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12-03-2013 | Surgery | Article

‘More attention needed’ to reduce long-term rectal cancer QoL burden


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medwireNews: Researchers are calling for more investigations into interventions for late-onset bowel function problems after rectal cancer surgery, after a study highlighted that patients increasingly trade improved survival for lower quality of life (QoL).

It adds to emerging evidence that post-surgery bowel symptoms such as urgency, increased frequency, and incontinence are more likely to persist in the long term since the advent of neoadjuvant radiotherapy and sphincter-preserving surgery.

"Pelvic function is an important issue after treatment for rectal cancer and has so far been underestimated in terms of the impact of poor function on day-to-day life," say authors Gillian Knowles (Edinburgh Cancer Centre, UK) and colleagues.

The study, published in the European Journal of Oncology Nursing, included questionnaire results from 138 rectal cancer and 243 colon cancer patients a median of 53 months after surgery.

Questions about bowel function revealed that 17% of rectal cancer patients always used a protective pad and 41% had to alter their activities some or all of the time because of their bowel function , while 55% reported that they could not regularly control the passage of gas. These findings contrasted with patients who had undergone abdominal surgery for colon cancer, with corresponding percentages of 5%, 16%, and 29%.

The findings also highlighted that rectal cancer patients were significantly more likely than colon cancer patients to have an increased number of bowel movements per day, to have issues with soilage and urgency, and to need to modify their diet to regulate bowel function, according to the Memorial Sloan-Kettering Cancer Centre bowel function instrument.

Notably, these scores were significantly worse among patients who had undergone radiotherapy compared with those who had not. For example, rectal cancer patients who had neoadjuvant radiotherapy scored a median of 12 out of 20 for urgency/soilage compared with 18 out of 20 among patients without radiotherapy.

The greater incidence of defecation and gastrointestinal problems lead to a lower QoL among rectal cancer patients than colon cancer patients and was also particularly pronounced among those who underwent preoperative radiotherapy.

The results also support previous findings that sphincter preservation does not necessarily improve QoL, with comparable responses in this group to those of patients who had temporary or permanent stoma.

Knowles and colleagues say that services for late-onset bowel dysfunction are lacking. Identification of risk factors and early intervention are needed, but there is currently little information available to guide this, they add.

"Current interventions are primarily based on clinical experience and best practice," the authors write. "By introducing routine systematic early health assessment and evaluating interventions offered we will start to build an evidence base to support the management of pelvic dysfunction following rectal cancer treatment."

By Kirsty Oswald, medwireNews Reporter

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