QOL

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QOL

  1. 1. Preliminary Results of a Quality of Life Study in Rectal Cancer Patients with Radical Sphincter Preservation Surgery following Neoadjuvant Therapy Elsa Valsdottir, Shadi Yarandi, John H Marks, Gerald Marks Lankenau Hospital, Wynnewood, PA 5 th International Rectal Cancer Consensus Conference September 2008 The Quality of Life Question
  2. 2. Goals of cancer management <ul><li>Cancer control </li></ul><ul><ul><ul><li>Local recurrence </li></ul></ul></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><li>Quality of life </li></ul><ul><ul><ul><li>Avoid colostomy </li></ul></ul></ul><ul><ul><ul><li>Good function (bowel, bladder, sexual) </li></ul></ul></ul>
  3. 3. Purpose <ul><li>To evaluate function and quality of life in rectal cancer patients after radical sphincter preservation surgery following neoadjuvant treatment </li></ul>
  4. 4. Methods <ul><li>3 questionnaires: </li></ul><ul><ul><li>EORTC </li></ul></ul><ul><ul><li>Fecal Incontinece Quality of Life Scale </li></ul></ul><ul><ul><li>(Wexner´s scale)* </li></ul></ul><ul><ul><li>Specific questions about stoma </li></ul></ul><ul><ul><li>* Rockwood et al. Fecal Incontinence Quality of Life Scale – Quality of Life Instrument for Patients with Fecal Incontinence. Dis Colon Rectum 2000;43:9-17 </li></ul></ul>
  5. 5. Mailing numbers <ul><li>Questionnaires mailed: 553 </li></ul><ul><li>Deceased: 30 </li></ul><ul><li>Wrong address: 96 </li></ul><ul><li>Refused to participate: 12 </li></ul><ul><li>Returned questionnaires: 209 </li></ul><ul><li>Responce rate: 48.9% </li></ul>
  6. 6. Demographics <ul><li>61 TATA patients </li></ul><ul><li>Age 57.7 (33-77 years old) </li></ul><ul><li>19 women, 42 men </li></ul><ul><li>Level in rectum 1.95 cm (-1,5 to 10 cm) </li></ul>
  7. 7. Treatment <ul><li>XRT mean dose 5500 cGy </li></ul><ul><li>Concurrent 5FU -based chemotherapy </li></ul><ul><li>Surgery 8-12 weeks later: TATA </li></ul>
  8. 8. T-stage Pre op %(n) Pathological %(n) T0 0 (0) 16 (10) T1 1 (1) 8 (5) T2 15 (9) 33 (20) T3 52 (32) 15 (9) T4 0 (0) 0 (0) NA 31 (19) 28 (17)
  9. 9. Sample question 1 <ul><li>“ Due to accidental bowel leakage, whenever I am away from home, I try to stay near a restroom as much as possible” </li></ul><ul><li>- Most of the time 21% (n=13) </li></ul><ul><li>- Some of the time 12% (n=7) </li></ul><ul><li>- A little of the time 28% (n=17) </li></ul><ul><li>- None of the time 26% (n=16) </li></ul><ul><li>- n/a 13% (n=8) </li></ul>
  10. 10. Sample question 1 <ul><li>“ Due to accidental bowel leakage, whenever I am away from home, I try to stay near a restroom as much as possible” </li></ul><ul><li>- Most of the time 21% (n=13) </li></ul><ul><li>- Some of the time 12% (n=7) </li></ul><ul><li>- A little of the time 28% (n=17) </li></ul><ul><li>- None of the time 26% (n=16) </li></ul><ul><li>- n/a 13% (n=8) </li></ul>=67%
  11. 11. Sample question 2 <ul><li>“ Due to accidental bowel leakage, I worry about bowel accidents” </li></ul><ul><li>- Most of the time 8% (n=5) </li></ul><ul><li>- Some of the time 31% (n=19) </li></ul><ul><li>- A little of the time 28% (n=17) </li></ul><ul><li>- None of the time 10% (n=6) </li></ul><ul><li>- n/a 23% (n=14) </li></ul>
  12. 12. Sample question 2 <ul><li>“ Due to accidental bowel leakage, I worry about bowel accidents” </li></ul><ul><li>- Most of the time 8% (n=5) </li></ul><ul><li>- Some of the time 31% (n=19) </li></ul><ul><li>- A little of the time 28% (n=17) </li></ul><ul><li>- None of the time 10% (n=6) </li></ul><ul><li>- n/a 23% (n=14) </li></ul>=61%
  13. 13. Wexner´s scale <ul><li>Scale from 1 to 4 </li></ul><ul><li>(1 poor, 4 no problems) </li></ul>Lifestyle 3.21 Coping/behavior 2.70 Depression/perseption 3.49 Embarrassment 3.00
  14. 14. Would you prefer to have a stoma?
  15. 15. Would your QOL be better with a stoma?
  16. 16. Would your sexual life be better with a stoma?
  17. 17. Would you be able to enjoy more activities with a stoma?
  18. 18. Comments
  19. 19. Conclusions <ul><li>Radical sphicter preservation surgery for rectal cancer patients following neoadjuvant therapy provides good quality of life and acceptable function </li></ul><ul><li>Despite mild functional imparement, majority of patients would not prefer to have a stoma </li></ul>

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