gms | German Medical Science

Aims: Current studies assessing the impact of neo-adjuvant therapy for rectal carcinoma focus on toxicity and survival. Little is known about the impact on perceived QoL. Therefore, the aim of this study was to assess quality of life over time among patients receiving neo-adjuvant radiation and chemotherapy for rectal carcinoma and patients without neoadjuvant treatmentat all.

Methods: Since 1998, the EORTC-QLQ-C30 and a tumor specific ad-hoc module were prospectively administered to patients before surgery, at discharge, 3, 6, 12 and 24 months postoperatively. Altogether, 368 patients, who provided QoL data for at least one time point, were included in the analysis.

Results: Out of the 368 patients, 183 were female and 185 male. Both groups were comparable in terms of age, tumor stage and surgical procedure. 16.8% of the male and 7.7% of the female patients received neo-adjuvant radiation and chemotherapy.

In terms of general QoL (EORTC QLQ-C30) we found no significant differences pre operatively. At discharge, significant differences were found for Social Functioning, Global Health, Pain, Insomnia und Appetite Loss with patients following neo-adjuvant treatment reporting poorer QoL. After 6, 12 and 24 months postoperatively there is no longer a difference. On the QoL module, patients following neo-adjuvant therapy reported significant higher levels of sexual impairment and strain.

In a multivariate analysis we found out that women following neo-adjuvant therapy tend to report worse QoL scores (except for diarrhoea) than men, but these findings should be re-analysed with bigger sample size.

Conclusion: Neo-adjuvant therapy seems to have positive effects in terms of downstaging. These positive effects however lead to a temporarily impairment of QoL especially in terms of sexuality: the sexual impairment remains stable over the time observed, while other aspects of QoL improve over time. This should be included in the preoperative counseling.