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Quality of Life and Functional Results Following Pelvic Exenteration

Quality of Life and Functional Results Following Pelvic Exenteration. Erin Kennedy September 19, 2015. No conflicts of interest. Objectives. Provide overview for QoL following pelvic exenteration Assessment of QoL studies Review QoL outcomes for primary rectal cancer

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Quality of Life and Functional Results Following Pelvic Exenteration

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  1. Quality of Life and Functional Results Following Pelvic Exenteration Erin Kennedy September 19, 2015

  2. No conflicts of interest

  3. Objectives • Provide overview for QoL following pelvic exenteration • Assessment of QoL studies • Review QoL outcomes for primary rectal cancer • Compare these outcomes to QoL for locally advanced and recurrent rectal cancer

  4. Assessing quality of life studies • Validated instruments • Prospectively collected data • Baseline values (need pre-op scores) • Sample size • Missing data

  5. Quality of Life Assessment Camilleri, Brennan, & Steele, BJS 2001 • 65 patients assessed prospectively • 21 anterior resection • 26 anterior resection plus ileostomy • 18 APR • 17 pre/post radiation • Mean age 67 yrs • EORTC QLQ C-30 and CR 38 • Baseline (pre-op) and 3, 6, 9, 12 months after surgery

  6. Quality of Life Assessment Camilleri-Brennan and Steele, BJS 2001 • Overall QoL scores the same • Profile of the individual domains change • Global QL, emotional function and future prospective were significantly better post-operatively • Role function, fatigue and pain were the same and remained relatively unchanged • Gastrointestinal problems (abdo pain, bloating) and defecation problems improved but did not return to baseline • Sexual enjoyment, male sexual problems, body image decreased and continued to decline

  7. Meta-analysis of QoL APR relative to AR • 11 studies • Overall QoL scores similar before and after surgery with APR and AR • Specific “domains” likely more important than overall QoL scores • Bowel function • Sexual function • Body image

  8. QoL Studies for Pelvic Exenteration

  9. QoL for Advanced and Recurrent Rectal Cancer Thaysen, 2013 Colorectal Disease • Prospective longitudinal study • 122 locally advanced or recurrent rectal cancers undergoing complex “beyond the TME plane” surgery • 48 LAR or APR in the standard TME plane • EORTC QLQ C-30 and EORTC CR 38 • Baseline (pre-op) and 3, 6, 12, 18 and 24 months after surgery

  10. Results Thaysen, 2013 Colorectal Disease • Overall QoL similar between groups at 12 months • Future prospective, Global health status, Emotional function and Role function significantly improved between 3 and 12 months post-operatively • Body image declined and stabilized but did not return to baseline • Pain – no change • Results for micturition, gastrointestinal, defecation problems, stoma related problems and weight loss domains NOT reported • Unable to perform analysis for Sexual function

  11. QoL in Locally Advanced Cancer Palmer, 2008 Ann Surg Onc • Cross sectional study • 43 locally advanced or recurrent rectal cancer having complex “beyond TME plane” surgery • 80 primary rectal cancer with standard surgery in TME plane • EORTC QLQ C-30 and EORTC CR-38 • Mean follow up in both groups ~ 4 years • Mean age in both groups = 65 years

  12. Results Palmer, 2008, Ann Surg Onc • Trend towards decrease in overall QoL score in “beyond TME” (60 vs 69, p<0.05) • Significantly lower scores for: • Physical • Role • Social • Fatigue • Body Image • Trend towards lower scores for: • Nausea and vomiting • Defecation problems

  13. Qualitative Assessment of Patient Experiences Wright, J of Surg Onc 2006 and 2010 • Extended Pelvic Resection • All that is important is your health – happy to be alive • Unanticipated morbidity (mobility, ADLs, sexual well being) • Mistaken perception of cure • Sacrectomy • Life changing impact of surgery • leisure activities, return to work, social interactions, family dynamics, sexual well being • Significant chronic pain • Grateful to be alive

  14. Summary • Overall QoL similar/slightly decreased with “beyond TME” or pelvic exenteration • Profiles of domains not well reported but seems to parallel primary rectal cancer • Body image, bowel and sexual function • Qualitative studies very informative and support findings from quantitative studies • Want the information even if limited treatment options • Best time to discuss is after surgery • Patient want to know about

  15. THANK YOU!

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