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Health-Related Quality of Life during Chemoradiation in Locally Advanced Rectal Cancer: Impacts and Ethnic Disparities

1
Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales 2170, Australia
2
Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, New South Wales 2560, Australia
3
University of New South Wales, Kensington, New South Wales 2052, Australia
4
Western Sydney University, Liverpool, New South Wales 2170, Australia
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Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales 2170, Australia
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Department of Medical Oncology, Bankstown Hospital, Bankstown, New South Wales 2200, Australia
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Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales 2170, Australia
8
School of Psychology, University of Sydney, Camperdown, New South Wales 2006, Australia
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(9), 1263; https://doi.org/10.3390/cancers11091263
Received: 25 July 2019 / Accepted: 26 August 2019 / Published: 28 August 2019
Aims: There is limited data on health-related quality of life (HRQoL) in locally advanced rectal cancer. We assessed HRQoL before, during and after neoadjuvant chemoradiation, correlated this to corresponding clinician-reported adverse events (CR-AEs) and explored disparities between patients of Asian ethnicity versus Caucasians. Correlation between HRQoL and treatment response was also assessed. Methods: A consecutive sample of patients was recruited. HRQoL was assessed with the EORTC QLQ-C30 before chemoradiation, week three of chemoradiation and one-week pre-surgery. Clinical variables including CR-AEs were recorded at these time-points. Patients self-reported socio-demographic variables. Treatment response was assessed by the tumour regression grade. HRQoL data were analysed with multilevel models. Results: Fifty-one patients were recruited. HRQoL completion rates were ≥86%. Cognitive and role functioning worsened significantly during treatment. Emotional, role and social functioning improved significantly at pre-surgery. Fatigue and nausea/vomiting worsened during treatment while fatigue, appetite loss, diarrhoea and financial difficulties improved from treatment to pre-surgery. Almost 30% of the cohort were Asian ethnicity. Differences were found in multiple HRQoL domains between Asians and Caucasians, with Asians faring worse. Significant differences were evident in physical, role and cognitive functioning, and in seven out of the 8 symptom scales. The correlation between patient-reported outcomes and clinician-reported outcomes was weak, with diarrhoea having the strongest correlation (r = 0.58). Vomiting during treatment correlated with poor response, whilst baseline constipation correlated with good response. Conclusion: Chemoradiation for locally advanced rectal cancer affects multiple HRQoL domains. Our findings highlight the importance of psychological aspects of treatment. Significant differences were identified between the Asian and Caucasian populations, with Asians consistently performing worse. Poor correlations between patient and clinician reporting strongly support the inclusion of patient-reported outcomes in clinical studies. HRQoL domains of vomiting and constipation are potential biomarkers of treatment response. View Full-Text
Keywords: health-related quality of life; chemoradiation; rectal cancer health-related quality of life; chemoradiation; rectal cancer
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MDPI and ACS Style

Lim, S.H.-S.; Ip, E.; Ng, W.; Chua, W.; Asghari, R.; Roohullah, A.; Descallar, J.; Henderson, C.; Spring, K.; de Souza, P.; King, M.T. Health-Related Quality of Life during Chemoradiation in Locally Advanced Rectal Cancer: Impacts and Ethnic Disparities. Cancers 2019, 11, 1263. https://doi.org/10.3390/cancers11091263

AMA Style

Lim SH-S, Ip E, Ng W, Chua W, Asghari R, Roohullah A, Descallar J, Henderson C, Spring K, de Souza P, King MT. Health-Related Quality of Life during Chemoradiation in Locally Advanced Rectal Cancer: Impacts and Ethnic Disparities. Cancers. 2019; 11(9):1263. https://doi.org/10.3390/cancers11091263

Chicago/Turabian Style

Lim, Stephanie H.-S., Emilia Ip, Weng Ng, Wei Chua, Ray Asghari, Aflah Roohullah, Joseph Descallar, Christopher Henderson, Kevin Spring, Paul de Souza, and Madeleine T. King. 2019. "Health-Related Quality of Life during Chemoradiation in Locally Advanced Rectal Cancer: Impacts and Ethnic Disparities" Cancers 11, no. 9: 1263. https://doi.org/10.3390/cancers11091263

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