Patients with rectal cancer report ‘good’ quality of life with watch-and-wait approach
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Key takeaways:
- Patients with rectal cancer who were observed by a watch-and-wait approach reported good quality of life.
- Quality of life deteriorated in patients requiring surgery.
Patients with rectal cancer who were observed by a watch-and-wait approach reported “good” quality of life and less major bowel dysfunction than those requiring surgery, according to study results in JAMA Surgery.
“Patients observed by the watch-and-wait (WW) approach presumably have a better quality of life (QoL) and functional outcome because they do not require a definitive colostomy and have less surgery-related morbidity,” Petra A. Custers, MD, of the department of surgery at the Netherlands Cancer Institute, and colleagues wrote. “A small matched-controlled study revealed that patients observed by the WW approach scored better on several QoL domains and reported fewer bowel, urinary and sexual dysfunctions compared with patients after [total mesorectal excision]. Nevertheless, prospective long-term data on QoL and functional outcome after the WW approach are limited.”
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Using data from the Dutch Watch-and-Wait registry, researchers conducted two prospective cohort studies to assess long-term QoL and functional outcomes of 278 patients (median age, 66 years; 67% men) with rectal cancer and a clinical complete or near-complete response after neoadjuvant chemoradiotherapy or radiotherapy.
Researchers evaluated QoL at 3, 12 and 24 months after study inclusion using three European Organization for Research and Treatment of Cancer-Quality of Life questionnaires and a 36-item short-form health survey.
In the first 24 months, 80% of patients had sustained clinical complete response and were observed by a WW approach, 14% underwent total mesorectal excision (TME) and 6% underwent additional local excision.
Among WW patients, 25.3%, 24% and 24.9% reported major bowel dysfunction at 3, 12 and 24 months, respectively. Of 151 men in the WW group, 31.8% reported severe erectile dysfunction and 19.1% reported moderate urinary dysfunction at 24 months; women also reported decreased sexual satisfaction and function during follow-up.
Overall, though, “patients observed by the WW approach who did not require additional surgery reported good QoL, with limited variation over time,” researchers wrote.
Despite similar QoL scores, patients who underwent additional local excision reported more major bowel dysfunction (55.6%) compared with those who did not require additional surgery. Researchers noted those who underwent TME scored “significantly worse” on several QoL subscales.
“The data provided by the present study are essential for shared decision-making and for counseling patients on what to expect with the WW approach,” Custers and colleagues concluded. “With expanding treatment options available for patients with rectal cancer, making the optimal treatment decision for the individual patient is an increasingly challenging task. It requires a good understanding of all treatment options, including the associated oncologic outcome, as well as data on QoL and functional outcome.”
Perspective
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Emre Gorgun, MD, MBA, FACS, FASCRS
Over the past several years, total neoadjuvant therapy (TNT) has become the standard of care for managing rectal cancer. This provides our patients an organ-sparing, sound and safe approach with close monitoring.
That said, does this approach also achieve better results than surgery from a functional and quality-of-life standpoint? This is an especially important question since TNT patients are intensively treated with chemotherapy agents and radiation. The current study from The Netherlands aimed to answer this question and concluded that TNT patients with watch-and-wait approach had good quality of life, with some patients reporting bowel and sexual dysfunction.
This study confirms that organ-sparing methods, even with radiation and chemotherapy, may be associated with better quality of life, despite the fact some changes might be observed as a result of treatment, such as from radiation and chemotherapy. Undoubtedly, further research will be required to investigate long-term effects, especially in patients who would still require surgery after TNT.
Certainly, TNT as an organ-preserving approach in the management of rectal cancer is continuing to grow, and we expect the therapy to provide patients with a better quality of life.
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