Watch-and-wait approach for rectal cancer may boost potential of maintaining good quality of life

Patients with rectal cancer who are monitored using a watch-and-wait approach are more likely to have a good quality of life, whereas those who undergo surgery appear to experience deterioration in quality of life and functional outcome, as reported in a study.

For the study, data from two prospective cohort studies (a single-centre study and an ongoing multicentre study) were used. A total of 278 patients (median age 66 years, 67 percent male) with rectal cancer who achieved a clinical complete response or near-complete response after neoadjuvant chemoradiotherapy or radiotherapy were included in the analysis. Patients were observed by a watch-and-wait approach, but additional local excision or total mesorectal excision was performed for those with residual disease or regrowth.

Quality of life was assessed using the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire–C30 (EORTC-QLQ-C30), EORTC-QLQ-CR38 or EORTC-QLQ-CR29, and 36-Item Short-Form Health Survey. The scores ranged from 0–100, with a high score indicating a high level of functioning for some scales or a high level of complaints and symptomatology for others.

Meanwhile, functional outcome was evaluated using the Low Anterior Resection Syndrome score, Vaizey incontinence score, International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index.

In the first 2 years, 221 patients (80 percent) underwent observation using a watch-and-wait approach without requiring surgery, 18 patients (6 percent) received additional local excision, and 39 patients (14 percent) received total mesorectal excision.

Overall, patients in the watch-and-wait approach group reported good quality of life that did not change much over time. Major bowel dysfunction occurred in 56 of 221 patients (25.3 percent) at 3 months, in 53 patients (24.0 percent) at 12 months, and in 55 patients (24.9 percent) at 24 months.

At 24 months, 48 of 151 male patients (31.8 percent) had severe erectile dysfunction. For female patients, on the other hand, sexual satisfaction and overall sexual function declined throughout follow-up.

Of note, more patients who underwent local excision reported major bowel dysfunction (10 of 18 patients [55.6 percent]) relative to those without additional surgery. However, quality-of-life scores were similar in the two groups. Patients who underwent total mesorectal excision had significantly worse score on several quality-of-life subscales.