Comparing Quality of Life in Rectal Cancer Survivors Managed With Watch-and-Wait Versus Surgery

Abstract

Background

A nonoperative (watch-and-wait) approach is increasingly accepted for patients with rectal cancer who achieve a complete clinical response to neoadjuvant treatment. This study aimed to investigate the effect of surgery—compared with a watch-and-wait strategy—on long-term quality of life among rectal cancer survivors following chemoradiotherapy.

Patients and Methods

This cross-sectional study included survivors of resectable rectal cancer treated with long-course chemoradiotherapy between 2011 and 2019 at Flinders Medical Centre, Australia. Participants were categorized as sustained watch-and-wait, surgery after regrowth, or standard surgery after chemoradiotherapy. Patient-reported outcome measures were collected by mail or during clinic visits. Primary multivariable analyses examined the effect of surgery on patient-reported outcomes. Linear regression models were adjusted for receipt of adjuvant chemotherapy, sex, age at assessment, tumor distance from the anal verge, comorbidity burden, and time from treatment completion.

Results

Of 190 eligible participants approached, 78 were enrolled. Median age was 70 years; 33.3% were female. A total of 32 (41.0%) were in the watch-and-wait group, 8 (10.3%) had been managed with surgery due to regrowth after initial watch-and-wait, and 38 (48.7%) were in the standard surgery group. The comorbidity burden had a negative impact on quality of life (P < .05). Surgery was independently associated with lower QLQ-C30 summary and social functioning scores (both P < .05), and with higher pain, bowel-function, urinary, and embarrassment symptom scores (all P < .05).

Conclusion

Surgery was associated with worse quality of life, higher symptom burden, and poorer psychosocial outcomes. This study highlights the need for long-term symptom monitoring and personalized care in survivors of rectal cancer.