Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer

Background: Little is known of how the quality of life of patients with rec tal cancer changes after surgery, and whether or not quality of life is ass ociated with and predictive of survival. The aims of this study were to add ress these issues. Methods: The Medical Outcomes Study Short Form 36 (SF-36), and the European Organization for the Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 quality of life questionnaires were administered to patients before surger y for rectal cancer, on discharge home and at 3-month intervals after opera tion for up to I year. Survival was measured in days from the time of surge ry to death. Results: Sixty-five patients with a median age of 67 years participated. Mo st quality of life scores dropped significantly below baseline in the early postoperative period. From the third month onwards some scores, such as th e global quality of life score and emotional function score on the QLQ-C30, improved. Other scores, including role function, fatigue and pain on the Q LQ-C30, were similar to baseline values after 3-6 months and remained uncha nged. However, scores such as sexual enjoyment and male sexual problems on the QLQ-CR38 were worse than baseline in the early postoperative period and remained poor thereafter. Stepwise regression analyses showed that preoper ative quality of life dimension scores for physical function, nausea/vomiti ng and sexual enjoyment, together with age, predicted postoperative 1-year survival with an accuracy of 76.8 per cent. Conclusion: The findings of this study confirm that quality of life after r ectal cancer surgery changes with time. It is generally worst in the early postoperative period. Preoperative quality of life is a good predictor of s urvival at 1 year.