THE RELATIONSHIP BETWEEN BOWEL DYSFUNCTION AND BOWELRELATED QUALITY OF LIFE IMPAIRMENT OVER TIME

ABSTRACT

Purpose/Background: Bowel dysfunction following rectal cancer surgery changes with time and patients adapt to symptoms. The impact of bowel dysfunction on quality of life (QOL) over time is uncertain. Hypothesis/Aim: To evaluate the change in QOL due to bowel dysfunction over time. Methods/Interventions: A prospective database starting in July 2017 of adult patients who had undergone sphincter preserving rectal cancer surgery at a single university-affiliated colorectal cancer referral centre was queried. Patients were excluded if they had local recurrence, metastasis, or persistent stoma beyond 1-year follow-up. Follow-ups were arranged according to current guidelines. Main outcomes were QOL measured by the Short Form-36 survey (8 scales and 2 summary scores), bowel dysfunction was classified using the Low Anterior Resection Syndrome (LARS) score (no LARS, minor LARS and Major LARS), and bowel-related quality of life was evaluated using the single-item Bowel-Related Quality of Life (BQOL) survey. The SF-36 and LARS scores were collected as part of the ongoing registry. Eligible patients were then called at 3 months after their last in-person follow-up and administered the SF-36, LARS score and BQOL. Patients were also asked how they would have answered the BQOL 3-months prior. Changes in LARS and BQOL scores were noted and compared to SF-36 scores. Results/Outcome(s) Overall, 136 patients were included (75% response rate). Mean age 61.8 (+/-10.6 years), 71% male, mean distance from the anal verge was 8.7 cm (+/-4), 54% underwent neoadjuvant radiotherapy, 51% had a diverting loop ileostomy, 87% were laparoscopic, and median follow-up was 35.4 months [23.5-64.3]. There was no significant change in 3-month BQOL (96% of patients had no change, 3% improved, and 1% deteriorated. In patients who reported no change in BQOL, 54% (72/131) had no change in their LARS score, 31% (41/131) scored worse, and 27% (31/131) improved. Patients that showed improvement in their LARS score had an associated increase in their physical component summary, role emotional, role physical, physical functioning and bodily pain. Whereas patients with a deterioration of their LARS score had an associated decrease in their general health, vitality, and mental health. Interestingly, patients with no change in their LARS score reported increases in physical functioning and role emotional, but decreases in their scores for vitality and mental health (Table). Limitations: Recall bias, Covid-19, and volunteer bias. Conclusions/Discussion: Assessment of patients' bowel related QOL is complex. Improvements in bowel dysfunction appears to be associated with improved QOL. Whereas patients with worsening bowel dysfunction had an associated deterioration in QOL. Of note, BQOL scores did not change significantly over the study period. There is currently a paucity of instruments with sensitivity to detect changes specific to bowel dysfunction- related QOL.