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Pain and Quality of Life After Treatment in Patients With Locally Recurrent Rectal Cancer

From the Departments of Surgery, Biostatistics, and Radiation, and Pain Research Group, The University of Texas M.D. Anderson Cancer Center, Houston, and Department of Surgery, The University of Texas Health Science Center, San Antonio, TX.

Address reprint requests to Nestor F. Esnaola, MD, MPH, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 444, Houston, TX 77030-4009; email: nesnaola{at}mdanderson.org

PURPOSE: Because survival in patients with locally recurrent rectal cancer (LRRC) is limited, pain control and quality of life (QOL) are important parameters. The purpose of this study was to assess the prevalence of posttreatment pain and QOL of patients with LRRC treated with nonsurgical palliation or resection and identify predictors of poor outcome.

PATIENTS AND METHODS: Posttreatment pain severity and QOL were prospectively assessed in 45 patients with LRRC using the Brief Pain Inventory and Functional Assessment of Cancer Therapy–Colorectal questionnaire.

RESULTS: Fifteen patients received nonsurgical palliation, and 30 patients underwent resection of their pelvic tumors. There was a significant association between higher posttreatment pain scores and worse QOL (P < .001). Patients treated with nonsurgical palliation reported moderate to severe pain beyond the third month of treatment. Resected patients reported comparable levels of pain during the first 3 postoperative years, particularly after bony resections; long-term survivors (beyond 3 years), however, reported minimal pain and good QOL. Female sex, pelvic/sciatic pain at presentation, total pelvic exenteration, and bony resection were associated with higher rates of moderate to severe posttreatment pain (P = .04, P < .001, P = .04, and P = .02, respectively). Pain at presentation was an independent predictor of posttreatment pain (odds ratio, 7.4 [95% confidence interval, 1.8 to 30.3]; P = .006).

CONCLUSION: Patients with LRRC treated with nonsurgical palliation or resection experience significant levels of pain after treatment. Close posttreatment pain monitoring is warranted in patients presenting with pelvic pain, and more aggressive pain management strategies may improve posttreatment QOL.

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