree of LARS among participants.…”

The content and effectiveness of physical activity for cancer‐related fatigue among colorectal cancer survivors: Systematic review and meta‐analysis

“…One of the most common treatment options for CRC in clinical practice is radical resection combined with chemotherapy, which has greatly improved the survival rate (Iveson et al, 2019). However, the quality of life of CRC patients has not been promoted significantly due to the many adverse effects caused by cancer itself and treatments, especially chemotherapy, such as chronic pain, sleep disturbances, fatigue, depression and so on (Ketelaers et al, 2022;Sakr et al, 2020).Therefore, the burden of follow-up care for CRC survivors is expected to increase, and exploring ways to improve cancer-related symptoms and quality of life in this population deserves attention.Cancer-related fatigue (CRF), a sustained and distressing sense of tiredness or exhaustion, is currently recognized as one of the…”