The quality-of-life effects of neoadjuvant chemoradiation in locally advanced rectal cancer.
OBJECTIVE
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
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.
Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231-2410, USA. jherma15@jhmi.edu
Joseph M
JM
Herman
Amol K
AK
Narang
Kent A
KA
Griffith
Mark M
MM
Zalupski
Jennifer B
JB
Reese
Susan L
SL
Gearhart
Nolifer S
NS
Azad
June
J
Chan
Leah
L
Olsen
Jonathan E
JE
Efron
Theodore S
TS
Lawrence
Edgar
E
Ben-Josef
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D003967:Diarrhea / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012737:Sex Factors; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology; D014839:Vomiting / Q000209:etiology