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Can Differences in Bowel Function After Surgery for Rectal Cancer Be Identified by the European Organization for Research and Treatment of Cancer Quality of Life Instrument?

¹ Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York 10021, USA
² Department of Biostatistics and Health Outcomes Research, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York 10021, USA
³ Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York 10021, USA
⁴ Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York 10021, USA

Correspondence: Address correspondence and reprint requests to: Larissa K. Temple, MD, FACS; E-mail: templel{at}mskcc.org

Background: Bowel function is an important outcome after rectal cancer surgery that affects quality of life (QOL). Postoperative bowel function is often assessed with QOL instruments, but their ability to detect functional differences has not been evaluated. This study evaluated the efficacy of the European Organization for the Research and Treatment of Cancer (EORTC) Core (C)-30 and Colorectal (CR)-38 QOL instruments in identifying functional differences among patients undergoing sphincter-preserving surgery, grouped by clinical and treatment-related factors known to be associated with bowel function.

Methods: A total of 123 patients who underwent sphincter-preserving surgery for stage I to III rectal cancer completed the EORTC C-30 and CR-38 a median of 22.9 months after restoration of bowel continuity. The global QOL, Social and Physical Function subscales of the EORTC C-30, and Gastrointestinal (GI) Symptom and Defecation subscales of the EORTC CR-38 were hypothesized to be affected by bowel function. Known factors associated with function (age, sex, radiation, procedure, rectal reconstruction) were used to group patients. Differences in the QOL scores between patient groups were evaluated (t-test or analysis of variance).

Results: The global QOL was high, with a mean score of 76.84 ± 18.6. The Defecation subscale detected differences in patients grouped by age (P = .002), use of radiation (P = .04), and procedure type (P = .05). However, the remaining subscales failed to identify any differences.

Conclusions: We found neither the EORTC C-30 nor CR-38 to be sensitive instruments in delineating differences in bowel function. The use of a validated instrument designed to assess function in patients with rectal cancer will more effectively and efficiently identify those patients with poor postoperative function.

Key Words: Bowel function • Quality of life • EORTC • Sphincter-preserving surgery • Rectal cancer