Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer
| Autor: | Nick J, Battersby, Therese, Juul, Peter, Christensen, Ahmed Z, Janjua, Graham, Branagan, Katrine J, Emmertsen, Christine, Norton, Robert, Hughes, Søren, Laurberg, Brendan J, Moran, N, Woodcock |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Constipation Colorectal cancer medicine.medical_treatment Cohort Studies Postoperative Complications 0302 clinical medicine Quality of life Fecal incontinence Digestive System Surgical Procedures Neoadjuvant therapy Aged 80 and over Anastomosis Surgical Great Britain Gastroenterology Chemoradiotherapy General Medicine Middle Aged Neoadjuvant Therapy medicine.anatomical_structure 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology medicine.symptom Adult Diarrhea medicine.medical_specialty Rectum Adenocarcinoma 03 medical and health sciences medicine Humans Aged Neoplasm Staging Rectal Neoplasms business.industry Chemoradiotherapy Adjuvant medicine.disease United Kingdom Surgery Patient Outcome Assessment Radiation therapy Cross-Sectional Studies Quality of Life business Fecal Incontinence |
| Zdroj: | Battersby, N J, Juul, T, Christensen, P, Janjua, A Z, Branagan, G, Emmertsen, K J, Norton, C, Hughes, R, Laurberg, S, Moran, B & United Kingdom Low Anterior Resection Syndrome Study Group 2016, ' Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer : A Multicenter Cross-Sectional Study ', Diseases of the Colon and Rectum, vol. 59, no. 4, pp. 270-80 . https://doi.org/10.1097/DCR.0000000000000552 |
| ISSN: | 0012-3706 |
| Popis: | BACKGROUND: Restorative anterior resection is considered the optimal procedure for most patients with rectal cancer and is frequently preceded by radiotherapy. Both surgery and preoperative radiotherapy impair bowel function, which adversely affects quality of life.OBJECTIVE: This study aimed to report symptoms associated with and key predictors for bowel-related quality-of-life impairment.DESIGN: The study included a cross-sectional cohort.SETTINGS: This was a multicenter study from 12 United Kingdom centers.PATIENTS: A total of 578 patients with rectal cancer underwent curative restorative anterior resection between 2001 and 2012 (median, 5.25 years postsurgery).MAIN OUTCOME MEASURES: Patients completed outcome measures that assessed bowel dysfunction (low anterior resection syndrome score), incontinence (Wexner score), and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30), plus an anchor question: "Overall how does bowel function affect your quality of life?"RESULTS: The response rate was 80% (462/578). Overall, 85% (391/462) of patients reported bowel-related quality-of-life impairment, with 40% (187/462) reporting major impairment. A large difference in global quality of life (22 points; p < 0.001) was reported for "none" versus "major" impairment, with greatest symptom severity being diarrhea (25 points; p < 0.001), insomnia (24 points; p < 0.001), and fatigue (20 points; p < 0.001). Regression analysis identified major impairment in 60% and 45% of patients with low rectal cancer treated with and without preoperative radiotherapy compared with 47% and 33% of middle/upper rectal cancers with and without preoperative radiotherapy.LIMITATIONS: Advances in radiotherapy delivery and improvements in posttreatment symptom control, although currently of limited efficacy, imply that the content of this consent aid should be re-evaluated in 5 to 10 years.CONCLUSIONS: Before a restorative anterior resection, patients with rectal cancer should be informed that bowel-related quality-of-life impairment is common. The key risk factors are neoadjuvant therapy and a low tumor height. This study presents quality-of-life and functional outcome data, along with a consent aid, that will enhance this preoperative patient discussion. |
| Databáze: | OpenAIRE |
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