Functional outcomes and health-related quality of life following curative treatment for rectal cancer: A population-level study in England.

BACKGROUND: There is a growing population of cancer survivors at risk of treatment-related morbidity. This study investigates how potentially curative rectal cancer treatment influences subsequent function and health-related quality of life (HRQL) using data from a large-scale survey of patient-reported outcomes.

METHODS: All individuals 12-36 months post-diagnosis of colorectal cancer in England were sent a survey in January 2013. The survey responses were linked with cancer registration, hospital admissions and radiotherapy data through the National Cancer Registration and Analysis Service. Outcome measures were cancer-specific (FACT and Social Difficulties Inventory items related to faecal incontinence, urinary incontinence and sexual difficulties) and generic (EQ-5D).

RESULTS: Surveys were returned by 6,713 (64.2%) of 10,452 rectal cancer patients. 3,998 were in remission after a major resection and formed the final analysis sample. Compared to those who had surgery alone, patients who received pre-operative radiotherapy had higher odds of reporting poor bowel control (43.6% vs. 33.0%; OR=1.55, 95%CI 1.26-1.91), severe urinary leakage (7.2% vs. 3.5%; OR=1.69, 95%CI 1.18-2.43) and severe sexual difficulties (34.4% vs. 18.3%; OR=1.73, 95%CI 1.43-2.11). Patients who received long-course chemoradiotherapy reported significantly better bowel control than those who had short-course radiotherapy, with no difference for other outcomes. Respondents with a stoma present reported significantly higher levels of severe sexual difficulties and worse HRQL compared to those who had never had a stoma or had undergone reversal.

CONCLUSIONS: This study demonstrates the feasibility of a large-scale assessment of patient-reported outcomes and provides 'real world' data regarding the impact of rectal cancer treatment. The results show that patients who receive pre-operative radiotherapy report poorer outcomes, particularly for bowel and sexual function, and highlight the negative impact of a stoma. We hope that our experience will encourage researchers to perform similar studies in other healthcare systems.