The time course of health-related Quality of Life in rectal cancer patients undergoing combined modality treatment.

BACKGROUND AND PURPOSE

This exploratory prospective observational study investigated the changes in Health-related Quality of Life (HRQoL) in rectal cancer patients (RCPs), from diagnosis to one-year-post-surgery follow-up and explored the role of physical symptoms and psychological determinants on HRQoL at the different time points.

MATERIALS AND METHODS

We assessed HRQoL, psychological distress, coping, affectivity, alexithymia and social support in 43 RCPs treated with preoperative (chemo)radiation and surgery, at three different assessment time points: diagnosis (T0), one month after the end of preoperative treatment (T1), one month after resection surgery (T2), and at follow-up (T3).

RESULTS

The data showed that HRQoL decreased during active treatments, especially between T1 and T2 ( = 0.005), before increasing again at follow-up ( = 0.002).Baseline intestinal symptoms ( < 0.001) and negative affectivity trait ( = 0.03) significantly predicted HRQoL at T0. Baseline pain ( < 0.001), intestinal ( = 0.003) and urinary ( = 0.009) symptoms at T1 significantly predicted HRQoL at T1. A fatalistic coping style at T1 ( = 0.013), psychological distress ( = 0.003), mouth symptoms ( = 0.001) at T2 significantly predicted HRQoL at T2. Similarly, a fatalistic coping style at T1 ( = 0.006), psychological distress ( = 0.004), mouth ( = 0.002) and pain symptoms ( = 0.002) at T3 significantly predicted HRQoL at T3.

CONCLUSION

Several physical and psychological factors are involved in the changes occurring after diagnosis in RCPs' HRQoL. While cancer-related symptoms and treatment-related physical side effects are the main predictors of HRQoL at diagnosis and during active treatments, early psychological reactions have a higher predictive weight in post-treatment HRQoL.These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.