Pain and quality of life (QoL) in patients with locally recurrent rectal cancer (LRRC)

Abstract

8249 Purpose: Although multimodality therapy for LRRC has been improving in prognosis, survival rate is still poor. Posttreatment pain is a common problem in patients with LRRC treated with either nonsurgical palliation or radical resection. Given the limited survival after treatment of LRRC, posttreatment pain and QoL are important parameters in the assessment of treatment. Patients and Methods: Patients with confirmed LRRC who had treatment at our institution were included in this study. Assessments of pain and QoL were carried out by two doctors. Severity of pain was assessed using the visual analog scale (VAS), and QoL was assessed using the Functional Assessment of Cancer Therapy- General (FACT-G) questionnaire. VAS score and FACT-G scores were analyzed using Mann-Whitney U tests. Results: Assessments of pain and QoL were performed 22 times in 20 patients. Median age 59 (range 50–68). Thirteen patients underwent surgery with curative intent (5 total pelvic exenteration, 3 low anterior resection, one abdominoperineal resection, 4 local excision). Sacral bone resection was performed in 7 patients. Seven patients treated with nonsurgical palliation consisting of chemotherapy, chemoradiation, or supportive care alone. Median VAS worst pain score in patients after resection without recurrence (n=10) was 31% and that after nonsurgical palliation (n=8) was 12%, but not statistically significant (p=0.06). All FACT-G scores between the two groups were comparable. Median VAS worst pain score in patients after resection with recurrence (n=4) was 62%. Median VAS worst pain score in patients after bony resection was greater than that without bony resection even without recurrence (44% vs 4%). All FACT-G scores with recurrence were significantly lower than those without recurrence irrespective of treatment. Conclusion: Patients with LRRC experience significant levels of pain after treatment. To avoid bony resection may have better results in pain control, but radical resection is necessary because tumor recurrence may cause severe pain and poor QoL. No significant financial relationships to disclose.