Study of Changes in Quality of Life After Rectal Cancer Surgery Using FACT-C Questionnaire

Rectal cancer and its treatment significantly affect the quality of life (QOL) of the patients. Standard treatment for locally advanced rectal cancer is neoadjuvant radiation therapy followed by surgery and surgical options include sphincter-preserving surgeries (SPS) or abdominoperineal resection (APR). This study aims at determining the pattern of changes in quality of life of patients undergoing rectal cancer surgery using the FACT-C (Malayalam) questionnaire. The Malayalam translation of Functional Assessment of Cancer Therapy for Colorectal Cancer (FACT-C) questionnaire which was previously validated was used to assess the QOL in a prospective study of 102 rectal cancer patients who underwent surgery. QOL scores were recorded at four time points-preoperative, and postoperative at 1 month, 3 months, and 1 year after surgery. Means of QOL scores were compared using paired t-test. The overall FACT-C score and scores of all four QOL domains-physical, emotional, social, and functional well being domains-dropped significantly at 1 month after surgery. Most profound fall in scores was noticed with the physical well being (PWB) domain followed by the functional well being (FWB) domain. QOL scores did not differ between patients who underwent SPS and APR. QOL score recovery was faster in APR patients compared to patients who had SPS. No significant difference was noted in overall QOL scores or individual scores of each domain between different age groups, sex, type of procedure (laparoscopic or open), stage of disease, or adjuvant therapy. Faster improvement of QOL scores of social domain was noted in patients with age < 60 years. Female patients were shown to have faster improvement in most of the QOL scores after surgery, though not statistically significant. Rectal cancer surgery results in fall in quality of life scores of all domains and gradual improvement of scores is seen over 1 year. QOL recovery is faster in young patients but sex, stage of disease, type of surgery, and surgical approach are not found to significantly affect the pattern of QOL scores. Patients undergoing APR are shown to have early recovery of QOL scores at 3 months after surgery while the same is attained at the end of 1 year in patients undergoing anterior resection with temporary stoma.