nach oben

Erschienen in:

01.05.2010 | Original Article

Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery

verfasst von: Salvatore Pucciarelli, Paola Del Bianco, Fabio Efficace, Paola Toppan, Samantha Serpentini, Maria Luisa Friso, Sara Lonardi, Gian Luca De Salvo, Donato Nitti

Erschienen in: Supportive Care in Cancer | Ausgabe 5/2010

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate health-related quality of life (HRQOL), faecal continence and bowel function of patients with rectal cancer who underwent preoperative chemoradiotherapy (pCRT) in a cross-sectional setting.

Methods

Out of 185 consecutive patients who underwent pCRT for rectal cancer from 1994 to 2004 at a single institution, 101 were eligible for the study. Causes of exclusion were: death (n = 38), not radical surgery or recurrence (n = 21), presence of stoma at the time of the survey (n = 15), lost to follow-up (n = 6) and miscellaneous (n = 4). Eligible patients were asked to complete: the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, the disease specific colorectal module (EORTC QLQ-CR38) and faecal incontinence and bowel function questionnaires. HRQOL outcomes were compared with reference data from the general population, and the association among clinical variables and HRQOL was also investigated with linear regression analyses.

Results

Questionnaires were completed by 80% of eligible patients. Compared to population-based norms, patients showed clinically meaningful worse outcomes in terms of constipation and diarrhoea. Stool fractionation (p < 0.01) and use of enema/laxative (p < 0.01) were negatively associated with global health status/QOL. Urgency negatively affected physical (p < 0.01), role (p < 0.01) and social functioning (p < 0.01). Sensation of incomplete evacuation negatively affected social functioning (p < 0.01).

Conclusions

Although HRQOL profile of these patients is broadly similar to that of healthy subjects, there are still important limitations in terms of key symptoms. The use of validated questionnaires is crucial to provide standardised information on relevant health status areas.

National Comprehensive Cancer Network. Colon and Rectal Cancer. Treatment Guidelines for Patients. Version V / October 2007. Last accessed June 2008. http://www.nccn.org/patients/default.asp

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMed

Bosset J-F, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123CrossRefPubMed

Gérard J-P, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancer: results of FFCD 9203. J Clin Oncol 24:4620–4625CrossRefPubMed

Valentini V, Coco C, Cellini N et al (2001) Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumour response, and sphincter preservation in three consecutive studies. Int J Radiation Oncology Biol Phys 5:371–383

Pucciarelli S, Toppan P, Friso ML et al (2004) Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum 47:1798–1807CrossRefPubMed

Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223CrossRefPubMed

Sauer R, Fietkau R, Wittekind C et al (2003) Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis 5:406–415CrossRefPubMed

Pietrzak L, Mujko K, Novacki MP et al (2007) Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomized trial. Radiother Oncol 84:217–225CrossRefPubMed

10.

Gervaz P, Wexner SD, Pemberton JH (2002) Pelvic radiation and anorectal function: introducing the concept of sphincter-preserving radiation therapy. J Am Coll Surg 195:387–394CrossRefPubMed

11.

Marijnem CAM, van de Velde CJH, Putter H et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23:1847–1858CrossRef

12.

Peeters KC, van de Velde CJ, Leer JW et al (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 23:6199–6206CrossRefPubMed

13.

Guren MG, Eriksen MT, Wiig JN et al (2005) Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 31:735–742CrossRefPubMed

14.

Hassan I, Larson DW, Cima RR et al (2006) Long-term functional and quality of life outcomes after coloanal anastomosis for distal rectal cancer. Dis Colon Rectum 49:1266–1274CrossRefPubMed

15.

Hendren SK, O'Connor BI, Liu M et al (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242:212–223CrossRefPubMed

16.

Engel J, Kerr J, Schleisinger-Racib A et al (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238:203–213PubMed

17.

Rauch P, Miny J, Conroy T, Neyton L, Guillermin F (2004) Quality of life among disease-free survivors of rectal cancer. J Clin Oncol 22:354–360CrossRefPubMed

18.

Neuman HB, Schrag D, Cabral C et al (2007) Can differences in bowel function after surgery for rectal cancer be identified by the European organization for research and treatment of cancer quality of life instruments? Ann Surg Oncol 14:1727–1734CrossRefPubMed

19.

Langenhoff BS, Krabbe PFM, Wobbes T, Ruer TJM (2001) Quality of life as an outcome measure in surgical oncology. Br J Surg 88:643–652CrossRefPubMed

20.

Blazeby JM, Avery K, Sprangers M et al (2006) Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol 24:3178–3186CrossRefPubMed

21.

Schulze T, Wurst P, Gellermann J et al (2006) Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients. Int J Hyperthermia 22:301–318CrossRefPubMed

22.

AJCC American Joint Committee on Cancer (1997) In: Fleming DI, Cooper SJ, Henson ED et al (eds) AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia, pp 83–90

23.

Urso E, Serpentini S, Pucciarelli S et al (2006) Complications, functional outcome and quality of life after intensive preoperative chemoradiotherapy for rectal cancer. Eur J Surg Oncol 32:1201–1208CrossRefPubMed

24.

Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMed

25.

Sprangers MAG, te Velde A, Aaronson NK (1999) The Construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer 35:238–247CrossRefPubMed

26.

Cull A, Sprangers M, Bjordal K, Aaronson N, West K, Bottomley A (2002) EORTC quality of life group translation procedure, 2nd edn. EORTC, Brussels

27.

Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80PubMedCrossRef

28.

Fazio WF, Zutshi M, Remzi FH et al (2007) A randomized trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246:481–490CrossRefPubMed

29.

Fayers P, Aaronson N, Bjordal K, Curran D, Groenvold M (1999) EORTC QLQ-C30 scoring manual, 2nd edn. EORTC Quality of Life Study Group, Brussels

30.

Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37:1345–1351CrossRefPubMed

31.

Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMed

32.

Thiesen F, Kauer WKH, Nekarda H et al (2006) Neoadjuvant radiochemotherapy for patients with locally advanced rectal cancer leads to impairment of the anal sphincter. J Gastrointest Surg 10:309–314CrossRef

33.

Pollack J, Holm T, Cedermark B, Holmstrom B, Mellgren A (2006) Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 49:345–352CrossRefPubMed

34.

Temple LK, Bacik J, Savatta SG et al (2005) The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 48:1353–1364CrossRefPubMed

35.

Pucciarelli S, Del Bianco P, Toppan P et al (2008) Health-related quality of life outcomes in disease-free survivors of mid-low rectal cancer after curative surgery. Ann Surg Oncol 15:1846–1854CrossRefPubMed

36.

Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H (2006) Restrictions in quality of life in colorectal cancer patients over three years after diagnosis: a population based study. Eur J Cancer 42:1848–1857CrossRefPubMed

37.

Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H (2004) Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: a population-based study. J Clin Oncol 22:4829–4836CrossRefPubMed

38.

Guren MG, Dueland S, Skovlund E et al (2003) Quality of life during radiotherapy for rectal cancer. Eur J Cancer 39:587–594CrossRefPubMed

39.

Apolone G, Filiberti A, Cifani S, Ruggiata R, Mosconi P (1998) Evaluation of the EORTC QLQ-C30 questionnaire: a comparison with SF-36 health survey in a cohort of Italian long-survival cancer patients. Ann Oncol 9:549–557CrossRefPubMed

40.

Coco C, Valentini V, Manno A et al (2007) Functional results after radiochemotherapy and total mesorectal excision for rectal cancer. Int J Colorectal Dis 22:903–910CrossRefPubMed

41.

Sprangers MAG, Schwartz CE (1999) The challenge of response shift for quality-of-life-based clinical oncology research. Ann Oncol 10:747–749CrossRefPubMed

42.

Hagedoorn M, Sneeuw KCA, Aaronson N (2002) Changes in physical functioning and quality of life in patients with cancer: response shift and relative evaluation of one's condition. J Clin Epidemiol 55:176–183CrossRefPubMed

Titel: Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery
verfasst von: Salvatore Pucciarelli
Paola Del Bianco
Fabio Efficace
Paola Toppan
Samantha Serpentini
Maria Luisa Friso
Sara Lonardi
Gian Luca De Salvo
Donato Nitti
Publikationsdatum: 01.05.2010
Verlag: Springer-Verlag
Erschienen in: Supportive Care in Cancer / Ausgabe 5/2010
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-009-0699-y

Springer Medizin

Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery