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. 2025 May;27(5):e70110.
doi: 10.1111/codi.70110.

Prospective longitudinal trajectory of cancer survivorship among patients with recurrent rectal cancer: impact of treatment modalities and resection status

Tarik Sammour  1 , Oliver Peacock  1 , Brian K Bednarski  1 , Arvind Dasari  2 , Prajnan Das  3 , Benny Johnson  2 , Grace L Smith  3   4 , George J Chang  1   4 , John Skibber  1 , Y Nancy You  1
Affiliations

Prospective longitudinal trajectory of cancer survivorship among patients with recurrent rectal cancer: impact of treatment modalities and resection status

Tarik Sammour et al. Colorectal Dis. 2025 May.

Abstract

Aim: Recurrent rectal cancer (RRC) can be morbid and optimising cancer survivorship is a priority. The longitudinal trajectories of survivorship associated with RRC have not been prospectively depicted.

Methods: We prospectively enrolled patients with RRC. Participants self-reported quality of life (QOL) using validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and CR29, and pain using the Brief Pain Inventory, at baseline and then every 6 months for up to 5 years or until death. Baseline scores and the longitudinal trajectory of scores were examined using linear mixed-effects modelling.

Results: Among 104 patients, 73 (70.2%) received multimodality salvage treatment with curative intent, while the remainder received best palliative treatments. Curative-intent salvage including surgery was associated with a 30-day operative morbidity rate of 49% and a 5-year overall survival of 51%. Patients undergoing curative-intent salvage versus palliative treatments did not differ in baseline QOL or pain, but the longitudinal trajectory after curative-intent salvage showed sustained improvement of QOL and symptoms over time. This contrasted with the initial transient improvement but persistent decline with palliative treatments. Baseline QOL was significantly impacted by the anatomical site of RRC, with posterior location associated with worst QOL (P = 0.012). Long-term QOL was impacted by anatomical site and status of residual tumour. Pain scores were worse among men.

Conclusion: Trajectories of cancer survivorship for patients with RRC diverge, mainly influenced by anatomical site of the RCC, residual tumour status, and ability to complete curative-intent salvage. These should inform treatment planning. Optimising selection and success of multimodality therapy remains the cornerstone for durable cancer survivorship.

Keywords: EORTC; exenteration; quality of life; rectal cancer; recurrent rectal cancer.

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Conflict of interest statement

We declare that we have no relevant conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Patient flow diagram.
FIGURE 2
FIGURE 2
Trajectory of quality of life (EORTC‐C30, EORTC‐CR29) and pain (Brief Pain Inventory) in patients managed with curative‐intent salvage versus those who were not. Score is expressed as mean with SE in error bars. Function scales, global health, higher score is better. Symptom scales, for both pain scales, higher is worse.
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