The Quality-of-Life Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

Journal Article · Tue Jan 01 04:00:00 EST 2013 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2012.09.006· OSTI ID:22149708

Narang, Amol K. ^[1]; Griffith, Kent A. ^[2]; Zalupski, Mark M. ^[3]; Reese, Jennifer B. ^[4]; Gearhart, Susan L. ^[5]; Azad, Nolifer S. ^[5]; Chan, June; Olsen, Leah ^[6]; Efron, Jonathan E. ^[7]; Lawrence, Theodore S.; Ben-Josef, Edgar ^[6]

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1. Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)
2. Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)
3. Department of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)
4. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)
5. Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)
6. Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)
7. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

Purpose: 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 and Materials: 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.

• OSTI ID: 22149708
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 85; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
DIARRHEA
FATIGUE
NAUSEA
NEOPLASMS
PATIENTS
RADIOTHERAPY
RECTUM
STANDARD OF LIVING
TOXICITY
VOMITING