The impact of bowel dysfunction on health-related quality of life after rectal cancer surgery: a systematic review

Rashid, F. Al; Liberman, Alexander; Charlebois, Patrick; Stein, Barry S.; Feldman, Liane S.; Fiore, Julio F.; Lee, L.

doi:10.1007/s10151-022-02594-0

Cited by 26 publications

(19 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 17 Although a higher degree of bowel dysfunction has been associated with worsening HRQOL, the relationship between HRQOL and the objective LARS score is not consistent. 4 Furthermore, HRQOL is highly individualized and not all patients will give importance to the same aspects. Therefore, the objective of this study was to assess whether there was a difference in HRQOL impacts based on the patient-reported BQOL compared to the objective LARS score.…”

Section: Discussionmentioning

confidence: 99%

“…There are many existing studies assessing the correlation between bowel function (commonly via the LARS score) and HRQOL after sphincter-preservation surgery. 4 What is surprising is the magnitude of effect that major LARS has on HRQOL. One would expect that major LARS would be associated with worse HRQOL.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent systematic review, almost all differences in the European Organization for the Treatment of Cancer (EORTC) Quality of Life Questionnaire-30 (QLQ-C30) and SF-36 subscales between major LARS versus the other categories were of small or trivial magnitude of effect. 4 This suggests that the LARS score may be an appropriate measure of bowel function, but it does not always correlate well with HRQOL.…”

Section: Discussionmentioning

confidence: 99%

“… 3 Patients that undergo sphincter preservation have a high incidence of bowel dysfunction which may have a negative impact on HRQOL, as many past studies have shown an association between increased bowel dysfunction and poor HRQOL. 4 …”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 Previous studies have not shown a consistent relationship between increasing LARS categories and worse HRQOL. 4 In order to adequately counsel patients on impact of rectal cancer treatments, it is important to measure the impact of bowel dysfunction on HRQOL based on the patient’s own assessment. Therefore, the objective of this study is to determine whether there is a difference between patient-reported bowel-related impairment versus a bowel dysfunction measured using the standardized LARS score on HRQOL scores.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life?

Robitaille

Liberman

Feldman

et al. 2023

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Background Bowel dysfunction after rectal cancer surgery is common, but its effect on health-related quality of life (HRQOL) is complex. Objective measures of bowel function may not be a good representation on the actual impact on HRQOL. Therefore, the objective of this study is to determine whether there are differences between patient-reported bowel-related impairment versus a standardized measure of bowel dysfunction on HRQOL. Methods A prospective database starting in September 2018 of adult patients who had undergone sphincter preserving rectal cancer surgery up to October 2021 was queried. Patients were excluded if they had local recurrence, metastasis, persistent stoma, or had less than 1-year follow-up. Patients were administered the study instruments at their standard surveillance visit: patient-reported bowel-related quality of life(BQOL) impairment, HRQOL using the Short Form-36 (SF-36), and bowel dysfunction using the low anterior resection syndrome(LARS) score. Results Overall, 136 patients were included. There were 43% with no LARS, 22% with minor LARS, and 35% with major LARS. For the BQOL, 26% of subjects reported no impairment, 57% minor impairment, and 17% major impairment. There was a high proportion of discordance between BQOL and LARS, with 23% minor or major LARS in patients with no BQOL impairment, and 32% with no or minor LARS with major BQOL impairment. The BQOL was associated with more changes in SF-36 scores compared to the LARS score. Conclusions The patient-reported BQOL is likely to be a more relevant outcome of interest to patients than the objective LARS score. This has important implications for shared decision-making for rectal cancer treatments.

show abstract

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

Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life?

Robitaille

Liberman

Feldman

et al. 2023

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

show abstract

Low anterior resection syndrome: Incidence and association with quality of life

Homma

Mimura

Koinuma

et al. 2023

Annals of Gastroent Surgery

View full text Add to dashboard Cite

AimLow anterior resection syndrome (LARS) causes devastating symptoms and impairs quality of life (QOL). Although its incidence and risk factors have been reported, these data are scarce in Japan. This study aimed to elucidate the incidence and risk factors of LARS as well as to evaluate its association with QOL in Japanese patients.MethodPatients with anal defecation at the time of the survey between November 2020 and April 2021 were included, among those who underwent anus‐preserving surgery for rectal tumors between 2014 and 2019 in tertiary referral university hospital. The severity of LARS and QOL were evaluated with the LARS score and the Japanese version of the fecal incontinence quality of life scale (JFIQL), respectively. Primary endpoint was the incidence of major LARS. Secondary endpoints were risk factors and association with JFIQL.ResultsOf 332 eligible patients, 238 (71.7%) answered the LARS survey completely. The incidence of major LARS was 22% overall, and 48% when limited to lower tumors. Independent risk factors included lower tumors (OR: 7.0, 95% CI: 2.1–23.1, p = 0.001) and surgical procedures with lower anastomoses (OR: 4.6, 95% CI: 1.2–18.5, p = 0.03). The JFIQL generic score correlated moderately with the LARS score (correlation coefficient of −0.65). The JFIQL generic score was also significantly lower in lower tumors.ConclusionsThe incidence of major LARS is 22% in Japanese patients, and independent risk factors include lower tumors and surgical procedures with lower anastomoses. More severe LARS is associated with worse QOL which is significantly more impaired in patients with lower tumors.

show abstract

SWOG S1820: A pilot randomized trial of the Altering Intake, Managing Bowel Symptoms Intervention in Survivors of Rectal Cancer

Sun,

Guthrie,

Crane

et al. 2024

Cancer

View full text Add to dashboard Cite

BackgroundSurvivors of rectal cancer experience persistent bowel dysfunction after treatments. Dietary interventions may be an effective approach for symptom management and posttreatment diet quality. SWOG S1820 was a pilot randomized trial of the Altering Intake, Managing Symptoms in Rectal Cancer (AIMS‐RC) intervention for bowel dysfunction in survivors of rectal cancer.MethodsNinety‐three posttreatment survivors were randomized to the AIMS‐RC group (N = 47) or the Healthy Living Education attention control group (N = 46) after informed consent and completion of a prerandomization run‐in. Outcome measures were completed at baseline and at 18 and 26 weeks postrandomization. The primary end point was total bowel function score, and exploratory end points included low anterior resection syndrome (LARS) score, quality of life, dietary quality, motivation, self‐efficacy, and positive/negative affect.ResultsMost participants were White and college educated, with a mean age of 55.2 years and median time since surgery of 13.1 months. There were no statistically significant differences in total bowel function score by group, with the AIMS‐RC group demonstrating statistically significant improvements in the exploratory end points of LARS (p = .01) and the frequency subscale of the bowel function index (p = .03). The AIMS‐RC group reported significantly higher acceptability of the study.ConclusionsSWOG S1820 did not provide evidence of benefit from the AIMS‐RC intervention relative to the attention control. Select secondary end points did demonstrate improvements. The study was highly feasible and acceptable for participants in the National Cancer Institute Community Oncology Research Program. Findings provide strong support for further refinement and effectiveness testing of the AIMS‐RC intervention.

show abstract

The impact of bowel dysfunction on health-related quality of life after rectal cancer surgery: a systematic review

Cited by 26 publications

References 51 publications

Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life?

Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life?

Low anterior resection syndrome: Incidence and association with quality of life

SWOG S1820: A pilot randomized trial of the Altering Intake, Managing Bowel Symptoms Intervention in Survivors of Rectal Cancer

Contact Info

Product

Resources

About