A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

Abstract

Background: Total mesorectal excision (TME) combined with preoperative short-term radiotherapy (PRT) reduces local recurrence rates in rectal cancer treatment. However, treatment with radiotherapy increased morbidity and did not result in a longer survival. The aim of this analysis is to provide a comprehensive longitudinal overview of the health-related quality of life (HRQL) and symptoms experienced by rectal cancer patients in the Dutch randomized TME trial from baseline until 14 years after treatment. Methods: Rectal cancer patients (n ¼1530) were randomly allocated to PRT (5 Â 5 Gy) followed by TME or to TME alone. At baseline, 3, 6, 12, 18, and 24 months, 5 years and 14 years after treatment HRQL was evaluated in surviving patients (n ¼606, at 14 years after treatment). Results: None of the general symptoms differed significantly between PRT + TME and TME. However, in both treatment arms the general symptoms were increased at the diagnosis of rectal cancer, after surgery and by aging. With PRT + TME bowel symptoms were increased, specifically more fecal incontinence was reported at all time points, resulting in more use of pads for fecal incontinence (PRT + TME vs. TME at 5 years 51.5% vs. 30.5%, respectively, and at 14 years 56.4% vs. 37.1%, respectively).Conclusions: This longitudinal analysis shows that general symptoms in both groups are increased at the diagnosis of rectal cancer, after surgery and by aging, but not by RT. However, irradiated patients reported more bowel dysfunction at all time points.

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

“…204 Patients in the Dutch TME-trial that received RT reported impaired quality of life (QoL) even after a follow up of 14 years. 205 However, no impact on general symptoms was seen in the irradiated group. Symptoms of urinary dysfunction such as increased frequency, chronic cystitis and incontinence are more common in patients after RT.…”

Anorectal Function and Quality of Life in Patients With Early Stage Rectal Cancer Treated With Chemoradiation and Local Excision

“…However, other studies have shown that AF and HRQOL seem to stabilize 1 to 2 years after treatment and deteriorate slowly thereafter. 26 Third, baseline scores were obtained when the patients already had a tumor in the rectum. The impact of the tumor on anorectal function and some domains of HRQOL is unknown.…”

Effect of Neoadjuvant Therapy and Rectal Surgery on Health-related Quality of Life in Patients With Rectal Cancer During the First 2 Years After Diagnosis

“…[1][2][3] However, treatment of intermediate-and high-risk rectal cancer, involving neoadjuvant radiotherapy with or without chemotherapy followed by total mesorectal excision (TME), is invasive and associated with significant postoperative short-and long-term morbidity. [4][5][6] As more patients live with the consequences of treatment, resulting from both the increasing rectal cancer incidence and the improving survival rate, 7 patients' quality of life (QOL) has increasingly become a focus of attention.…”