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Prognostic Value of Quality of Life and Pain in Patients with Locally Recurrent Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Care of patients with locally recurrent rectal cancer (LRRC) requires careful patient selection. While curative resection offers survival benefits, significant trade-offs exist for the patient. Knowledge of patient-reported outcomes will help inform treatment decisions.

Methods

Quality of life (QOL) and pain were prospectively assessed in 105 patients treated for LRRC at a single institution, using the validated Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and Brief Pain Inventory (BPI) questionnaires. In 54 patients enrolled and followed from diagnosis of LRRC, relationship between pretreatment pain, QOL, and overall survival (OS) were examined.

Results

Patients underwent curative surgical resection (C, 59%), noncurative surgery (NC, 12%) or nonsurgical treatment (NS, 28%). Median OS was 7.1, 1.4, and 1.9 years, respectively (C versus NC: p < 0.001; C versus NS: p = 0.006; NC versus NS: p = 0.261). Physical well-being QOL differed over time (p = 0.042), with greatest difference between C and NC surgery patients (p = 0.049). The remaining QOL domain scores and pain scores demonstrated no significant time or treatment effect. For the 54 patients assessed from diagnosis, median OS was independently predicted by treatment group (C, NC, NS: 4.3, 1.7, versus 2.4 years; p < 0.001) and pretreatment pain intensity (score ≤ 4 versus > 4: 3.8 versus 2.0 years; p = 0.001).

Conclusion

Curative surgery offered prolonged survival, but significant pain exists among long-term survivors and should be a focus of survivorship care. Noncurative surgery did not offer apparent advantages over nonsurgical palliation. Patient’s pretreatment pain has prognostic value, and should be assessed, treated, and considered in treatment decisions.

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Acknowledgment

Authors are grateful for the assistance in data analysis provided by Wei Qiao from the Department of Biostatics, The University of Texas MD Anderson Cancer Center, Houston TX.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Y. Nancy You MD, MHSc, Halim Habiba MPH, George J. Chang MD, MS, Miguel A. Rodriguez-bigas MD & John M. Skibber MD

Authors
  1. Y. Nancy You MD, MHSc
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  2. Halim Habiba MPH
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  3. George J. Chang MD, MS
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  4. Miguel A. Rodriguez-bigas MD
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  5. John M. Skibber MD
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Corresponding author

Correspondence to John M. Skibber MD.

Additional information

Accepted for oral presentation at the 63rd Annual Meeting of the Society of Surgical Oncology, St. Louis, MO, 2010.

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You, Y.N., Habiba, H., Chang, G.J. et al. Prognostic Value of Quality of Life and Pain in Patients with Locally Recurrent Rectal Cancer. Ann Surg Oncol 18, 989–996 (2011). https://doi.org/10.1245/s10434-010-1218-6

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  • DOI: https://doi.org/10.1245/s10434-010-1218-6

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