International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationImpact of Preoperative Radiotherapy on General and Disease-Specific Health Status of Rectal Cancer Survivors: A Population-Based Study
Introduction
Preoperative radiotherapy (pRT) for rectal cancer improves local control but offers no additional survival advantage when provided concurrently with total mesorectal excision (TME) technique 1, 2, 3. Dutch treatment guidelines reco-mmend pRT (5 fractions of 5 Gy) for all resectable clinical tumor stage (cT)2–3 rectal tumors (4).
With improvements in treatment, the number of rectal cancer survivors in the Netherlands is projected to increase from 19,000 in 2000 to ≈34,000 by 2015 (5), of whom >50% will be long-term survivors (>5 years after diagnosis) 6, 7. As survival improves, the long-term effects of pRT on patients’ well-being are of greater significance. Results from randomized trials indicated that pRT was associated with poorer urinary, bowel, and sexual function at >5 years after diagnosis 3, 8. Relatively few population-based studies have evaluated the long-term effect of pRT on health status of rectal cancer survivors 9, 10, 11, 12. Furthermore, hardly any studies have investigated the association between age at diagnosis and pRT on health status. Concerns regarding the feasibility of radiotherapy exist, especially among elderly patients with a range of heterogeneous comorbid conditions that could influence their radiotherapy tolerance 13, 14.
This population-based study aimed to assess the impact of pRT on general and disease-specific health status of rectal cancer survivors up to 10 years postdiagnosis. Our hypotheses were as follows: (1) pRT survivors would have comparable general but poorer disease-specific health status than survivors treated with surgery only (SU); (2) survivors would have comparable general but poorer disease-specific health status compared with a Dutch normal population; (3) older pRT survivors (≥75 years old at diagnosis) would have poorer general and disease-specific health status than younger pRT survivors.
Section snippets
Setting and participants
The Eindhoven Cancer Registry (ECR) records data of all newly diagnosed cancer patients in the southern part of The Netherlands, an area with 2.4 million inhabitants, 10 hospitals, and two large radiotherapy institutes (15). Individuals diagnosed with rectal cancer in the period 1998 to 2007, as registered in the ECR, were eligible for participation in the study. Patients who had died, according to the ECR and the Central Bureau for Genealogy, which records all deaths via the Dutch civil
Results
The response rate in this study was 85% (Fig. 1). There were no significant differences in demographic and clinical characteristics among respondents, nonrespondents, and survivors with nonverifiable addresses (Table 1).
Baseline characteristics of the 340 rectal cancer respondents included in the final analyses showed that pRT survivors were more likely to be younger and married and had a shorter follow-up since diagnosis than SU survivors (Table 2). In regard to clinical characteristics, pRT
Discussion
In this population-based study of rectal cancer survivors, pRT survivors had comparable general but poorer disease-specific health status than SU survivors up to 10 years after initial diagnosis. pRT survivors had poorer body image and more problems with the gastrointestinal tract, defecation, and male sexual dysfunction than SU survivors.
Comparisons with a normal population showed that survivors had similar general health status. However, survivors, in particular female survivors, had poorer
Conclusions
Overall, pRT had no significant impact on general health status but was associated with poorer function in several disease-specific domains. More focus, clinical and psychological, on possible long-term morbidity of treatment and its effects on health status is recommended for better survivorship care following rectal cancer.
References (34)
- et al.
Improved overall survival for patients with rectal cancer since 1990: The effects of TME surgery and pre-operative radiotherapy
Eur J Cancer
(2008) - et al.
Quality of life among long-term (≥ 5 years) colorectal cancer survivors: Systematic review
Eur J Cancer
(2010) - et al.
Late side effects and quality of life after radiotherapy for rectal cancer
Int J Radiat Oncol Biol Phys
(2010) - et al.
Sexual function in males after radiotherapy for rectal cancer
Int J Radiat Oncol Biol Phys
(2010) - et al.
Adjuvant radiotherapy on older and oldest elderly rectal cancer patients
Arch Gerontol Geriatr
(2009) - et al.
Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: A population-based study
Eur J Cancer
(2006) - et al.
Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations
J Clin Epidemiol
(1998) - et al.
The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38)
Eur J Cancer
(1999) - et al.
Risk factors for sexual dysfunction after rectal cancer treatment
Eur J Cancer
(2009) - et al.
Does “normal” aging imply urinary, bowel, and erectile dysfunction? A general population survey
Urology
(2008)
Impact of external beam adjuvant radiotherapy on health-related quality of life for long-term survivors of endometrial adenocarcinoma: A population-based study
Int J Radiat Oncol Biol Phys
The morbidity of treatment for patients with Stage I endometrial cancer: Results from a randomized trial
Int J Radiat Oncol Biol Phys
Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): An open-label, non-inferiority, randomised trial
Lancet
The TME trial after a median follow-up of 6 years: Increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma
Ann Surg
Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: Increased bowel dysfunction in irradiated patients: A Dutch colorectal cancer group study
J Clin Oncol
Trends, prognoses, en implicaties voor zorgvraag [Cancer in the Netherlands. Trends, prognoses and implications for health care]
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Conflict of interest: none.