title: Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study.
abstract: BACKGROUND
  Restorative anterior resection is considered the optimal procedure for most patients with rectal cancer and is frequently preceded by radiotherapy. Both surgery and preoperative radiotherapy impair bowel function, which adversely affects quality of life.
  
  
  OBJECTIVE
  This study aimed to report symptoms associated with and key predictors for bowel-related quality-of-life impairment.
  
  
  METHODS
  The study included a cross-sectional cohort.
  
  
  METHODS
  This was a multicenter study from 12 United Kingdom centers.
  
  
  METHODS
  A total of 578 patients with rectal cancer underwent curative restorative anterior resection between 2001 and 2012 (median, 5.25 years postsurgery).
  
  
  METHODS
  Patients completed outcome measures that assessed bowel dysfunction (low anterior resection syndrome score), incontinence (Wexner score), and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30), plus an anchor question: "Overall how does bowel function affect your quality of life?"
  
  
  RESULTS
  The response rate was 80% (462/578). Overall, 85% (391/462) of patients reported bowel-related quality-of-life impairment, with 40% (187/462) reporting major impairment. A large difference in global quality of life (22 points; p < 0.001) was reported for "none" versus "major" impairment, with greatest symptom severity being diarrhea (25 points; p < 0.001), insomnia (24 points; p < 0.001), and fatigue (20 points; p < 0.001). Regression analysis identified major impairment in 60% and 45% of patients with low rectal cancer treated with and without preoperative radiotherapy compared with 47% and 33% of middle/upper rectal cancers with and without preoperative radiotherapy.
  
  
  CONCLUSIONS
  Advances in radiotherapy delivery and improvements in posttreatment symptom control, although currently of limited efficacy, imply that the content of this consent aid should be re-evaluated in 5 to 10 years.
  
  
  CONCLUSIONS
  Before a restorative anterior resection, patients with rectal cancer should be informed that bowel-related quality-of-life impairment is common. The key risk factors are neoadjuvant therapy and a low tumor height. This study presents quality-of-life and functional outcome data, along with a consent aid, that will enhance this preoperative patient discussion.
authors.affiliation: 1 Pelican Cancer Foundation, The Ark, Basingstoke, Hampshire, United Kingdom 2 Department of Surgery, Aarhus University Hospital, Aarhus, Denmark 3 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark 4 Colorectal Surgery, Salisbury National Health Service Foundation Trust, Wiltshire, United Kingdom 5 Florence Nightingale Faculty of Nursing and Midwifery, King's College, London, United Kingdom 6 Department of Colorectal Oncology, Mount Vernon and Lister Hospitals, Hertfordshire, United Kingdom 7 Department of Colorectal Surgery, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, United Kingdom.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Battersby
authors.forename: Therese
authors.initials: T
authors.lastname: Juul
authors.forename: Peter
authors.initials: P
authors.lastname: Christensen
authors.forename: Ahmed Z
authors.initials: AZ
authors.lastname: Janjua
authors.forename: Graham
authors.initials: G
authors.lastname: Branagan
authors.forename: Katrine J
authors.initials: KJ
authors.lastname: Emmertsen
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
authors.forename: Robert
authors.initials: R
authors.lastname: Hughes
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Moran
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D003248:Constipation / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology / Q000503:physiopathology; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D006113:United Kingdom