The literature on the health-related quality of life (HRQOL) after rectal cancer is growing, however, a comparison between patients with nonadvanced disease (NAD), locally advanced rectal cancer (LARC), locally recurrent rectal cancer (LRRC) and a normative population has not been made. Data on the sexual functioning of patient groups is also scarce. We compared (i) the HRQOL of patients with NAD, LARC, or LRRC, with a special focus on sexual functioning and (ii) the HRQOL of the three treatment groups with a normative population. The EORTC QLQ-C30 and QLQ-CR38 were completed by 80 patients with NAD, 292 LARC patients and 67 LRRC patients. The normative population (n 5 350) completed the EORTC QLQ-C30 and the Sexual Functioning and Sexual Enjoyment scales of the CR38. LRRC patients reported a lower Physical Function, Social Function, Future Perspective, Sexual Functioning and more Pain compared with LARC and NAD patients. Also, LRRC patients had a worse Body image than NAD patients and a lower Male Sexual Functioning than LARC patients. More than 75% of men and 50% of women were sexually active preoperative, compared with less than 50% and less than 35% postoperative. Male LRRC patients had more problems with erectile or ejaculatory functioning and felt less masculine than NAD or LARC patients. Women did not differ on Lubrication, Dyspareunia and Body Image. About 10% of patients used aids in order to improve erectile functioning (men) or lubrication (women). The treatment groups reported a lower HRQOL and sexual functioning compared with the normative population.Rectal cancer is one of the most common malignancies worldwide and has a still increasing incidence and prevalence.1,2 In 10-15% of the patients, the rectal cancer is considered locally advanced.3 In addition, 5-10% of rectal cancer patients develop a local recurrence without metastatic disease which can still be treated with a curative intent. 4 Treatment for rectal cancer is based on clinical T-stage, pathological lymph nodes and distant metastasis.5 The standard treatment for nonadvanced rectal cancer in The Netherlands is neoadjuvant radiotherapy followed by a total mesorectal excision with autonomous nerve preservation, except for cT1N0 patients were radiotherapy is not indicated. 5 Patients with locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) are treated with neoadjuvant radiochemotherapy often followed by more extensive extra-anatomical surgery in order to achieve a curative resection. During these procedures an intraoperative radiotherapy (IORT) boost dose can be applied at the area of risk in order to improve local control. 6 The current multidisciplinary treatment for rectal cancer has led to decreased morbidity and a significant improvement of survival.7-9 However, treatment for LARC of LLRC may still be accompanied by high morbidity rates (15-68%).10-13 Therefore, the complex and extensive treatment for LARC and LRRC can be very burdensome for the patients.Even though the importance of patient-reported outcom...
