title: Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life.
abstract: OBJECTIVE
  Survival from rectal cancer has improved substantially. Understanding the consequences of treatment is important to optimise patient support and minimise impact on daily life. We aimed to define the long-term prevalence of pelvic dysfunction following curative rectal cancer surgery (+/- radiotherapy) within the context of overall quality of life.
  
  
  METHODS
  We evaluated bowel, urinary and sexual function and quality of life using three validated questionnaires in patients treated for rectal cancer. This group was compared to patients undergoing abdominal surgery without pelvic dissection for colon cancer during the same time period.
  
  
  RESULTS
  The response rate was 57% (381/667) with a median time interval of 4.4 years. A subset of rectal patients documented persistent problems with faecal leakage (16%); requiring to alter daily activities (18%); always needing to wear a protective pad (17%); rarely or never emptying their bowels fully (31%); difficulty controlling the passage of gas (32%) and requiring to modify diet (30%). Altered bowel function was found to impact on overall quality of life. Men reported increased erectile function difficulties. Pre-operative radiotherapy was associated with increased defecation problems as was low level of anastomosis (≤6 cm).
  
  
  CONCLUSIONS
  In keeping with emergent evidence, this study has quantified the extent of late adverse effects with a sub-set of rectal cancer patients reporting persistent bowel function problems. The implications are now to consider current follow-up services and to 'trial' new models of comprehensive assessment and interventions in patients who are 'at risk' of experiencing late adverse effects of treatment.
authors: Edinburgh Cancer Centre, Lothian University Hospitals Division, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland, UK. Electronic address: Gillian.knowles@luht.scot.nhs.uk.
authors: Gillian
authors: G
authors: Knowles
authors: Rachel
authors: R
authors: Haigh
authors: Catriona
authors: C
authors: McLean
authors: Hamish A
authors: HA
authors: Phillips
authors: Malcolm G
authors: MG
authors: Dunlop
authors: Farhat V N
authors: FV
authors: Din
mesh_terms: D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D017741:Survivors; D006113:United Kingdom; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology
keywords: Cancer survivors; Late effects; Quality of life; Radiotherapy; Rectal cancer; Surgery