Charlton Mary E, Stitzenberg Karyn B, Lin Chi, Schlichting Jennifer A, Halfdanarson Thorvardur R, Juarez Grelda Yazmin, Pendergast Jane F, Chrischilles Elizabeth A, Wallace Robert B
University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ
University of Iowa College of Public Health, Iowa City, IA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; University of Nebraska Medical Center, Omaha, NE; and Mayo Clinic Cancer Center, Scottsdale, AZ.
J Oncol Pract. 2015 Jul;11(4):e476-86. doi: 10.1200/JOP.2015.004564. Epub 2015 Jun 16.
Many patients do not receive guideline-recommended neoadjuvant chemoradiotherapy for resectable rectal cancer. Little is known regarding long-term quality of life (QOL) associated with various treatment approaches. Our objective was to determine patient characteristics and subsequent QOL associated with treatment approach.
Our study was a geographically diverse population- and health system-based cohort study that included adults age 21 years or older with newly diagnosed stage II/III rectal cancer who were recruited from 2003 to 2005. Eligible patients were contacted 1 to 4 months after diagnosis and asked to participate in a telephone survey and to consent to medical record review, with separate follow-up QOL surveys conducted 1 and 7 years after diagnosis.
Two hundred thirty-nine patients with stage II/III rectal cancer were included in this analysis. Younger age (< 65 v ≥ 65 years: odds ratio, 2.49; 95% CI, 1.33 to 4.65) was significantly associated with increased odds of receiving neoadjuvant or adjuvant chemoradiotherapy. The adjuvant chemoradiotherapy group had significantly worse mean EuroQol-5D (range, 0 to 1) and Short Form-12 physical health component scores (standardized mean, 50) at 1-year follow-up than the neoadjuvant chemoradiotherapy group (0.75 v 0.85; P = .002; 37.2 v 43.3; P = .01, respectively) and the group that received only one or neither form of treatment (0.75 v 0.85; P = .02; 37.2 v 45.1; P = .008, respectively).
Neoadjuvant treatment may result in better QOL and functional status 1 year after diagnosis. Further evaluation of patient and provider reasons for not pursuing neoadjuvant therapy is necessary to determine how and where to target process improvement and/or education efforts to ensure that patients have access to recommended treatment options.
许多患者未接受针对可切除直肠癌的指南推荐的新辅助放化疗。关于各种治疗方法相关的长期生活质量（QOL），人们了解甚少。我们的目标是确定与治疗方法相关的患者特征及后续生活质量。
我们的研究是一项基于人群和卫生系统的队列研究，研究对象来自不同地理位置，纳入了2003年至2005年新诊断为II/III期直肠癌的21岁及以上成年人。符合条件的患者在诊断后1至4个月被联系，被要求参与电话调查并同意病历审查，在诊断后1年和7年分别进行后续生活质量调查。
本分析纳入了239例II/III期直肠癌患者。年龄较小（<65岁与≥65岁：比值比，2.49；95%置信区间，1.33至4.65）与接受新辅助或辅助放化疗的几率增加显著相关。在1年随访时，辅助放化疗组的欧洲五维健康量表（范围，0至1）和简明健康调查12项身体健 康分量表得分（标准化均值，50）显著低于新辅助放化疗组（分别为0.75对0.85；P = 0.002；37.2对43.3；P = 0.01）以及仅接受一种治疗或未接受任何一种治疗的组（分别为0.75对0.85；P = 0.02；37.2对45.1；P = 0.008）。
新辅助治疗可能在诊断后1年带来更好的生活质量和功能状态。有必要进一步评估患者和医疗服务提供者不采用新辅助治疗的原因，以确定如何以及在何处针对流程改进和/或教育工作，确保患者能够获得推荐的治疗选择。
