The quality-of-life effects of neoadjuvant chemoradiation in locally advanced rectal cancer

Abstract

Purpose: Existing studies that examine the effect of neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer on patient quality of life (QOL) are limited. Our goals were to prospectively explore acute changes in patient-reported QOL endpoints during and after treatment and to establish a distribution of scores that could be used for comparison as new treatment modalities emerge.

Methods and materials: Fifty patients with locally advanced rectal cancer were prospectively enrolled at 2 institutions. Validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) and colorectal cancer-specific (EORTC QLQ-CR38 and EORTC QLQ-CR 29) QOL questionnaires were administered to patients 1 month before they began CRT, at week 4 of CRT, and 1 month after they had finished CRT. The questionnaires included multiple symptom scales, functional domains, and a composite global QOL score. Additionally, a toxicity scale was completed by providers 1 month before the beginning of CRT, weekly during treatment, and 1 month after the end of CRT.

Results: Global QOL showed a statistically significant and borderline clinically significant decrease during CRT (-9.50, P=.0024) but returned to baseline 1 month after the end of treatment (-0.33, P=.9205). Symptoms during treatment were mostly gastrointestinal (nausea/vomiting +9.94, P<.0001; and diarrhea +16.67, P=.0022), urinary (dysuria +13.33, P<.0001; and frequency +11.82, P=.0006) or fatigue (+16.22, P<.0001). These symptoms returned to baseline after therapy. However, sexual enjoyment (P=.0236) and sexual function (P=.0047) remained persistently diminished after therapy.

Conclusions: Rectal cancer patients undergoing neoadjuvant CRT may experience a reduction in global QOL along with significant gastrointestinal and genitourinary symptoms during treatment. Moreover, provider-rated toxicity scales may not fully capture this decrease in patient-reported QOL. Although most symptoms are transient, impairment in sexual function may persist after the completion of therapy and merits further investigation.

Conflict of interest statement

Conflict of interest: none.

Copyright © 2013 Elsevier Inc. All rights reserved.

Figures

Fig. 1

Mean European Organization for Research and Treatment of Cancer QLQ-C30 scores by questionnaire item at each study time point. *Denotes a significant difference in item score compared with pretreatment levels. RT = radiation therapy.

Fig. 2

Mean European Organization for Research and Treatment of Cancer QLQ-CR38 scores by questionnaire item at each study time point. *Denotes a significant difference in item score compared with pretreatment levels. ^Denotes a borderline significant difference in item score compared with pretreatment levels. ◇ Denotes a significant difference in item score compared with levels at the fourth week of therapy. Note that only 2 patients had stomas. RT = radiation therapy.

Fig. 3

Mean European Organization for Research and Treatment of Cancer QLQ-CR29 scores by questionnaire item at each study time point. *Denotes a significant difference in item score compared with pretreatment levels. ^Denotes a borderline significant difference in item score compared with pretreatment levels. ◇ Denotes a significant difference in item score compared with levels at the fourth week of therapy. RT = radiation therapy.