Quality of Life in Patients Treated for Curable Rectal Cancer

Given the advances in oncologic outcome after treatment for rectal cancer, it is important to understand how therapy affects patients' long-term quality of life (QOL). In recent years a significant number of publications have used validated instruments to report QOL in patients treated for rectal cancer. Numerous factors are hypothesized to affect QOL after surgery for rectal cancer, including permanent stomas, the use of radiotherapy, type of rectal reconstruction, and several patient demographic factors. Although there are several limitations to these studies, current evidence indicates that a permanent stoma is not associated with as much impairment as previously hypothesized. Specifically, the data suggest that a permanent stoma is associated with greater impairment of sexual function and body image, while sphincter preservation is associated with numerous functional (defecation) problems. Radiation therapy may also contribute to a decrease in sexual QOL subscales. Bowel and sexual function appear to significantly affect quality of life. These findings are not consistent, however, as the studies have been methodologically flawed. Additionally, these studies are retrospective, sampling small heterogenous patient populations and using different QOL instruments. Further research is required to better understand factors associated with QOL, and to devise strategies for improving QOL following surgery for rectal cancer.