Late Side Effects and Quality of Life After Radiotherapy for Rectal Cancer

Bruheim, Kjersti; Guren, Marianne G.; Skovlund, Eva; Hjermstad, Marianne Jensen; Dahl, Olav; Frykholm, Gunilla; Carlsen, Erik; Tveit, Kjell Magne

doi:10.1016/j.ijrobp.2009.03.010

Cited by 215 publications

(127 citation statements)

References 32 publications

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“…The use of these specific categories was mainly triggered by the description of results by previous studies. These studies showed that symptoms caused by radiotherapy are still present after a longer follow-up time [6,25,26]. Furthermore, several population-based studies found the effect of aging in HRQL; patient functioning decreased and general symptoms increased [27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

et al. 2015

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Background: Total mesorectal excision (TME) combined with preoperative short-term radiotherapy (PRT) reduces local recurrence rates in rectal cancer treatment. However, treatment with radiotherapy increased morbidity and did not result in a longer survival. The aim of this analysis is to provide a comprehensive longitudinal overview of the health-related quality of life (HRQL) and symptoms experienced by rectal cancer patients in the Dutch randomized TME trial from baseline until 14 years after treatment. Methods: Rectal cancer patients (n ¼1530) were randomly allocated to PRT (5 Â 5 Gy) followed by TME or to TME alone. At baseline, 3, 6, 12, 18, and 24 months, 5 years and 14 years after treatment HRQL was evaluated in surviving patients (n ¼606, at 14 years after treatment). Results: None of the general symptoms differed significantly between PRT + TME and TME. However, in both treatment arms the general symptoms were increased at the diagnosis of rectal cancer, after surgery and by aging. With PRT + TME bowel symptoms were increased, specifically more fecal incontinence was reported at all time points, resulting in more use of pads for fecal incontinence (PRT + TME vs. TME at 5 years 51.5% vs. 30.5%, respectively, and at 14 years 56.4% vs. 37.1%, respectively).Conclusions: This longitudinal analysis shows that general symptoms in both groups are increased at the diagnosis of rectal cancer, after surgery and by aging, but not by RT. However, irradiated patients reported more bowel dysfunction at all time points.

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Section: Discussionmentioning

confidence: 99%

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

et al. 2015

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“…Postoperative RT treatment volumes for rectal cancer generally include several critical structures that may cause toxicity such as the small intestine, part of the large bowel, anal canal, sometimes, sphincters, bladder, genital organs and the residual rectal volume. A previous toxicity and QOL study in rectal cancer patients performed by Bruheim et al (2010) showed that patients treated with postoperative RT had significant long-term toxicity including fecal incontinence and increased bowel frequency comparing with the non-irradiated ones.…”

Section: Discussionmentioning

confidence: 99%

“…These questionnaires are comprehensive and had been validated in different cultural populations (Bruheim et al, 2010;Mrak et al, 2011;Theodoropoulos et al, 2012). Besides the generally used RTOG toxicity scale, LENT-SOMA scoring system which might have been the best and semi-objective was used for the first time in a QOL study.…”

Section: Discussionmentioning

confidence: 99%

“…QOL represents an individual's capacity to undertake daily activities, combined with satisfaction with one's state of health and balance between disease control and treatment-related adverse effects (Matrah et al, 2012). The literature from Western countries offers some information about rectal cancer survivors' adjustment years after adjuvant CRT for rectal cancer (Bruheim et al, 2010;Kasparek et al, 2012). It is not always possible to adopt the findings of these studies to other countries with a different sociocultural background which may have an important impact on the QOL.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Adjuvant Chemoradiotherapy for Rectal Cancer on the Long-Term Quality of Life and Late Side Effects: A Multicentric Clinical Evaluation by the Turkish Oncology Group

Kılıç

Yalman²,

Aksu³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Aim: Although preoperative chemoradiatherapy (CRT) has proven its benefits in terms of decreased toxicity, there is still a considerable amount of cases that do not receive postoperative CRT. Oncologists at different geographic locations still need to know the long-term effects of this treatment in order to manage patients successfully. The current paper reports on long-term quality of life (QOL) and late side effects after adjuvant CRT in rectal cancer patients from 5 centers in Anatolia. Methods: Rectal cancer patients treated with postoperative CRT with minimum 1-year follow-up and were in complete remission, were evaluated according to RTOG and LENT-SOMA scales. They were also asked to complete Turkish version of EORTC QLQ-C30 questionnaire and the CR-38 module. Each center participated with the required clinical data. Results: Two hundred and thirty patients with median age of 55 years participated and completed the study. Median follow-up time was 5 years. All patients received RT concomitant with chemotherapy. Common parameters that both increased functional health scales and yielded better symptom scores were long term interval after treatment and sphincter-saving surgery. In addition, surgery type and follow-up time were determined to be predictors of QOL scores and late toxicity grade. Conclusion: Postoperative CRT was found to have a great impact on the long term QOL and side effects in rectal cancer survivors. The factors that adversely affect these are abdominoperineal resection and shorter interval. The findings may encourage life-long follow-up and cooperation with patients, which should be mentioned during the initial counseling.

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“…The chance of this happening may be increased by the use of radiotherapy, creating a trade-off between mortality and quality of life risks (Lange et al, 2007;Bruheim et al, 2010). Those facing this risk at the time of surgery have to confront the sheer impossibility of imagining what it would be like personally and socially to live with such a radical bodily modification over the shorter and longer term.…”

Section: The Clinical Background: Anal Cancer and Its Treatmentmentioning

confidence: 99%

The case of the lady who risked exploding: A study of multiple consequences and contested values

Heyman

McGrath

Nastro

et al. 2012

Health, Risk & Society

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Late Side Effects and Quality of Life After Radiotherapy for Rectal Cancer

Abstract: Radiotherapy for rectal cancer is associated with considerable long-term effects on anorectal function, especially in terms of bowel frequency and fecal incontinence. RT+ patients have worse social function, and fecal incontinence has a negative impact on QoL.

Cited by 215 publications

References 32 publications

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

Impact of Adjuvant Chemoradiotherapy for Rectal Cancer on the Long-Term Quality of Life and Late Side Effects: A Multicentric Clinical Evaluation by the Turkish Oncology Group

The case of the lady who risked exploding: A study of multiple consequences and contested values

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