Local Recurrence of Rectal Cancer: Risk factors, diagnosis and Quality of Life

Abstract

Aim To explore different aspects of local recurrence of rectal cancer, including intraoperative adverse events as a risk factor, symptoms and diagnosis, survivorship issues and Quality of Life, and to validate data on local recurrence in the Swedish ColoRectal Cancer Registry. Methods Papers I and II are based on a retrospective review of medical records for a regional population-based cohort. Paper III is an international, multicentre qualitative study based on semi-structured, in-depth interviews with long-term survivors. Paper IV is a validation of data on local recurrence in the Swedish ColoRectal Cancer Registry including a national two-year cohort, with a review of medical records as the “gold standard”. Results Intraoperative adverse events were a risk factor for local recurrence (paper I). Most patients were diagnosed with symptomatic disease outside of follow-up. Pain was a possible alarm symptom (paper II). Long-term survivors generally described having a good Quality of Life despite several survivorship issues (paper III). The validity of local recurrence in the Swedish ColoRectal Cancer Registry is inadequate, with ~40% of cases not reported. Conclusions Enabling patients to report symptoms may improve diagnosis of local recurrence. Using a prediction model, including intraoperative adverse events, to select high-risk patients for intensive monitoring could be of value. Local recurrence has a long-lasting impact. However, the Quality of Life of survivors is generally good following adaptation. To be useful, improved validity of local recurrence in the Swedish ColoRectal Cancer Registry is crucial.