Quality of Life and Functions After Chemoradiation for Rectal Cancer: A Review of Recent Publications

We have systematically reviewed studies published in the last three years on patients’ self-reported evaluations of quality of life (QoL) and functions after chemoradiotherapy (CRT) for rectal cancer. Overall, the findings from 13 studies confirmed that CRT negatively affect functions and, consequently, patients’ QoL, especially for bowel, role, and social function. The studies’ heterogeneity limited the possibility of comparison among findings. We discuss and comment on the ideal characteristics of studies assessing QoL and function. We emphasise how this type of evidence is relevant to decision-making at all levels of health-care practice.     

Patient-Reported Outcomes and Health-Related Quality of Life Following Radiotherapy for Bladder Cancer

Bladder cancer is the 11th most common cancer in the UK and with an ageing population the incidence is increasing. There is a relative lack of prospective quality of life (QoL) data evaluating the impact of the illness and treatment on QoL and patient-reported outcomes (PROs). Here we evaluate the available tools to assess QoL and PROs, and summarise the published data evaluating outcomes in patients treated with radiotherapy for muscle-invasive disease. We also discuss some of the recently completed studies and those ongoing that will help to shape future care and assist in decision making for patients and their clinicians.     

Quality of Life of Breast Cancer Survivors After a Recurrence: A Follow-Up Study

Previous studies on breast cancer recurrence provide a mixed picture of the quality of life of women following a recurrence. To clarify the picture, the present study addresses some previous methodological concerns by offering a multidimensional assessment with follow-up, a matched comparison group of disease-free survivors, and a closer look at the nature of recurrence (local versus metastatic). Fifty-Four of 817 women who participated in an earlier study experienced a recurrence at follow-up, and are compared to a matched sample of 54 women who remained disease-free. Analyses indicate that women who had a recurrence report significantly poorer functioning on various health-related quality of life (HRQOL) domains compared to women who remained disease-free. However, the differences appear to be largely due to the poorer HRQOL of women with metastatic disease. Although women who had a recurrence report good mood, low stress, and good quality of interpersonal relationships, they report significantly higher cancer-specific stress compared to disease-free women at follow-up. Women who had a recurrence also report experiencing both more meaning and vulnerability as a result of breast cancer than disease-free women, but report similar levels of spirituality and benefit-finding at follow-up as disease-free women. These results suggest that although women report relatively good psychosocial adjustment following a recurrence, cancer-specific domains of quality of life are most likely to be negatively affected. These results may be useful in identifying individuals with breast cancer recurrences who are most in need of psychosocial services.     

Quality of Life Assessment in Women with Breast Cancer: A Prospective Study Including Hormonal Therapy

Purpose

Evaluating the effect of hormonal treatment on quality of life (QoL) in breast cancer patients by using the Functional Assessment of Cancer Treatment (FACT) questionnaire is the main purpose of this trial.

Methods

Breast cancer patients treated with adjuvant between January 2007 and December 2009 were evaluated. The first survey was done after patients completed their whole adjuvant treatment except for the hormonal therapy and this was as ''basal assessment.'' The second survey was done 6 to 12 months after the basal surveys during their routine policlinic controls. The last survey was done within the last 18 to 24 months of the follow-up period.

Results

The effect of marital status, number of pregnancies, residence in the village or city, hemoglobin levels, chemotherapy and hormonal therapy for any other reason except for breast cancer on the QoL could not be seen. Endocrine subscale scores were detected to be higher in patients aged >60 years than in younger ones. The other dimension scores were low in the elderly patient group. There was a statistically significant relationship between being >30 years old and improvement in the social well-being score (p=0.028). The functional well-being scores were found to be significantly higher in the patient group that had no comorbid disease (p=0.018). Endocrine subscale scores were statistically worse in patients who had psychiatric disease (p=0.057) but the general QoL data were similar with others. It was shown that all QoL scores for all dimensions had statistically significant changes (p<0.001) in terms of hormonal regimes.

Conclusion

The diagnosis of breast cancer was found to be an independent factor that affects social well-being and social life in a negative way. We must give attention to complaints including complaints about sexual life and hormonal status in order to ensure compliance of patients with the required hormonal regimens. By the help of future research, we can improve the prognosis of this disease through increased treatment adherence and belief of patients.     

Quality of Life for Patients with Esophageal/Gastric Cardia Precursor Lesions or Cancer: A One-year Prospective Study

Background: The current study examined health-related quality of life (QoL) for patients with esophageal/gastric cardia precursor lesions or cancer before and after treatment to facilitate improved prevention andtreatment. Materials and Methods: Patients with different stages of esophageal/gastric cardia lesions completedtwo QoL questionnaires, EORTC QLQ-C30 and supplemental QLQ-OES 18, before primary treatment, and at 1,6 and 12 months after treatment. Results: Fifty-nine patients with precursor lesions, 57 with early stage cancer,and 43 with advanced cancer responded to our survey. Patients with precursor lesions or early stage cancerreported better QoL overall than those with advanced cancer before treatment (p<0.01). Global QoL scores beforetreatment and at 1 month after treatment were 71±9 versus 69±9 (p>0.01), 71±8 versus 61±11 (p<0.01), 67 ± 11versus 62 ± 9 (p<0.01) for three stages of lesions. At 6 months after treatment, some QoL measures recoveredgradually in precursor lesion and early cancer patients, while some continuously deteriorated in advancedcancer patients. At 12 months, all QoL scores were comparable to baseline for patients with precursor lesions(p>0.01), while global QoL, social, pain, and insomnia scores for early stage and advanced cancer were inferior tocorresponding baseline levels (difference between means>5, p<0.01). At this time point, compared with patientswith early stage cancer, those with advanced cancer showed worse QoL with all function and most symptommeasures (p<0.01). Conclusions: Patients with precursor lesions or early stage esophageal/gastric cardia cancershow better QoL than those with advanced cancer. This indicates that screening, early diagnosis and treatmentmay improve the QoL for esophageal/gastric cardia cancer patients. Target intervention and counseling shouldbe given by health care providers during treatment and follow-up to facilitate QoL improvement.     

Survival After Induction Chemotherapy and Chemoradiation Versus Chemoradiation and Adjuvant Chemotherapy for Locally Advanced Rectal Cancer

BackgroundTotal neoadjuvant therapy (TNT) improves tumor response in locally advanced rectal cancer (LARC) patients compared to neoadjuvant chemoradiotherapy alone. The effect of TNT on patient survival has not been fully investigated.Materials and MethodsThis was a retrospective case series of patients with LARC at a comprehensive cancer center. Three hundred and eleven patients received chemoradiotherapy (chemoRT) as the sole neoadjuvant treatment and planned adjuvant chemotherapy, and 313 received TNT (induction fluorouracil and oxaliplatin-based chemotherapy followed by chemoradiotherapy in the neoadjuvant setting). These patients then underwent total mesorectal excision or were entered in a watch-and-wait protocol. The proportion of patients with complete response (CR) after neoadjuvant therapy (defined as pathological CR or clinical CR sustained for 2 years) was compared by the χ² test. Disease-free survival (DFS), local recurrence-free survival, distant metastasis-free survival, and overall survival were assessed by Kaplan-Meier analysis and log-rank test. Cox regression models were used to further evaluate DFS.ResultsThe rate of CR was 20% for chemoRT and 27% for TNT (P=.05). DFS, local recurrence-free survival, metastasis-free survival, and overall survival were no different. Disease-free survival was not associated with the type of neoadjuvant treatment (hazard ratio [HR] 1.3; 95% confidence interval [CI] 0.93-1.80; P = .12).ConclusionsAlthough TNT does not prolong survival than neoadjuvant chemoradiotherapy plus intended postoperative chemotherapy, the higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.