Health‐related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer: a review

Thaysen, Henriette Vind; Jess, P.; Laurberg, Søren

doi:10.1111/j.1463-1318.2011.02668.x

Cited by 37 publications

(46 citation statements)

References 28 publications

(86 reference statements)

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“…15 Dietary and behavioral adjustments are common functional self-care strategies for managing bowel dysfunction. 13,16,17 More than half of CRC survivors report using dietary adjustments and intentional social isolation to prevent bowel accidents in public. 18 However, evidence describing the specific types of dietary and behavioral adjustments is lacking.…”

Section: Introductionmentioning

confidence: 99%

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

et al. 2015

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BACKGROUND Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N=856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high versus low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS CRC survivors made substantial, permanent dietary and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.

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Section: Introductionmentioning

confidence: 99%

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

et al. 2015

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“…Rectal cancer is one of the most common malignancies worldwide and has a still increasing incidence and prevalence . In 10–15% of the patients, the rectal cancer is considered locally advanced . In addition, 5–10% of rectal cancer patients develop a local recurrence without metastatic disease which can still be treated with a curative intent…”

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confidence: 99%

“…Even though the importance of patient‐reported outcomes and quality of life are increasingly recognized, research on LARC or LRRC has predominantly focused on assessing local or distance control and overall survival. A recent review concluded that only seven studies evaluated the patients' health‐related quality of life (HRQOL) after treatment for LARC or LRRC . These studies reported that the HRQL in LRRC and LARC was lower compared with patients with nonadvanced disease (NAD) and normative populations .…”

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“…A recent review concluded that only seven studies evaluated the patients' health‐related quality of life (HRQOL) after treatment for LARC or LRRC . These studies reported that the HRQL in LRRC and LARC was lower compared with patients with nonadvanced disease (NAD) and normative populations . However, these findings were based on small sample sizes .…”

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“…However, these findings were based on small sample sizes . Furthermore, information on sexual dysfunction is lacking . Therefore, the objectives of this cross‐sectional study were ( i ) to compare the HRQOL of three patient populations ( i.e .…”

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Measuring the health‐related quality of life and sexual functioning of patients with rectal cancer: Does type of treatment matter?

Traa

Orsini

Oudsten

et al. 2013

Intl Journal of Cancer

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The literature on the health-related quality of life (HRQOL) after rectal cancer is growing, however, a comparison between patients with nonadvanced disease (NAD), locally advanced rectal cancer (LARC), locally recurrent rectal cancer (LRRC) and a normative population has not been made. Data on the sexual functioning of patient groups is also scarce. We compared (i) the HRQOL of patients with NAD, LARC, or LRRC, with a special focus on sexual functioning and (ii) the HRQOL of the three treatment groups with a normative population. The EORTC QLQ-C30 and QLQ-CR38 were completed by 80 patients with NAD, 292 LARC patients and 67 LRRC patients. The normative population (n 5 350) completed the EORTC QLQ-C30 and the Sexual Functioning and Sexual Enjoyment scales of the CR38. LRRC patients reported a lower Physical Function, Social Function, Future Perspective, Sexual Functioning and more Pain compared with LARC and NAD patients. Also, LRRC patients had a worse Body image than NAD patients and a lower Male Sexual Functioning than LARC patients. More than 75% of men and 50% of women were sexually active preoperative, compared with less than 50% and less than 35% postoperative. Male LRRC patients had more problems with erectile or ejaculatory functioning and felt less masculine than NAD or LARC patients. Women did not differ on Lubrication, Dyspareunia and Body Image. About 10% of patients used aids in order to improve erectile functioning (men) or lubrication (women). The treatment groups reported a lower HRQOL and sexual functioning compared with the normative population.Rectal cancer is one of the most common malignancies worldwide and has a still increasing incidence and prevalence.1,2 In 10-15% of the patients, the rectal cancer is considered locally advanced.3 In addition, 5-10% of rectal cancer patients develop a local recurrence without metastatic disease which can still be treated with a curative intent. 4 Treatment for rectal cancer is based on clinical T-stage, pathological lymph nodes and distant metastasis.5 The standard treatment for nonadvanced rectal cancer in The Netherlands is neoadjuvant radiotherapy followed by a total mesorectal excision with autonomous nerve preservation, except for cT1N0 patients were radiotherapy is not indicated. 5 Patients with locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) are treated with neoadjuvant radiochemotherapy often followed by more extensive extra-anatomical surgery in order to achieve a curative resection. During these procedures an intraoperative radiotherapy (IORT) boost dose can be applied at the area of risk in order to improve local control. 6 The current multidisciplinary treatment for rectal cancer has led to decreased morbidity and a significant improvement of survival.7-9 However, treatment for LARC of LLRC may still be accompanied by high morbidity rates (15-68%).10-13 Therefore, the complex and extensive treatment for LARC and LRRC can be very burdensome for the patients.Even though the importance of patient-reported outcom...

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Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer

et al. 2019

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for the CARTS Study Group IMPORTANCE Treatment of rectal cancer is shifting toward organ preservation aiming to reduce surgery-related morbidity. Short-term outcomes of organ-preserving strategies are promising, but long-term outcomes are scarce in the literature.OBJECTIVE To explore long-term oncological outcomes and health-related quality of life (HRQL) in patients with cT1-3N0M0 rectal cancer who underwent neoadjuvant chemoradiotherapy (CRT) followed by transanal endoscopic microsurgery (TEM). DESIGN, SETTING, AND PARTICIPANTSIn this multicenter phase II feasibility study, patients with cT1-3N0M0 rectal cancer admitted to referral centers for rectal cancer throughout the Netherlands between February 2011 and September 2012 were prospectively included. These patients were to be treated with neoadjuvant CRT followed by TEM in case of good response. An intensive follow-up scheme was used to detect local recurrences and/or distant metastases. Data from validated HRQL questionnaires and low anterior resection syndrome questionnaires were collected. Data were analyzed from February 2011 to April 2017. MAIN OUTCOMES AND MEASURESThe primary study outcome of the study was the number of ypT0-1 specimens by performing TEM. Secondary outcome parameters were locoregional recurrences and HRQL. RESULTSOf the 55 included patients, 30 (55%) were male, and the mean (SD) age was 64 (39-82) years. Patients were followed up for a median (interquartile range) period of 53 (39-57) months. Two patients (4%) died during CRT, 1 (2%) stopped CRT, and 1 (2%) was lost to follow-up. Following CRT, 47 patients (85%) underwent TEM, of whom 35 (74%) were successfully treated with local excision alone. Total mesorectal excision was performed in 16 patients (4 with inadequate responses, 8 with completion after TEM, and 4 with salvage for local recurrence). The actuarial 5-year local recurrence rate was 7.7%, with 5-year disease-free and overall survival rates of 81.6% and 82.8%, respectively. Health-related quality of life during follow-up was equal to baseline, with improved emotional well-being in patients treated with local excision (mean score at baseline, 72.0; 95% CI, 67.1-80.1; mean score at follow-up, 86.9; 95% CI, 79.2-94.7; P = .001). Major, minor, and no low anterior resection syndrome was experienced in 50%, 28%, and 22%, respectively, of patients with successful organ preservation. CONCLUSIONS AND RELEVANCEIn early-stage rectal cancer (cT1-3N0M0), CRT enables organ preservation with additional TEM surgery in approximately two-thirds of patients with good long-term oncological outcome and HRQL. This multimodality treatment triggers a certain degree of bowel dysfunction, and one-third of patients still undergo radical surgery and are overtreated by CRT.

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Health‐related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer: a review

Abstract: Several aspects of HRQoL are impaired for a variable time after treatment for locally advanced or recurrence of rectal cancer. Larger prospective longitudinal studies are needed to provide further information regarding the effects of this extensive surgery on quality of life.

Cited by 37 publications

References 28 publications

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

Measuring the health‐related quality of life and sexual functioning of patients with rectal cancer: Does type of treatment matter?

Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer

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