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

Couwenberg, Alice M.; Burbach, J.P.M.; Grevenstein, Wilhelmina M U van; Smits, Anke B.; Consten, Esther C. J.; Schiphorst, A. H. W.; Wijffels, Niels; Heikens, Joost T.; Intven, Martijn; Verkooijen, Helena M.

doi:10.1016/j.clcc.2018.03.009

Cited by 73 publications

(59 citation statements)

References 51 publications

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“…There are several reasons why patients may refuse recommended rectal cancer surgery. These include avoidance of radical surgery and quality of life concerns, 14,20 personal values, 15,16 communication difficulties with providers, 18,19 and the racial/socioeconomic barriers discussed previously 12,17,18 . Patients are often concerned with quality of life following rectal cancer surgery given the high rate of morbidity following surgery, including low anterior resection syndrome, sexual dysfunction, and permanent colostomy.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, in a survey, patients said they were willing to accept higher rates of tumor recurrence and decreased survival to avoid radical surgery 15 . Several studies have indeed shown that there is a decrease in quality of life after surgery for rectal cancer, although this decrease often returns to baseline within 6 months to 2 years after surgery 20,30 …”

Section: Discussionmentioning

confidence: 99%

“…15 Several studies have indeed shown that there is a decrease in quality of life after surgery for rectal cancer, although this decrease often returns to baseline within 6 months to 2 years after surgery. 20,30 Another reason for surgery refusal may be a complete response following neoadjuvant chemoradiation. Up to 40% of patients may show a complete pathologic response following neoadjuvant chemoradiation.…”

Section: Discussionmentioning

confidence: 99%

“…Although there have been advances in the treatment of rectal cancer which have led to decreases in cancer mortality, there are still patients who are not receiving recommended treatment 9‐11 . Studies have shown that between 30% and 80% who do not receive the recommended therapy are refusing surgery, although the exact number of patients is unknown 12,13 There are several reasons why patients might refuse surgery, which include avoidance of a radical operation, 14 personal values, or beliefs, 15,16 racial or socioeconomic barriers, 12,17,18 difficulties in physician communication, 18,19 or quality of life concerns 14‐20 …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Studies have shown that between 30% and 80% who do not receive the recommended therapy are refusing surgery, although the exact number of patients is unknown 12,13 There are several reasons why patients might refuse surgery, which include avoidance of a radical operation, 14 personal values, or beliefs, 15,16 racial or socioeconomic barriers, 12,17,18 difficulties in physician communication, 18,19 or quality of life concerns. [14][15][16][17][18][19][20] Refusal of surgery is associated with worse oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of stage I‐III rectal cancer: Who is refusing surgery?

Fields

Yoo

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Surgical resection is a cornerstone in the management of patients with rectal cancer. Patients may refuse surgical treatment for several reasons although the rate of refusal is currently unknown. Methods The National Cancer Database was utilized to identify patients with stage I‐III rectal cancer. Patients who refused surgical resection were compared to patients who underwent curative resection. Results A total of 509 (2.6%) patients with stage I and 2082 (3.5%) patients with stage II/III rectal cancer refused surgery. In multivariable analysis for stage I disease, older age, Black race, and Medicaid/no insurance were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had a higher income or lived further distances from the treatment facility. In multivariable analysis for stage II/III disease, older age, Black race, insurance other than private, and rural county were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had higher Charlson comorbidity scores, lived further distances from the treatment facility, or underwent chemoradiation. There was a significant decrease in survival for patients refusing surgery compared to patients undergoing recommended surgery. Conclusions A small proportion of patients refuse surgery for rectal cancer, and this treatment decision significantly affects survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of stage I‐III rectal cancer: Who is refusing surgery?

Fields

Yoo

et al. 2020

Journal of Surgical Oncology

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Quality of life following perioperative optimization with nutritional supplements in patients undergoing gastrointestinal surgery for cancer: A randomized, placebo‐controlled feasibility clinical trial

Griffiths,

D'Souza,

Rodriguez

et al. 2024

Journal of Surgical Oncology

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BackgroundUp to two thirds of patients presenting for abdominal cancer surgery are malnourished pre‐operatively. Perioperative nutritional supplementation has been proposed to improve surgical outcomes, though its effect on quality of life (QoL) is not yet understood.MethodsA randomized controlled feasibility trial for perioperative nutrition among patients undergoing major abdominal cancer surgery was conducted. Participants in the intervention group received supplements for 30 days before surgery. Participants completed two QoL questionnaires (EORTC‐QLQ‐C‐30 and FACT‐G) at baseline, then 4 and 12 weeks postoperatively. Participants were compared between and within groups at baseline, Weeks 4, and 12 using t tests. Minimal clinically important differences (MCIDs) were considered as a 10‐point worsening from baseline.ResultsSixty‐six participants were available for analysis in this study, including 33 in the intervention and 30 in the control arms. Baseline demographics were balanced between groups except for different rates of pancreas cancer (36% intervention vs. 9% control) and colorectal cancer (19% intervention vs. 34% control). At baseline, participants in the intervention group had lower overall QoL (59% vs. 77%, p = 0.01), role functioning (72% vs 88%, p = 0.045), and cognitive functioning (79% vs 90%, p = 0.047). Following surgery, role and physical functioning worsened in the control group, without significant differences between groups. Role functioning was persistently worsened at 12 weeks in the control group. The rates of MCIDs were similar between both intervention and control groups.DiscussionPerioperative nutrition was associated with preservation of QoL in the postoperative period following major abdominal cancer surgery compared to placebo.SummaryAmong patients undergoing surgery for cancer, the majority present at high risk for malnutrition. In this placebo‐controlled randomized trial among patients undergoing major abdominal surgery for cancer, preoperative nutrition supplementation was associated with the preservation of QoL in the postoperative period.

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