title: Assessment of quality of life in patients with rectal cancer treated by preoperative radiotherapy: a longitudinal prospective study.
abstract: OBJECTIVE
  To assess prospectively the quality of life (QOL) of patients treated by preoperative radiotherapy (RT) and surgery for locally advanced rectal cancer.
  
  
  METHODS
  We studied 53 patients treated with bi-fractionated RT (50 Gy in 40 fractions within 4 weeks) followed at a median interval of 45 days by abdominoperineal resection in 11 patients and low anterior resection in 42 patients. Their QOL was assessed using two self-rating questionnaires developed by the European Organization for Research and Treatment of Cancer (EORTC): one was cancer specific (EORTC QLQ-C30) and one was site specific (EORTC QLQ-C38). The questionnaires were completed before RT and 12-16 months after RT, at which time 17 patients had undergone colostomy. We hypothesized that at least some scores of the various scales would vary between the two analyses.
  
  
  RESULTS
  Compared with the pre-RT scores, at 1 year, patients reported statistically significant improvement in their emotional state (median 75 vs. 100, p <0.0001), perspective of the future (67 vs. 100, p = 0.0004), and their global QOL (75 vs. 83, p = 0.0008), as well as a decrease in GI symptoms (13 vs. 0, p = 0.002). However, the sexual dysfunction score increased significantly, particularly in men (17 vs. 83, p = 0.0045), and a trend toward a lower body image score was observed (100 vs. 89, p = 0.068). At 1 year, patients with colostomies reported similar or significantly improved symptom scores for fatigue, pain, GI problems, and sleep disturbance, but no such improvements were observed in patients without stomas.
  
  
  CONCLUSIONS
  One year after combined treatment for locally advanced rectal cancer, patients exhibited statistically significant improvement in some important QOL outcomes, including global QOL, despite a decrease in sexual function and body image. Any additional improvement in QOL outcome may require refinements in the RT and surgical techniques to reduce late sequelae, particularly sexual dysfunction. Our results suggest that QOL considerations do not justify sphincter-conserving approaches if locoregional tumor control would be compromised.
authors.affiliation: Radiation Oncology Service, University Hospital of Geneva, 24 Micheli-du-Crest St., 1211 Geneva 14, Switzerland. abdelkarim.allal@hcuge.ch
authors.forename: Abdelkarim S
authors.initials: AS
authors.lastname: Allal
authors.forename: Pascal
authors.initials: P
authors.lastname: Gervaz
authors.forename: Philippe
authors.initials: P
authors.lastname: Gertsch
authors.forename: Jacques
authors.initials: J
authors.lastname: Bernier
authors.forename: Arnaud D
authors.initials: AD
authors.lastname: Roth
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Sabine
authors.initials: S
authors.lastname: Bieri
mesh_terms: D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D000093542:Gemcitabine
chemical_list: D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D000093542:Gemcitabine