Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Nick J Battersby, Pelican Cancer Foundation, Storbritannien
  • Therese Juul
  • Peter Christensen
  • Ahmed Z Janjua, Pelican Cancer Foundation, Storbritannien
  • Graham Branagan, Colorectal Surgery, Salisbury National Health Service Foundation Trust, Wiltshire, Storbritannien
  • Katrine J Emmertsen
  • Christine Norton, Florence Nightingale Faculty of Nursing and Midwifery, Kings College, London, Storbritannien
  • Robert Hughes, Department of Colorectal Oncology, Mount Vernon and Lister Hospitals, Hertfordshire, Storbritannien
  • Søren Laurberg
  • Brendan Moran
  • ,
  • United Kingdom Low Anterior Resection Syndrome Study Group

BACKGROUND: Restorative anterior resection is considered the optimal procedure for most patients with rectal cancer and is frequently preceded by radiotherapy. Both surgery and preoperative radiotherapy impair bowel function, which adversely affects quality of life.

OBJECTIVE: This study aimed to report symptoms associated with and key predictors for bowel-related quality-of-life impairment.

DESIGN: The study included a cross-sectional cohort.

SETTINGS: This was a multicenter study from 12 United Kingdom centers.

PATIENTS: A total of 578 patients with rectal cancer underwent curative restorative anterior resection between 2001 and 2012 (median, 5.25 years postsurgery).

MAIN OUTCOME MEASURES: Patients completed outcome measures that assessed bowel dysfunction (low anterior resection syndrome score), incontinence (Wexner score), and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30), plus an anchor question: "Overall how does bowel function affect your quality of life?"

RESULTS: The response rate was 80% (462/578). Overall, 85% (391/462) of patients reported bowel-related quality-of-life impairment, with 40% (187/462) reporting major impairment. A large difference in global quality of life (22 points; p < 0.001) was reported for "none" versus "major" impairment, with greatest symptom severity being diarrhea (25 points; p < 0.001), insomnia (24 points; p < 0.001), and fatigue (20 points; p < 0.001). Regression analysis identified major impairment in 60% and 45% of patients with low rectal cancer treated with and without preoperative radiotherapy compared with 47% and 33% of middle/upper rectal cancers with and without preoperative radiotherapy.

LIMITATIONS: Advances in radiotherapy delivery and improvements in posttreatment symptom control, although currently of limited efficacy, imply that the content of this consent aid should be re-evaluated in 5 to 10 years.

CONCLUSIONS: Before a restorative anterior resection, patients with rectal cancer should be informed that bowel-related quality-of-life impairment is common. The key risk factors are neoadjuvant therapy and a low tumor height. This study presents quality-of-life and functional outcome data, along with a consent aid, that will enhance this preoperative patient discussion.

OriginalsprogEngelsk
TidsskriftDiseases of the Colon and Rectum
Vol/bind59
Nummer4
Sider (fra-til)270-80
Antal sider11
ISSN0012-3706
DOI
StatusUdgivet - apr. 2016

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