Systematic review of health‐related quality of life issues in locally recurrent rectal cancer

Abstract

The standardization of surgical techniques supplemented with appropriate neoadjuvant chemoradiation has led to the decline in local recurrence rates of rectal cancer (LRRC) from 25-50% to 5-10%. The outcomes reported for surgical intervention in LRRC is encouraging, however, a number of controversies exist especially in the ultra-advanced and palliative setting. Incorporating health-related quality of life (HRQoL) outcomes in this field could supplement traditional clinical endpoints in assessing the effectiveness of surgical intervention in this cohort. This review aimed to identify the HRQOL themes that might be relevant to patients with LRRC. A systematic review was undertaken to identify all studies reporting HRQoL in LRRC. Each study was evaluated with regards to its design and statistical methodology. A meta-synthesis of qualitative and quantitative studies was undertaken to identify relevant HRQoL themes. A total of 14 studies were identified, with 501 patients, with 80% of patients undergoing surgery. HRQoL was the primary endpoint in eight studies. Eight themes were identified: physical, psychological and social impact, symptoms, financial and occupational impact, relationships with others, communication with healthcare professionals and sexual function. The impact on HRQoL is multifactorial and wide ranging, with a number of issues identified that are not included in current measures. These issues must be incorporated into the assessment of HRQoL in LRRC through the development of a validated, disease-specific tool.

Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors

“…27,28 Survivors with permanent ostomies are also more likely to experience social distress post-treatment. 29 Similar to other studies 4,5 , we found a high prevalence of persistent sexual dysfunction associated symptoms in both female and male survivors regardless of ostomy status. This suggests that problems with the physiologic functionality that impact sexual function are universal for all RC survivors.…”

“…This has been suggested previously 4,5 , although the absence of sexual activity may not be an accurate reflection of physiologic functionality or the presence of associated symptoms. 6 Lack of sexual activity after surgery with a permanent ostomy can likely be psychogenic or be a result of functional disorders such as erectile dysfunction.…”

Adjuvant radiotherapy for the treatment of stage IV rectal cancer after curative resection

“…Several studies have demonstrated that pelvic failure significantly affects patient quality of life in terms of fatigue, nausea/vomiting, and pain. [15–17] According to a study by Wong et al [17] , >80% of patients with locally recurrent rectal cancer experienced severe pain, and approximately 25% of them experienced bleeding, discharge, and urinary problems, which could significantly impact quality of life. Our results indicated that adjuvant RT did not increase OS or DFS times of patients with stage IV rectal cancer; however, it did have potential oncologic benefits in terms of reducing the risk of local recurrence, which could be important for improving patient quality of life.…”

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Surgical Management

“…Postoperative chemotherapy offers limited benefit (Harris et al, 2016). Following surgery of this nature, quality of life is satisfactory and superior to non-surgical palliation (Harji et al, 2015).…”