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Abstract
Rectal cancer treatments may impact negatively on patients’ bowel and sexual functions and, in turn, on health-related quality of life. Information on the likely effects of treatment is essential in order to facilitate the care process and the adaptation of patients to their condition. Studies that report on the comparison between rectal cancer patients and the general population are a useful source of this evidence, providing elements to aid in answering questions such as ‘is my life going to be the same as before?’ In this article, the authors have systematically reviewed articles published in the last 6 years that report on the comparison between rectal patients’ and the general population’s health-related quality of life. Sixteen out of 645 articles were included. The results are summarized and critically discussed.
Financial & competing interests disclosure
The authors were supported by a regional grant (convenzione AIRC-Fondazione CARIPARO 2013/2015). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
During patient–clinician consultations, it is of crucial importance to provide patients with accurate information concerning the most likely changes that they are going to experience during and after treatment.
The authors systematically reviewed 16 articles that compared patients’ and general population’s health-related quality of life (HRQoL) in the past 6 years.
Most studies were cross-sectional, with a long-term perspective, and used generic questionnaires to compare patients and the general population. Four studies also used the sexuality subscales of a colorectal cancer specific instrument.
Global health does not seem to differ between patients and the general population. Nevertheless, some functions and symptoms have been frequently found to be affected by treatment: social, physical and sexual functions, diarrhea and constipation.
Considering the type of treatment, sphincter-preserving surgery and the absence of stoma are not associated with better HRQoL, surgery only patients have scores comparable to the general population, whereas neoadjuvant treatments impact on symptoms and functioning.
Functioning and symptoms seem to improve over time, although the overall function remains slightly impaired up to 14 years after treatment.
The lack of differences between patients and controls or even better scores in patients might be due to two types of factors: psychological mechanisms ascribable to patients (e.g., rejoice, benefit-finding, post-traumatic growth, adaptation of patients to their condition) and methodological aspects (e.g., type of instruments, sample size, selection bias).
Few studies compared patients with the general population. The heterogeneity of the studies, the long-term perspective and the use of generic instruments suggest caution in generalizing the results.
In the next 5 years, this field of study would benefit from: an increase in the number of methodologically sound studies comparing patients with the general population at multiple assessment times; the development of instruments that are able to seize the specific symptomatology of rectal cancer and to assess its impact of patients’ HRQoL; and widening the collection of reference data for generic questionnaires as well as starting to collect normative data for specific questionnaires, reporting details about the sample drawn from the general population.