Clinical Investigation
Impact of Preoperative Radiotherapy on General and Disease-Specific Health Status of Rectal Cancer Survivors: A Population-Based Study

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Purpose

To date, few studies have evaluated the impact of preoperative radiotherapy (pRT) on long-term health status of rectal cancer survivors. Using a population-based sample, we assessed the impact of pRT on general and disease-specific health status of rectal cancer survivors up to 10 years postdiagnosis. The health status of older (≥75 years old at diagnosis) pRT survivors was also compared with that of younger survivors.

Methods and Materials

Survivors identified from the Eindhoven Cancer Registry treated with surgery only (SU) or with pRT between 1998 and 2007 were included. Survivors completed the Short Form-36 (SF-36) health survey questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Colorectal 38 (EORTC QLQ-CR38) questionnaire. The SF-36 and EORTC QLQ-CR38 (sexuality subscale) scores of the survivors were compared to an age- and sex-matched Dutch normal population.

Results

A total of 340 survivors (response, 85%; pRT survivors, 71%) were analyzed. Overall, survivors had similar general health status. Both short-term (<5 years) and long-term (≥5 years) pRT survivors had significantly poorer body image and more problems with gastrointestinal function, male sexual dysfunction, and defecation than SU survivors. Survivors had comparable general health status but greater sexual dysfunction than the normal population. Older pRT survivors had general and disease-specific health status comparable to that of younger pRT survivors.

Conclusions

For better survivorship care, rectal cancer survivors could benefit from increased clinical and psychological focus on the possible long-term morbidity of treatment and its effects on health status.

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)

  • L.V. van de Poll-Franse et al.

    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

    (2007)
  • C.L. Creutzberg et al.

    The morbidity of treatment for patients with Stage I endometrial cancer: Results from a randomized trial

    Int J Radiat Oncol Biol Phys

    (2001)
  • R.A. Nout et al.

    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

    (2010)
  • K.C. Peeters et al.

    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

    (2007)
  • K.C. Peeters et al.

    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

    (2005)
  • www.oncoline.nl. Accessed June 5,...
  • Trends, prognoses, en implicaties voor zorgvraag [Cancer in the Netherlands. Trends, prognoses and implications for health care]

    (2004)
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    Conflict of interest: none.

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