Assessing quality of life in recurrent rectal cancer patients

A recent collaborative study between researchers in the UK and Australia has made inroads into aligning outcome reporting with patient priorities in advanced cancer settings.

The study details the development, testing and analysis of a disease-specific measure to assess quality of life in patients with recurrent rectal cancer, regardless of treatment intent. It has been published in the journal eClinical Medicine (part of The Lancet Discovery Science).

The new measure developed by the scientists — known as the LRRC–QoL — consists of eight multi-item scales (healthcare services, psychological impact, pain, urostomy-related symptoms, lower limb symptoms, stoma, sexual interest and urinary symptoms) and three single items. Its aim is to capture and assess the wide-ranging nature of issues that affect patients with locally recurrent rectal cancer, reflecting the complex and varied nature of the disease and its management.

“The management of locally recurrent rectal cancer has undergone an evolution over the last decade, leading to significant clinical and oncological improvement,” said lead author Associate Professor Deena Harji from the Institute of Clinical Trials Research at the University of Leeds.

“Along with these advancements there is growing recognition that health-related quality of life also needs to be appropriately measured with integrated reporting in this patient population,” she continued.

“Due to the lack of disease-specific, validated patient-reported outcome measures, health-related quality of life has been variably assessed in the past. The LRRC-QoL will provide broader-based, patient-centred, contextual relevance to clinical and oncological outcomes such as morbidity, recovery and survival. It will help incorporate patient priorities into clinical practice and research, with equal value being placed on overall survival and maintaining quality of life,” Harji said.

Co-author Professor Michael Solomon from the Surgical Outcomes Research Centre at Royal Prince Alfred Hospital Sydney said that the LRRC-QoL had the potential to transform outcome assessment in locally recurrent rectal cancer.

“In clinical practice, the LRRC-QoL will be able to quantify patient symptoms, experience and overall satisfaction. This will lead to the disclosure and identification of potential issues not routinely reported and will aid the early detection and subsequent monitoring of symptoms,” Solomon said.

Locally recurrent rectal cancer is a complex clinical entity, affecting a considerable proportion of patients worldwide. In 2020 there were 1,931,590 global colorectal cancer cases. A third of these cases were rectal cancer, with locally recurrent rectal cancer affecting 5–10% of patients following a previous resection of rectal cancer. With treatments for locally recurrent rectal cancer often requiring invasive procedures with significant side effects, the LRRC–QoL is a timely and important tool for use in clinical and academic settings, the researchers said.

The LRRC–QoL is currently validated in the UK and Australia and available for uptake and adoption by clinicians, healthcare professionals and researchers for clinical and academic practice. There is ongoing work to develop the measure for further international use.

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