Health-Related Quality of Life during Chemoradiation in Locally Advanced Rectal Cancer: Impacts and Ethnic Disparities

Abstract

Aims: There is limited data on health-related quality of life (HRQoL) in locally advanced rectal cancer. We assessed HRQoL before, during and after neoadjuvant chemoradiation, correlated this to corresponding clinician-reported adverse events (CR-AEs) and explored disparities between patients of Asian ethnicity versus Caucasians. Correlation between HRQoL and treatment response was also assessed. Methods: A consecutive sample of patients was recruited. HRQoL was assessed with the EORTC QLQ-C30 before chemoradiation, week three of chemoradiation and one-week pre-surgery. Clinical variables including CR-AEs were recorded at these time-points. Patients self-reported socio-demographic variables. Treatment response was assessed by the tumour regression grade. HRQoL data were analysed with multilevel models. Results: Fifty-one patients were recruited. HRQoL completion rates were ≥86%. Cognitive and role functioning worsened significantly during treatment. Emotional, role and social functioning improved significantly at pre-surgery. Fatigue and nausea/vomiting worsened during treatment while fatigue, appetite loss, diarrhoea and financial difficulties improved from treatment to pre-surgery. Almost 30% of the cohort were Asian ethnicity. Differences were found in multiple HRQoL domains between Asians and Caucasians, with Asians faring worse. Significant differences were evident in physical, role and cognitive functioning, and in seven out of the 8 symptom scales. The correlation between patient-reported outcomes and clinician-reported outcomes was weak, with diarrhoea having the strongest correlation (r = 0.58). Vomiting during treatment correlated with poor response, whilst baseline constipation correlated with good response. Conclusion: Chemoradiation for locally advanced rectal cancer affects multiple HRQoL domains. Our findings highlight the importance of psychological aspects of treatment. Significant differences were identified between the Asian and Caucasian populations, with Asians consistently performing worse. Poor correlations between patient and clinician reporting strongly support the inclusion of patient-reported outcomes in clinical studies. HRQoL domains of vomiting and constipation are potential biomarkers of treatment response.

Assessment of Quality of Life Following Radiotherapy in Patients with Rectum Cancer

“…Lim et al evaluated QoL before and after treatment and before surgery in patients with local advanced stage rectum cancer who received neo-adjuvant therapy. While role function and cognitive function impaired during treatment, emotional function improved from baseline to pre-operative period [3]. In a similar study, while diarrhea, fatigue and loss of no functional difference could be shown [16].…”

“…Colorectal cancer is the third leading cancer type worldwide in both genders [1]. Rectum cancer consists 25-30% of colorectal cancers [2,3]. The main treatment approach is surgery in rectum cancer [4,5].…”

“…The main treatment approach is surgery in rectum cancer [4,5]. In local advanced rectum cancer, the standard treatment is neoadjuvant chemo-radiotherapy (CRT), surgery and adjuvant chemotherapy (CT) [3]. Adjuvant radiotherapy (RT) is recommended in patients who do not receive neoadjuvant therapy and who carry high risk for local recurrence [5].…”

IMMUNOREACT 0: Biopsy‐based immune biomarkers as predictors of response to neoadjuvant therapy for rectal cancer—A systematic review and meta‐analysis

“…T lymphocytes are a basic component of the adaptive immune response characterized by expression of the cluster of differentiation (CD) cell surface marker CD3. The relationship between the presence of CD3+ T lymphocytes and response to NT was extracted from three studies 17,28,29 . The results of the meta‐analysis demonstrated that high levels of CD3+ TILs in patients' biopsy specimens significantly predict good pathologic response (OR 1.78, 95% CI 1.08–2.95; participants = 267; I 2 = 0%) (Figure 2).…”

“…They are highly heterogeneous and dynamic, and they can enhance the tumor‐killing capacity of cytotoxic cells. The relationship between the presence of CD4+ Th lymphocytes and response to NT was extracted from four studies for total CD4+ TILs 16,18,28,30 and two studies for both CD4+ intraepithelial TILs (iTILs) and stromal TILs (sTILs) 15,19 (Figure 3). The meta‐analysis revealed a significant association between high levels of total CD4+ TILs of pretreatment biopsy specimens and good pathologic response (OR 2.26, 95% CI 1.30–3.94; participants = 239; I 2 = 0%) (Figure 3A).…”