Patient-Reported Bowel Function and Quality of Life Following Short and Long Course Radiotherapy for Locally Advanced Rectal Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Preoperative radiation therapy (RT) for locally advanced rectal cancer (LARC) can include long-course RT (LCRT) or short course RT (SCRT). Data characterizing long term patient-reported outcomes (PROs) following SCRT and LCRT are limited. <h3>Materials/Methods</h3> We identified individuals with LARC treated at our institution from 2016–2020 who were alive and without recurrent or metastatic disease. We surveyed all eligible patients and administered three validated PROs: Functional Assessment of Cancer Therapy- General (FACT-G7) for all patients and the Fecal Incontinence QOL Scale (FIQOL) as well as the Low Anterior Resection Syndrome Score (LARS) for patients without an ostomy. We used descriptive statistics to characterize FIQOL and LARS scores and univariate testing to identify associations between clinical and treatment variables including radiation fractionation. We then created a multiple regression model to identify predictors of FIQOL and LARS scores. <h3>Results</h3> Of 204 patients surveyed, 123 (60.3%) responded and were included for analysis. Median age at survey completion was 57.3 years (IQR 48.6-63.3) and median time from RT to survey completion was 2.5 years (1.5-3.6). Seventy-eight (63.4%) respondents received LCRT and 45 (36.5%) received SCRT. Respondents receiving SCRT were older (P=.020), had a longer interval from RT to survey completion (P<.001), more low-lying tumors (P=.044), higher T-stage (P=.025), higher N-stage (P<.001), were more likely to have extramural venous invasion (P<.001) and more likely to receive an end colostomy (P=.004). On univariate analysis, female sex and surgery type were associated with a lower (worse) FIQOL score. Shorter distance of the tumor from the anal verge and surgery type were associated with a higher (worse) LARS score. There were no significant differences in FIQOL or LARS between respondents receiving SCRT vs LCRT (<b>Table</b>). On multivariate testing, sex and surgery type remained significant for FIQOL, while surgery type and distance from the anal verge remained significant for LARS. Higher (better) FIQOL score and lower (better) LARS score were associated with higher FACT G7 scores signifying better QOL. <h3>Conclusion</h3> These results suggest long-term patient-reported bowel function and QOL may be similar for individuals receiving SCRT and LCRT for the treatment of LARC.