title: Predictors of Long-Term Quality of Life for Survivors of Stage II/III Rectal Cancer in the Cancer Care Outcomes Research and Surveillance Consortium.
abstract: OBJECTIVE
  Many patients do not receive guideline-recommended neoadjuvant chemoradiotherapy for resectable rectal cancer. Little is known regarding long-term quality of life (QOL) associated with various treatment approaches. Our objective was to determine patient characteristics and subsequent QOL associated with treatment approach.
  
  
  METHODS
  Our study was a geographically diverse population- and health system-based cohort study that included adults age 21 years or older with newly diagnosed stage II/III rectal cancer who were recruited from 2003 to 2005. Eligible patients were contacted 1 to 4 months after diagnosis and asked to participate in a telephone survey and to consent to medical record review, with separate follow-up QOL surveys conducted 1 and 7 years after diagnosis.
  
  
  RESULTS
  Two hundred thirty-nine patients with stage II/III rectal cancer were included in this analysis. Younger age (< 65 v ≥ 65 years: odds ratio, 2.49; 95% CI, 1.33 to 4.65) was significantly associated with increased odds of receiving neoadjuvant or adjuvant chemoradiotherapy. The adjuvant chemoradiotherapy group had significantly worse mean EuroQol-5D (range, 0 to 1) and Short Form-12 physical health component scores (standardized mean, 50) at 1-year follow-up than the neoadjuvant chemoradiotherapy group (0.75 v 0.85; P = .002; 37.2 v 43.3; P = .01, respectively) and the group that received only one or neither form of treatment (0.75 v 0.85; P = .02; 37.2 v 45.1; P = .008, respectively).
  
  
  CONCLUSIONS
  Neoadjuvant treatment may result in better QOL and functional status 1 year after diagnosis. Further evaluation of patient and provider reasons for not pursuing neoadjuvant therapy is necessary to determine how and where to target process improvement and/or education efforts to ensure that patients have access to recommended treatment options.
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ mary-charlton@uiowa.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Chi
authors.initials: C
authors.lastname: Lin
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Schlichting
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Thorvardur R
authors.initials: TR
authors.lastname: Halfdanarson
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Grelda Yazmin
authors.initials: GY
authors.lastname: Juarez
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Jane F
authors.initials: JF
authors.lastname: Pendergast
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.affiliation: University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
mesh_terms: D000367:Age Factors; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D010353:Patient Education as Topic; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors