Life In Rectal Cancer Patients Research Articles

High-dose rate endorectal brachytherapy for rectal cancer: A state-of-the-art review.

Rectal cancer is a common malignancy that requires multidisciplinary treatment. By utilizing the dose-response relationship in rectal cancer radiotherapy, increasing the radiotherapy dose can improve clinical complete remission rates. High-dose rate endorectal brachytherapy (HDREBT) is a novel technique that delivers high doses of radiotherapy directly to the tumor via an endorectal applicator, sparing the adjacent normal tissues from excessive radiation exposure. HDREBT includes contact X-ray brachytherapy and high-dose-rate intracavitary brachytherapy. We introduce the latest developments in applicators and imaging techniques for HDREBT in rectal cancer and summarize the current evidence on the efficacy, safety, and feasibility of HDREBT as a neoadjuvant, definitive, or palliative treatment option for all stages of rectal cancer patients. We also discuss the potential advantages and challenges of HDREBT in achieving organ preservation and improving the quality of life of rectal cancer patients. HDREBT has shown promising results in achieving high complete response rates, enabling nonoperative management, improving organ preservation rates, and providing effective palliation in rectal cancer patients. More studies are needed to optimize its dose and fractionation schemes in different clinical scenarios.

Radiation induced cystitis prophylactics and treatment with hydrogel compositions in rectal cancer patients: a retrospective study

INTRODUCTION: The incidence of rectal cancer in different countries tends to increase over the past 10 years. In the Russian Federation, the incidence of rectal cancer accounts for about 4.5% of the total oncological incidence, where stage III–IV is 25.9% and 23%, respectively. In the light of current trends, national clinical guidelines from different countries recommend starting the treatment of locally advanced rectal cancer with radiation or chemoradiotherapy. Radiation therapy is usually accompanied by radiation reactions and complications. For the last 10–15 years, hydrogel compositions have been included in the treatment of radiation reactions along with basic drugs.OBJECTIVE: To study the effect of the use of hydrogel compositions for the prevention and treatment of radiation reactions during irradiation of patients with rectal cancer.MATERIALS AND METHODS: The study included 257 patients, including 146 men and 111 women aged 27 to 88 years, the median was 59 years old, who lived in St. Petersburg, the Leningrad Region and in other regions of the Russian Federation, who received radiation therapy since 2013 to 2019 for rectal cancer. The severity of radiation reactions was assessed by the current RTOG/EORTC. Basic drug therapy, including non-steroidal anti-inflammatory drugs, antispasmodics, hemostatic agents, oil mixtures, etc., was used in 47% of patients. In the course of radiation therapy, 35 patients were prescribed hydrogel-based composite preparations with derinat, dioxidine and lidocaine.Statistics: Data processing was carried out using the Excel spreadsheet editor, as well as the Statistica 10 for Windows statistical data processing software package.RESULTS: Radiation proctitis was registered in 81 (31.5%), dermatitis in 50 (19.5%), cystitis in 45 (17.5%), enterocolitis, enteritis or colitis in 28 (10.9%), hematological toxicity in 8 (3.1%), vaginitis in 8 (3.1%), other in 7 (2.7%) patients. Taking into account that the bladder is the most frequently irradiated organ in cases where the target tumor is localized in adjacent organs of the small pelvis, as well as the lack of prevention and treatment standards (golden standard), radiation cystitis, which poisons the lives of apparently healthy patients, was carried out study of the effect of hydrogel compositions in the appointment of these drugs before, during and after the end of radiation therapy compared with the control. In the study group, a later onset of cystitis was noted (with SD from 20 to 34 Gy), the frequency of cystitis was 9% (p<0.05), the severity did not exceed 1 degree. In the control group, radiation reactions occurred when SD reached 14 to 27 Gy. RIC grade 1 was diagnosed in 10.3%, grade 2 in 8.8%, grade 3 in 5.9%. The overall frequency of RIC in the control group was 25%. Thus, the frequency of RIC in the control group significantly exceeded that in the main group. Further observations showed that patients, diagnosed with rectal cancer, who received hydrogel compositions suffered from overall incidence of late radiotherapy complications 2 times lower — 8.2% vs. 17.2%, respectively (p<0.05).DISCUSSION: The impact of radiation reactions and complications on the quality of life of rectal cancer patients is actively discussed in the Russian Federation and abroad. At the same time, the incidence of rectal cancer in the world is growing, as well as the need for radiation therapy. Radiation cystitis is a recognized complication of radiation therapy of the pelvic organs. The frequency of RIC, according to various authors, ranges from 23 to 80%. Hydrogel compositions are one of the proven effective means of combating radiation damage.CONCLUSION: the presence of radiation reactions during pre/postoperative radiation therapy for rectal cancer significantly contributes to a decrease in the five-year survival rate of patients. The frequency of radiation cystitis significantly decreases against the background of the appointment of hydrogel compositions before, during and after radiation therapy.

Long-term incidence of depression in rectal cancer patients with or without stoma: a population-based cohort study.

Significant improvements have been made in the surgical treatment of rectal cancer with a higher sphincter-saving rate without compromising oncologic results. There have been studies about the quality of life of rectal cancer patients after surgery. However, no study has reported the long-term annual incidence of depression after rectal cancer surgery according to stoma status. The objective of this study was to determine the annual incidence of depression after rectal cancer surgery and the factors affecting it, especially the prevalence of depression according to the presence or duration of a stoma. Using the Korea National Health Insurance Service database, patients who underwent radical surgery for rectal cancer from 2002 to 2019 were searched. We analyzed the incidence and risk factors of depression in patients who underwent radical surgery for rectal cancer according to stoma status. Annual incidence of depression in rectal cancer patients was decreasing annually for 15 years after surgery. There was no statistically significant difference in the incidence of depression according to the stoma status. However, the diagnosis of depression within 1 year after surgery was statistically significantly increased in the permanent stoma group. There was no difference in the overall incidence of depressive disorders among patients with rectal cancer based on their stoma status. However, a permanent stoma seems to increase the incidence in the first year after surgery. Education and intensive assessments of depressive disorders in patients with permanent stoma within 1 year after surgery are needed, particularly for female patients who are under 50 years old.

Quality of life assessment in patients with a stoma due to rectal cancer in Morocco

Colorectal cancer is a major public health problem in Morocco, according to the Moroccan. Cancer Registry; it represents the first gastro-intestinal cancer and the third most common cancer in Morocco. The aim of this paper is to compare the quality of life of rectal cancer patients with and without permanent colostomy in the course of rectal cancer treatment. Methods: Patients were recruited from the National Institute of Oncology in Rabat – Morocco, during the February 2016 - June 2018 period. The version of the third QLQ-C30 and C29 questionnaire of the European Organization for Research and Treatment of Cancer (EORTC) was translated for the first time in Moroccan Arabic and used to obtained relevant data. Psychometric properties were measured on patients with colorectal cancer recruited from different regions of the country. Statistical analysis included Cronbach’s alpha, correlation, multi-trait scaling and known groups comparisons. p value ≤ 0.05 was considered significant. Results: In total, 102 patients with rectal cancer were included in the study and 45 (44 %) patients with stoma. The mean age at diagnosis time was 51 years (+/- 11.4). Stoma patients did not show significant impairment of functioning, which did not negatively influence their quality of life. Patients with stoma had higher symptom scores related to diarrhea and experienced more financial difficulty as measured by EORTC C-30, in clinically distinct group comparison. With EORTC C-29, this group showed lower Functional scales scores for body image, sexual dysfunction for female patients and higher symptom scores related to urinary frequency, troubles with taste, hair loss, sore skin, psychosocial disturbance in the form of embarrassment due to the frequent need to change the stoma bag compared to patients without a stoma. Conclusions: The experience of stoma has a not large negative impact on Moroccan patients’ quality of life. Influence of stoma is most pronounced in the area of symptom and financial difficulty. Financial difficulties are, by far, more present. Keywords: quality of life; intestinal stoma; colo-rectal cancer.

Analysis of the Influence of Perioperative Nursing Intervention on the Psychology and Quality of Life of Rectal Cancer Patients Undergoing Radical Operation

Analysis of the Influence of Perioperative Nursing Intervention on the Psychology and Quality of Life of Rectal Cancer Patients Undergoing Radical Operation

The effect of demographic, clinical, and pathological data on quality of life in rectum cancer.

The aims of the current study are to describe the quality of life among patients with rectal cancer and to determine the clinical and demographic correlation that influences the quality of life of rectal cancer patients. In this study, 50 patients with rectal cancer treated in the Radiation Oncology Department of Kayseri CityEducation and Research Hospital were included. Ethics committee approval was received for the study. Data collection form was used to determine the demographic and clinicopathological characteristics of the patients. To assess the quality of life, the European Committee of Cancer Treatment and Organization Quality of Life Scale (EORTC QLQ-C30) question-answer scale was used. The data were collected by interviewing the patients face to face. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the data. Spearman correlation analysis was performed to reveal the relationship between dependent variables. As a result of this study, 52% of patients were 65years and older and 54% were male patients. The most common surgery was low anterior resection and the most common type of pathology was adenocarcinoma. According to American Cancer Committee (AJCC) 7th edition 2009 staging, 80% stage 3 was the most common. In EORTC C30 Cancer Quality of Life Scale Functional Scale Subscale, the highest score is from the physical function and the lowest score is from the emotional function. In the symptom scale subscale, the most common symptom was nausea/vomiting. Performance status (ECOG) was found to be significantly associated with T stage, N stage, TNM stage, and symptom scores. There was a moderately significant positive correlation between symptom scales and global health status scales (ρ = 0.51; p < 0.001). There was a perfectly positive and significant relationship between symptom scales and functional scales (ρ = 0.83; p < 0.001). As a result of this study we conducted, it was observed that rectal cancer patients decreased performance status and increased symptoms in the presence of advanced disease. Accordingly, it was found that the quality of life of the patient decreased.

Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospective analysis

BackgroundConservative approach has emerged as an option for the management of rectal cancer (RC) patients with a near or complete clinical response after neoadjuvant chemoradiotherapy (nCRT). The aim of this study is to assess the impact of the conservative approach by comparing patients’ survival outcomes and quality of life with those who had surgical resection. MethodsA single-institution and retrospective study including RC patients who reached a near complete or complete clinical response after nCRT from January 2010 to September 2019. Conservative approaches included local excision or watch and wait strategy; surgery approaches included anterior resection or abdominal-perineal resection.Local regrowth (LR), overall survival, disease free survival, metastasis free survival and colostomy free survival were evaluated through Kaplan-Meier curves and compared trough log-rank tests. Quality of life was measured by the following validated questionnaires: EORTC QLC30, EORTC QLQ – CR29 and Fecal Incontinence Quality of Life scale. ResultsOverall 157 patients were analyzed: 105 (66,9%) underwent radical surgery and 52 (33,1%) had a conservative approach. With a median follow-up of 51 months, 2 patients in the surgical group had a local recurrence and 8 in the conservative group had a LR, respectively. Distance metastasis occurred in 7 and 1 patients of surgical and conservative group, respectively. No differences were detected in terms of survival outcomes except for colostomy free survival (p: 0,01). The conservative group showed better intestinal (p < 0.01) and sexual (p: 0,04) function and emotional status (p: 0,02). ConclusionsConservative approach seems to be safe in terms of survival outcomes with a significant advantage on quality of life in RC patients who achieved clinical complete response after nCRT.

Quality of life in rectal cancer patients with or without oxaliplatin in the randomised CAO/ARO/AIO-04 phase 3 trial

The CAO/ARO/AIO trial has shown that oxaliplatin added to preoperative chemoradiotherapy and postoperative chemotherapy significantly improved disease-free survival in locally advanced rectal cancer (LARC). Here, we present a post-hoc analysis of quality of life (QoL) in disease-free patients. Between 2006 and 2010, 1236 patients with LARC were randomly assigned either to preoperative chemoradiotherapy followed by total mesorectal excision and postoperative chemotherapy (N=623) or combined with oxaliplatin (N=613). QoL questionnaires (EORTC QLQ-C30, colorectal module CR38) were completed at baseline, after postoperative chemotherapy and during follow-up. Analysis was performed according intent-to-treat. Available questionnaires (baseline) were 82% (N=512) in the control and 84% (N=513) in the investigational group. Response rates were 49% (533 of 1086) at 1 year and 43% (403 of 928) at 3 years. Global health status (GHS) for disease-free patients was stable in both groups (range 0-100). At baseline: standard arm 62.0 (mean, SD 21.6; N=491) versus oxaliplatin arm 63.2 (mean, SD 22; N=503); at 3 years: 69.4 (SD 19.3; N=187) versus 65.4 (SD 22.2; N=202). After treatment and at 3 years, no significant differences (≥10 points) between groups were found in QoL subscales. Disease-free patients experiencing neurotoxic side-effects (grade 1-4) showed reduced GHS at 3 years versus patients without neurotoxicity (mean 59.2 versus 69.3; P<0.001), while grade 3-4 rate was low. The addition of oxaliplatin was not associated with worse overall QoL. This information is of interest to patients in many ongoing rectal cancer trials. NCT00349076.

Perspective temporelle et qualité de vie des patients atteints d’un cancer du rectum : une étude exploratoire

The impact of rectal cancer on patient quality of life has been investigated but no research has yet examined the impact of time perspective in the assessment of quality of life of rectal cancer patients. Our goal is to explore the links between quality of life and time perspective and the role of time perspective as a determinant of quality of life. Data were collected from 69 patients who completed a questionnaire comprising a specific measure of quality of life (FACT-C), a measure of time perspective (ZTPI), a measure of emotional distress (HADS) and a collection of socio-demographic and medical data. Regression analyses revealed that present fatalist, past positive and future time perspective predicted quality of life. Present fatalist time perspective seemed to have a deleterious impact on specific measure of rectal cancer quality of life. Present fatalist and future time perspective predicted a better emotional quality of life whereas past positive predicted a worse emotional quality of life. These results suggest the importance of considering time perspective as a determinant of psychological quality of life in order to improve the QoL of patients.

Health-related quality of life in rectal cancer patients undergoing neoadjuvant chemoradiation with delayed surgery versus short-course radiotherapy with immediate surgery: a propensity score-matched cohort study

Background: Neoadjuvant chemoradiation with delayed surgery (CRT-DS) and short-course radiotherapy with immediate surgery (SCRT-IS) are two commonly used treatment strategies for rectal cancer. However, the optimal treatment strategy for patients with intermediate-risk rectal cancer remains a discussion. This study compares quality of life (QOL) between SCRT-IS and CRT-DS from diagnosis until 24 months after treatment.Methods: In a prospective colorectal cancer cohort, rectal cancer patients with clinical stage T2-3N0-2M0 undergoing SCRT-IS or CRT-DS between 2013 and 2017 were identified. QOL was assessed using EORTC-C30 and EORTC-CR29 questionnaires before the start of neoadjuvant treatment (baseline) and at 3, 6, 12, 18 and 24 months after. Patients were 1:1 matched using propensity sore matching. Between- and within-group differences in QOL domains were analyzed with linear mixed-effects models. Symptoms and sexual interest at 12 and 24 months were compared using logistic regression models.Results: 156 of 225 patients (69%) remained after matching. The CRT-DS group reported poorer emotional functioning at 3, 6, 12, 18 and 24 months (mean difference with SCRT-IS: −9.4, −12.1, −7.3, −8.0 and −7.9 respectively), and poorer global health, physical-, role-, social- and cognitive functioning at 6 months (mean difference with SCRT-IS: −9.1, −9.8, −14.0, −9.2 and −12.6, respectively). Besides emotional functioning, all QOL domains were comparable at 12, 18 and 24 months. Within-group changes showed a significant improvement of emotional functioning after baseline in the SCRT-IS group, whereas only a minor improvement was observed in the CRT-DS group. Symptoms and sexual interest in male patients at 12 and 24 months were comparable between the groups.Conclusions: In rectal cancer patients, CRT-DS may induce a stronger decline in short-term QOL than SCRT-IS. From 12 months onwards, QOL domains, symptoms and sexual interest in male patients were comparable between the groups. However, emotional functioning remained higher after SCRT-IS than after CRT-DS.

Tu1694 - Socio-Demographic Determinants of Quality of Life in Rectal Cancer Patients in Sri Lanka

Tu1694 - Socio-Demographic Determinants of Quality of Life in Rectal Cancer Patients in Sri Lanka

Follow-up observation of rectal cancer patients with clinical complete response receiving non-operative and standard operative management after neo-adjuvant chemoradiotherapy

Objective To investigate the feasibility of non-operative management (NOM) by comparing the therapeutic effects between NOM and total mesorectal excision (TME) for rectal cancer patients with clinical complete response (cCR) after neo-adjuvant chemoradiotherapy. Methods A total of 135 patients with stage Ⅱ/Ⅲ rectal cancer who obtained cCR after neo-adjuvant chemoradiotherapy in Sun Yat-sen University Cancer Center from 2006 to 2016 were recruited and assigned into the NOM (n=43) and standard operative management (SOM) groups (n=92). The local recurrence rate, accumulative local control (LC) rate after salvage therapy, disease-free survival (DFS), overall survival (OS) and sphincter preservation rate were statistically compared between two groups. Kaplan-Meier analysis and log-rank test were utilized to calculate the LC, OS and DFS.Chi-square test was performed to calculate the sphincter preservation rate. Results The mean follow-up duration was 39 months (range: 10-127 months). Of 135 patients, the local recurrence rate and distant metastasis rate were 3.7% and 11.1%, and the 3-year DFS and OS were 90.5% and 97.0%.In the NOM and SOM groups, the 3-year DFS were 87% and 93%, and the 5-year DFS were 73% and 87%(P=0.089). The 3-year OS were 98% and 99%, and the 5-year OS were 98% and 97%(P=0.578). In the NOM group, the local recurrence rate was 12%(n=5), 80% of patients received salvage treatment and the accumulative LC rate was calculated as 98%.In the SOM group, the local recurrence rate was 0, which was significantly lower than that in the NOM group (P=0.010). In the NOM group, the sphincter preservation rate was 93%, significantly higher compared with 70% in the SOM group (P=0.030). Conclusions It is feasible for rectal cancer patients with cCR to receive NOM following neo-adjuvant chemoradiotherapy. Partial locally recurrent patients can be healed by timely salvage therapy, thereby averting TME and relevant complications and enhancing the quality of life of rectal cancer patients. Key words: Rectal neoplasm; Neo-adjuvant chemoradiotherapy; Clinical complete response; Follow-up observation

Discussion of “Effects of radiation and surgery on function and quality of life in rectal cancer patients”

Discussion of “Effects of radiation and surgery on function and quality of life in rectal cancer patients”

Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection - A Matched-Controlled Study.

Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome. The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group). This was a matched controlled study. This study was conducted at multiple centers. The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years. Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score). The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function. This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study with a limited number of patients and with quality-of-life measurements on nonpredefined and variable intervals after surgery. After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains. However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 66.7% of the patients in the total mesorectal excision group. See Video Abstract at http://links.lww.com/DCR/A395.

Effect of conjugated linoleic acid supplementation on quality of life in rectal cancer patients undergoing preoperative Chemoradiotherapy

Objectives:This study set out with the aim of evaluating the effect of conjugated linoleic acid (CLA) supplementation on quality of life in rectal cancer patients undergoing to preoperative chemoradiotherapy.Methods:In this study, 33 volunteer patients with rectal cancer treated with preoperative chemoradiotherapy were allocated in the CLA (n=16) and the placebo groups (n=17). The CLA group and placebo groups received 3 gr CLA/d and 4 placebo capsules for 6 weeks respectively. Before and after intervention, quality of life of patients was assessed by EORTC QLQ-C30.Results:At the end of study, the mean scores of physical function, role function, and cognitive function enhanced significantly in the CLA group while reduced remarkably in the placebo group. Symptom scales improved in the CLA group at the end of study. Comparison of changes in fatigue, pain and diarrhea scores were statistically significant between two study groups (P<0.05). When we compared the global health status scores between two groups, significant changes were observed (P<0.001).Conclusion:It appears that CLA may be helpful in rectal cancer patients by improving global quality of life. Although, other clinical trials with large sample size are needed to achieve more precise results.

50. Quality of life in rectal cancer patients: Watch-and-wait policy versus standard treatment – A matched controlled study

50. Quality of life in rectal cancer patients: Watch-and-wait policy versus standard treatment – A matched controlled study

Nursing implications: symptom presentation and quality of life in rectal cancer patients.

To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. A prospective, quantitative correlational design using purposive sampling was adopted. Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times.

Fecal Incontinence and Quality of Life in Adults With Rectal Cancer After Lower Anterior Resection.

The purpose of this study was to explore the prevalence of fecal incontinence (FI) and its impact on health-related quality of life in rectal cancer patients following low anterior resection surgery for colorectal cancer. Descriptive, cross-sectional study. Patients who were diagnosed with rectal cancer and underwent low anterior resection were recruited from a 1264-bed hospital in southern Taiwan. Potential participants were mailed a questionnaire survey. They were followed up 8 to 16 months postoperatively. Some clinical data were collected via retrospective review of their medical records. Questionnaires were mailed to 172 patients, and 71 with colorectal cancer underwent low anterior resection and agreed to participate and completed questionnaires in the research, reflecting a return rate of 41%. Data were collected on demographic characteristics and disease-related variables. Participants were asked if they had experienced FI during the past week. Fecal incontinence health-related quality of life was measured using the Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Index. Completion of the questionnaire required approximately 15 minutes. More than half of the 71 participants (n = 45; 63.4%) experienced incontinence of flatus, 42.3% (n = 30) reported incontinence of liquid stool, and 14.1% (n = 10) stated that they experienced incontinence of solid stool. Based on mean CCIS scores, 35.2% (n = 25) experienced moderate to severe FI. One-third wore pads to contain FI and 21.1% changed daily activities because of FI. Nearly two-thirds reported FI during the week prior to completing the research questionnaire. The average Fecal Incontinence Quality of Life Index cumulative score was significantly lower in the FI group (2.62 ± 0.61) than in the without-FI group (3.32 ± 0.77; P < .001), as were all subscale mean scores (all P < .01-.001). Fecal incontinence is prevalent among persons undergoing low anterior resection for colorectal cancer. Persons with FI report poor health-related quality of life compared to persons who retained fecal continence. Health care providers should assess these patients for FI and treat or refer those who experience this common problem.

Investigation of quality of life in rectal cancer patients after anterior resection and expression of 5-hydroxytryptamine in rectal mucosa before and after operation

To investigate the quality of life of rectal cancer patients after anterior resection and the role of 5-hydroxytryptamine(5-HT) in the pathogenesis of anterior resection syndrome (ARS). Between November 2012 and October 2014, 90 rectal cancer patients who underwent Dixon procedure in the Institute of Surgery Research, Daping Hospital, Third Military Medical University, and developed ARS postoperatively were enrolled in the study. By clinic interview and telephone follow-up, they were investigated according to the 4 questionnaires, including gastrointestinal quality of life index(GIQLI), Wexner constipation and incontinence score(WCS, WIS), and 36-item short form health survey(SF-36). Associated clinical data and above parameters were compared between postoperative 0-6 months and 7-24 months. Expression of 5-HT in rectal mucosa was determined by immunohistochemistry preoperatively and postoperatively. The GIQLI, WCS and WIS were significantly improved in 7-24 months group compared with those in 0-6 months group(all P<0.05). Furthermore, the SF-36 test result also showed significant improvement in the terms of physical function, physical role, vitality, social function, emotional role and health changes spheres in 7-24 months group(P<0.05). 5-HT expression in rectal mucosa(upper anastomosis 3402.95±1876.24, lower anastomosis 3045.35±1373.59 of ARS patients was significantly down-regulated compared with the preoperative expression(rectal margin mucosa 7176.60±3927.61)(P<0.05). Patients with ARS experience a significant trend toward recovery in their whole long-term quality of life. The down-regulation of 5-HT expression in rectal mucosa after surgery may be related with the pathogenesis of ARS.

Factors affecting health related quality of life of rectal cancer patients undergoing surgery.

Maintaining quality of life (QOL) is one of the important aims of cancer treatment. Quality of life of a cancer patient is affected by various factors, which may be disease related, patient related, or treatment related. To study changes in health-related quality of life (HRQOL) brought about by treatment of rectal cancer and factors affecting the changes using Malayalam translation of FACT-C (Functional Assessment of Cancer Therapy-Colorectal) Questionnaire. Also to detect the minimally important clinical changes (MICC) in health-related quality of life of patients with carcinoma rectum, who have undergone surgery. Forty-five patients diagnosed with carcinoma rectum, who have undergone curative surgery, were studied. HRQOL was assessed at baseline 2weeks after surgery and 3months after surgery. The changes in scores were correlated with various demographic factors like age, sex, marital status, number of children, number of married children, and education and occupation of the patient and spouse. Also the treatment-related factors like presence of stoma, presence of morbidity, previous treatment, stage of disease, and administration of chemotherapy before and after surgery were correlated. All the subscales of FACT-C tool, except emotional well-being, were significantly reduced 2weeks after surgery and increased slightly above pre-treatment level 3months after surgery. The Chronbach α values were 0.88, 0.89 and 0.86 on three occasions, respectively, establishing internal validity of the test. Baseline HRQOL scores were better in males compared to females. Among the various subscales, the drops in SWB, FWB, FACT-G, total Score and TOI were significant (P < .05).There were no significant differences in scores between patients who have undergone open surgery and minimally invasive surgery or patients who had permanent colostomy versus no colostomy. The HRQOL scores after surgery reduced 2weeks after surgery and improved above pre-surgical levels 3months after surgery. The approach of surgery (minimally invasive versus open) or presence or absence of permanent colostomy didn't make any significant change in HRQOL. But since the sample size of the study was small, we need further larger studies to arrive at definite conclusions.