The time course of health-related Quality of Life in rectal cancer patients undergoing combined modality treatment

Background and purpose: This exploratory prospective observational study investigated the changes in Health- related Quality of Life (HRQoL) in rectal cancer patients (RCPs), from diagnosis to one-year-post-surgery follow-up and explored the role of physical symptoms and psychological determinants on HRQoL at the different time points. Materials and methods: We assessed HRQoL, psychological distress, coping, affectivity, alexithymia and social support in 43 RCPs treated with preoperative (chemo)radiation and surgery, at three different assessment time points: diagnosis (T0), one month after the end of preoperative treatment (T1), one month after resection surgery (T2), and at follow-up (T3). Results: The data showed that HRQoL decreased during active treatments, especially between T1 and T2 (p = 0.005), before increasing again at follow-up (p = 0.002). Baseline intestinal symptoms (p <0.001) and negative affectivity trait (p = 0.03) significantly predicted HRQoL at T0. Baseline pain (p < 0.001), intestinal (p = 0.003) and urinary (p = 0.009) symptoms at T1 significantly predicted HRQoL at T1. A fatalistic coping style at T1 (p = 0.013), psychological distress (p p = 0.003), mouth symptoms (p = 0.001) at T2 significantly predicted HRQoL at T2. Similarly, a fatalistic coping style at T1 (p = 0.006), psychological distress (p = 0.004), mouth (p = 0.002) and pain symptoms (p = 0.002) at T3 significantly predicted HRQoL at T3. Conclusion: Several physical and psychological factors are involved in the changes occurring after diagnosis in RCPs' HRQoL. While cancer-related symptoms and treatment-related physical side effects are the main predictors of HRQoL at diagnosis and during active treatments, early psychological reactions have a higher predictive weight in post-treatment HRQoL. These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.