Quality of life in rectal cancer patients: a four-year prospective study

Abstract

Objective: To assess long-term quality of life in a population-based sample of rectal cancer patients.

Summary background data: Quality of life in rectal cancer patients who suffer reduced bowel and sexual function is very important. Few studies, however, have long term follow-up data or sufficient sample sizes for reliable comparisons between operation groups.

Patients and methods: A 4-year prospective study of rectal cancer patients' quality of life was assessed by using the European Organization for Research and Treatment of Cancer QLQ-30 and CR38 questionnaires.

Results: A total of 329 patients returned questionnaires. Overall, anterior resection patients had better quality of life scores than abdominoperineal extirpation patients. High-anterior resection patients had significantly better scores than both low-anterior resection and abdominoperineal extirpation patients. Low-anterior resection patients, however, overall had a better quality of life than abdominoperineal extirpation patients, especially after 4 years. Abdominoperineal extirpation patients' quality of life scores did not improve over time. Stoma patients had significantly worse quality of life scores than nonstoma patients. Quality of life improved greatly for patients whose stoma was reversed.

Conclusions: Anterior resection and nonstoma patients, despite suffering micturition and defecation problems, had better quality of life scores than abdominoperineal extirpation and stoma patients. Comparisons between abdominoperineal extirpation and anterior resection patients should consider the effect of temporary stomas. Improvements in quality of life scores over time may be explained by reversal of temporary stomas or physiologic adaptation.

FIGURE 1. Significant differences between APE, LAR and HAR patients’ EORTC scores (4 years cross-sectional). Solid box, HAR (≥8 cm) patients; shaded box, LAR (<8 cm) patients; open box, APE patients. *P < 0.05, **P < 0.01.

FIGURE 2. Principal EORTC scores for APE, LAR, and HAR patients (4 years cross-sectional). Solid box, HAR (≥8 cm) patients; shaded box, LAR (<8 cm) patients; open box, APE patients.

FIGURE 3. Significant differences between stoma and nonstoma patients’ EORTC scores (4 years cross sectional). Solid box, nonstoma patients; open box, stoma patients. *P < 0.05, **P < 0.01.

FIGURE 4. Differences in EORTC scores over time (repeated measures) by stoma type. Medium shaded box, no stoma year 1; medium hatched box, no stoma year 2; solid box, temporary stoma year 1; dark hatched box, reversed stoma year 2; lightly shaded box, permanent stoma year 1; lightly hatched box, permanent stoma year 2.