HEALTH-RELATED QUALITY OF LIFE IN RECTAL CANCER PATIENTS DURING ACTIVE TREATMENT

Objective: The aim of this exploratory prospective observational study was to evaluate changes in Health-related Quality of Life (HRQoL) in rectal cancer patients (RCPs) during active cancer treatment, i.e. after diagnosis, after preoperative (chemo)radiotherapy and after surgical resection.Furthermore, the study aims to investigate which physical and psychosocial factors better predict HRQoL in the different treatment phases.Deepening the understanding of the positive and negative predictive factors for patients' HRQoL at different phases could indeed improve screening programs for early detection and intervention.Methods: 43 RCPs, expected to be treated with preoperative (chemo)radiation and surgery, were enrolled after diagnosis and assessed at three different time points: diagnosis (T0), one month after the end of preoperative treatment (T1), and one month after resection surgery (T2).HRQoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, EORTC-QLQ-C30 and its disease-specific supplementary, the QLQ-CR29), psychological distress (Hospital Anxiety and Depression Scale, HADS), coping (Mini-Mental Adjustment to Cancer Scale, Mini-MAC), affectivity (Positive and Negative Affect Scale, PANAS), alexithymia (Toronto Alexithymia Scale, TAS-20) and social support (Multidimensional Scale of Perceived Social Support Scale, MSPSS) were evaluate at the different time points.Results: The data showed that HRQoL decreased over time, especially between T1 and T2 (p=.005).Over time, patients' body image (p<.001) and urinary (p<.001), mouth (p=.015) and sexual (p<.001) symptoms worsened.Health anxiety (p<.001) and negative affectivity state (p=.037) improved after preoperative treatment, as did psychological distress (p<.001), although this increased again at T2 (p=.003).Baseline intestinal symptoms (p<.001) and negative affectivity trait (p=.03) were found to be significant predictors of HRQoL at T0. Baseline pain (p<.001), intestinal (p=.003) and urinary (p=.009) symptoms at T1 significantly predicted HRQoL at T1. Finally, a fatalistic coping style at T1 (p=.013), psychological distress (p=.003) and mouth symptoms (p=.001) at T2 significantly predicted HRQoL at T2.Conclusion: Our results suggest that several physical and psychological factors are involved in the changes occurring after diagnosis in RCPs' HRQoL, which decreases during active treatments.These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.