Quality of life and other patient reported outcomes following pelvic exenteration for pelvic malignancy: prospective, comparative study (#134)
Pelvic exenteration is the only treatment that offers potential cure for locally advanced pelvic cancer. Given the extensive nature of this procedure, its impact on subsequent quality of life is paramount. This study compared patient-reported outcomes over 12 months for patients with locally advanced or recurrent pelvic cancer who did and did not undergo pelvic exenteration.
Consecutive patients referred for consideration of pelvic exenteration at Royal Prince Alfred Hospital, Sydney or the Peter MacCallum Cancer Centre, Melbourne for rectal or other pelvic malignancy between May 2008 and December 2011 were asked to complete clinical and patient-reported outcome assessments at baseline, hospital discharge (exenteration patients only), 1, 3, 6, 9 and 12 months. Patient reported outcomes included cancer-specific quality of life (FACT-C), physical and mental health status (SF-36v2), psychological distress (Distress Thermometer), and pain (study specific composite). Linear mixed modelling compared trajectories between exenteration and non-exenteration groups. We aimed to recruit 90 exenteration and 56 non-exenteration patients.
182 patients were recruited, of which 148 (81%) underwent exenteration surgery. There were no baseline differences between the two groups. Among exenteration patients, the mean baseline FACT-C score (93.0) reduced by 14.4 points by hospital discharge, but increased to 86.7 at one month post-surgery and continued to improve. For patients in the non-exenteration group (n=34), FACT-C scores deteriorated between baseline and one month, improved slowly to six months before declining from nine months. There were few statistically or clinically significant differences in any patient reported outcomes between the exenteration and non-exenteration groups.
Patient reported outcomes improve rapidly after pelvic exenteration surgery. For the nine months following surgery, these outcomes are comparable with similar patients who do not have exenteration surgery; thereafter, non-exenteration patients decline. Pelvic exenteration surgery is associated with acceptable quality of life and related patient reported outcomes.