Prognostic value of quality of life and pain in patients with locally recurrent rectal cancer

Abstract

Background: Care of patients with locally recurrent rectal cancer (LRRC) requires careful patient selection. While curative resection offers survival benefits, significant trade-offs exist for the patient. Knowledge of patient-reported outcomes will help inform treatment decisions.

Methods: Quality of life (QOL) and pain were prospectively assessed in 105 patients treated for LRRC at a single institution, using the validated Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and Brief Pain Inventory (BPI) questionnaires. In 54 patients enrolled and followed from diagnosis of LRRC, relationship between pretreatment pain, QOL, and overall survival (OS) were examined.

Results: Patients underwent curative surgical resection (C, 59%), noncurative surgery (NC, 12%) or nonsurgical treatment (NS, 28%). Median OS was 7.1, 1.4, and 1.9 years, respectively (C versus NC: p < 0.001; C versus NS: p = 0.006; NC versus NS: p = 0.261). Physical well-being QOL differed over time (p = 0.042), with greatest difference between C and NC surgery patients (p = 0.049). The remaining QOL domain scores and pain scores demonstrated no significant time or treatment effect. For the 54 patients assessed from diagnosis, median OS was independently predicted by treatment group (C, NC, NS: 4.3, 1.7, versus 2.4 years; p < 0.001) and pretreatment pain intensity (score ≤ 4 versus > 4: 3.8 versus 2.0 years; p = 0.001).

Conclusion: Curative surgery offered prolonged survival, but significant pain exists among long-term survivors and should be a focus of survivorship care. Noncurative surgery did not offer apparent advantages over nonsurgical palliation. Patient's pretreatment pain has prognostic value, and should be assessed, treated, and considered in treatment decisions.

Figure 1

Overall survival of patients from diagnosis of LRRC by different treatment groups. Curative surgery (C): solid line; Noncurative surgery (NC): hashed line; Nonsurgical treatment (NS): dotted line.

Figure 2

Patient-reported physical well-being (PWB) domain scores (median) as measured by the FACT-C questionnaire.

Figure 3

a and b. Patient-reported pain intensity (a) and pain interference (b) scores (median) as measured by the Brief Pain Inventory. Among the 10 distinct patients who reported pain scores after 3 years of followup, 3 had developed metastatic rectal carcinoma and their reported pain intensity scores were 5, 3 and 2.

Figure 3

a and b. Patient-reported pain intensity (a) and pain interference (b) scores (median) as measured by the Brief Pain Inventory. Among the 10 distinct patients who reported pain scores after 3 years of followup, 3 had developed metastatic rectal carcinoma and their reported pain intensity scores were 5, 3 and 2.

Figure 4

Overall survival of patients from diagnosis of LRRC as stratified by baseline pain intensity score. Score ≤4: solid line; Score >4: hashed line.