Rectal cancer survivorship : work loss and long-term morbidity

In the last few decades, due to early detection and advances in treatments, rectal cancer survival has been improved significantly. Meanwhile, rectal cancer survivors and health practitioners are facing more challenges arising from the disease, in terms of survivors’ longterm morbidity and work ability. The general aims of the register-based doctoral projects therefore include: 1). to evaluate the short- and long-term work loss in incident relapse-free rectal cancer survivors, together with the underlying association between work loss and survivors’ clinical characteristics; 2). to investigate the long-term cardiotoxicity in irradiated relapse-free rectal cancer survivors; 3). to systematically estimate the long-term drug use as a proxy for morbidity in relapse-free rectal cancer survivors.

In Study I, we included 2815 curatively treated working-age rectal cancer patients without previous disability pension and their matched general comparators. After a median follow-up of 6 years (range 0-10 years), we found nearly one fourth relapse-free survivors and one tenth of their comparators were on disability pension listing, making the disability pension risk significantly doubled in the relapse-free survivors. Abdominoperineal resection was associated with higher disability pension risk than anterior resection. Surgical complications and reoperation also yielded more risk in survivors’ disability pension.

In Study II, using the same study design as the previous study, we found the median work loss days during the 1st after treatment was 147 days and 336 days among relapse-free rectal cancer survivors without (n=2,529) and with (n=909) prediagnostic work loss history, respectively. Among those who had prediagnostic work loss, the post-treatment work loss varied very little by clinical characteristics; whereas among those without any prediagnostic work loss, advanced stage at diagnosis, operated with Abdominoperineal resection, neoadjuvant (chemo)radiotherapy treatment and surgical complications were all associated with higher work loss risk in survivors.

In Study III, we included 14901 register-based (9227 received preoperative radiotherapy (RT) and surgery and 5674 were treated only with surgery) and 2675 trial-based (randomized into preoperative RT or not followed by surgery) relapse-free rectal cancer patients during a maximum follow-up of 18 and 33 years, respectively. We found no significant overall or subtypes of cardiovascular risk associated with preoperative RT. Although a slightly elevated risk of venous thromboembolism was noted in both cohorts during the first 6 months following treatment, the absolute number of patients affected was rather low, hence the safety of RT was further assured.

In Study IV, we evaluated the detailed prescribed drug dispensing using defined daily doses (DDDs) by the Anatomical Therapeutic Chemical (ATC) classification among relapse-free rectal cancer patients across a maximum follow-up of 10 years. In comparison to the general population, rectal cancer survivors had a slight increase in overall drug use. While the survivors did acquire more drugs in digestive system, this could be due to both the long-term disease complications and potential prophylactic treatment.

List of scientific papers

I. Risk of disability pension in patients following rectal cancer treatment and surgery. Lingjing Chen, Ingrid Glimelius, Martin Neovius, Sandra Eloranta, Sara Ekberg, Anna Martling, Karin Ekström Smedby. British Journal of Surgery. 2015 Oct;102(11):1426-32.
https://doi.org/10.1002/bjs.9885

II. Work Loss Duration and Predictors Following Rectal Cancer Treatment among Patients with and without Prediagnostic Work Loss. Lingjing Chen, Ingrid Glimelius, Martin Neovius, Sandra Eloranta, Sara Ekberg, Anna Martling, Karin Ekström Smedby. Cancer Epidemiology Biomarkers and Prevention. 2016 Jun; 25(6):987-94.
https://doi.org/10.1158/1055-9965.EPI-16-0112

III. Short- and long-term risks of cardiovascular disease following radiotherapy in rectal cancer in four randomized controlled trials and a population-based register in Sweden. Lingjing Chen, Sandra Eloranta, Anna Martling, Ingrid Glimelius, Martin Neovius, Bengt Glimelius, Karin Ekström Smedby. [Submitted]

IV. Long-term use of prescribed drugs in rectal cancer survivors compared to the general population in Sweden. Lingjing Chen, Sandra Eloranta, Anna Martling, Ingrid Glimelius, Martin Neovius, Karin Ekström Smedby. [Manuscript]