Quality of life following complete clinical response to chemoradiotherapy for rectal cancer: Patient-reported outcomes.
Authors: O'Neill Maeve , Larkin John , McCormick Paul , Mehigan Brian , Gillham Charles , Flannery Delia , O'Connor Katrina , O'Kane Grainne M. , Gallagher David James , Kelly Michael E 
Published: January 2025

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Background:
Complete clinical response (cCR) after neoadjuvant therapy (chemoradiotherapy/total neoadjuvant treatment) for rectal cancer may permit an organ-preserving approach with “watch and wait” (W&W) surveillance. This confers comparable survival, while avoiding the sequelae of pelvic surgery. Data on quality of life (QOL) for this cohort are lacking.
Methods:
Patient-reported outcomes were collated for patients on W&W following cCR in a single hospital network. Validated questionnaires evaluating surgical, radiation and chemotherapy-related QOL were completed, including Low Anterior Resection Syndrome (LARS) score, Functional Assessment of Chemotherapy: Colorectal (FACT-C), EORTC QLQ-CIPN20, EQ-5D-5L and a linear analogue and ordinal scale ranking self-perception of health.
Results:
From 2016-2023, 76 patients were enrolled on W&W. Median follow-up is 37 months (IQR20-63). 12 patients (15.8%) had local regrowth, of whom 11 (92%) had salvage surgery. Five patients (6.5%) developed metastases at median 8 months (IQR3-12) from W&W entry. Of 57 patients (75%) with sustained cCR on surveillance, 44 (77%) responded to structured questionnaires. Two with stomas were excluded from LARS. 74% of respondents had no LARS, 9% minor LARS and 17% major LARS. 43% reported faecal urgency and 33% faecal incontinence. 41% experienced functional impairment due to chronic chemotherapy-related side effects (Table). Median EORTC CIPN20 score was 23 (IQR20-28; possible range 19-76, high score = poor QOL). Median sensory score was 11 (IQR9-15.5, PR 9-36), median motor score 8 (IQR8-11, PR 8-32) and median autonomic score 4 (IQR3-6) for males (PR 3-12) and 2 (IQR2-2.5) for females (PR 2-8). 54% of men reported erectile dysfunction, of whom 62% experienced severe dysfunction (33% of all males). Median FACT-C score was 123.5 (IQR108-131; PR 0-136, high score = better QOL). Median overall health score was 80% (IQR70-95). 36% of patients reported difficulty with mobility, 27% with usual activities and 11% with self-care. 30% declared ongoing physical pain/discomfort, while 23% live with anxiety/depression related to their diagnosis. Overall, 86% of reported problems were mild/moderate and 14% severe/very severe.
Conclusions:
This study highlights self-reported QOL in patients on W&W pathway following neoadjuvant treatment of rectal cancer. It provides important insight to side-effects of treatment escalation in hope of organ preservation, and presents vital information for the counselling of future patients.

Patients (n=41)

Upper limb paraesthesia
12 (29%)

Lower limb paraesthesia
17 (41%)

Difficulty with:

- Walking/standing (foot drop or impaired sensation)
10 (24%)

- Stairs/sit-to-stand (leg weakness)
11 (27%)

- Hot/cold differentiation
4 (10%)

- Holding pen/manipulating small objects/opening jar/bottle
12 (29%)

Hearing impairment
13 (32%)

Blurred vision
4 (10%)