SS301 - Understanding the Discordance Between Low Anterior Resection Syndrome Scores and Bowel-Related Quality of Life: Secondary Analysis of a Multicenter Trial

Abstract Podium Presenter(s)

• RP

  Roseanna Presutti, MPH, MD, FRCSC

  Colorectal Surgery Fellow
  Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University
  McGill University
  Montreal, QC, Canada

  Disclosure information not submitted.

Author(s)

• MD

  Marie Demian, MSc

  Research Associate I
  Jewish General Hospital
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• SS

  Sarah Sabboobeh, MSc

  Research Associate
  Jewish General Hospital
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• SB

  Sahir Bhatnagar, PhD

  Associate Directory
  5 Prime Sciences; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• JS

  Julie Savard, BSc

  Clinical Nurse Coordinator
  Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• SD

  Sebastien Drolet, MD, FRCSC

  Colorectal Surgeon and Clinical Professor
  CHU de Québec Université Laval
  Quebec, Quebec, Canada

  Disclosure information not submitted.
• 

  Alexander Sender Liberman, MD, FACS, FASCRS, FRCSC (he/him/his)

  Professor of Surgery & Oncology
  McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• 

  Carl Brown, MD FRCSC

  Colorectal Surgeon
  St. Paul's Hospital - Vancouver
  University of British Columbia
  Vancouver, British Columbia, Canada

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• JP

  Jason Park, MD MEd FACS FRCSC

  Clinical Professor
  University of British Columbia
  Vancouver, British Columbia, Canada

  Disclosure information not submitted.
• CL

  Carmen G. Loiselle, Ph.D.

  Professor
  McGill University
  Westmount, Quebec, Canada

  Disclosure information not submitted.
• 

  Steven D. Wexner, MD, PhD (Hon)

  Surgeon
  Cleveland Clinic Florida
  Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
  Weston, Florida, United States

  Disclosure information not submitted.
• 

  Liliana Bordeianou, MD, MPHFASCRS

  Professor of Surgery
  Harvard Medical School; Mass General Brigham Division Colon and Rectal Surgery
  Harvard
  Boston, MA, United States

  Disclosure information not submitted.
• GG

  Gabriela Ghitulescu, MD, FRCSC

  Assistant Professor of Surgery
  Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• JF

  Julio Faria, MD, FRCSC

  Assistant Professor of Surgery
  Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• NM

  Nancy Morin, MDCM, FRCSC, FACS

  Program Director, Colorectal Surgery Residency Program, McGill University
  Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• CV

  Carol-Ann Vasilevsky, MDCM, FRCSC, FACS

  Associate Professor of Surgery, McGill University
  Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University
  McGill University
  Montreal, QC, Canada

  Disclosure information not submitted.
• 

  Marylise Boutros, MD, FRCSC, FACS, FACRS (she/her/hers)

  Colorectal Surgeon
  Cleveland Clinic Florida
  McGill University
  Weston, Florida, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Richard Garfinkle, MD, MSc, PhD

  Colon and Rectal Surgery
  Jewish General Hospital, McGill University
  Jewish General Hospital, McGill University
  Montreal, QC, Canada

  Disclosure information not submitted.

Purpose/Background: Low Anterior Resection Syndrome (LARS) affects most individuals with rectal cancer and has been well correlated with decreased quality of life attributable to their changed bowel function (BQoL). However, there is often discordance between the two measures, whereby individuals experiencing major LARS report no BQoL impairment while patients experiencing minor/no LARS report major BQoL impairment. The objectives of this study were to characterize the discordance between LARS and BQoL scores and to identify clinical factors and LARS symptoms most strongly associated with BQoL impairment.

Methods/Interventions

This study was a secondary analysis using data from a prior pan-Canadian randomized controlled trial that evaluated the impact of a LARS Patient-Centered Program on global quality of life. Adult patients who had undergone a restorative proctectomy for rectal cancer and who were being consented for ileostomy closure were included. Patient-reported outcomes were measured at 1, 3, 6 and 12 months after ileostomy closure, including the LARS Score and BQoL question. For the current study, the LARS Score was categorized as major (>30) or minor/none (<=30). BQoL, which was assessed according to the question "Overall how does your bowel function affect your quality of life?", was categorized as major BQoL impairment ("somewhat" or "a lot") or no BQoL impairment ("not at all" or "very little"). Patient and disease factors, as well as individual elements of the LARS Score, were compared separately for those with major LARS and minor/no LARS (at 6- and 12-months) to identify factors associated with discordant scores.

Results/Outcomes

In total, 135 patients completed relevant outcome data. The median age was 62.0 years (54.8-68) and 57.8% were male (n=78). The median tumor height from the anal verge was 7.0 (4.7-9.0) cm, 62.2% received neoadjuvant radiation therapy and 49.6% underwent a hand-sewn coloanal anastomosis. At 6 months follow-up, 60.7% reported major LARS and 39.3% had minor/no LARS. Among patients with major LARS (n=82), 39.0% had no BQoL impairment (LARS+/BQoL-). The only patient or disease factor associated with being LARS+/BQoL- was being retired (proportion of retired patients who were LARS+/BQoL-: 51.4% vs. proportion of working patients who were LARS+/BQoL-: 29.8%, p=0.044). Among those with minor/no LARS (n=53), 20.8% had major BQoL impairment (LARS-/BQoL+). No patient or disease factors were significantly associated with being LARS-/BQoL+. In the major LARS subgroup, patients with major BQoL impairment (LARS+/BQoL+) had significantly higher mean scores of stool incontinence (2.76 vs 1.88, p=0.001), frequency (2.48 vs. 1.63, p=0.010), and urgency (15.6 vs. 14.75, p=0.035) than those without BQoL impairment (LARS+/BQoL-), but similar scores of clustering and incontinence to flatus. In the minor/no LARS subgroup, patients with major BQoL impairment (LARS-/BQoL+) had significantly higher mean scores of frequency (1.73 vs. 0.95, p=0.047) than those without BQoL impairment (LARS-/BQoL-); all other scores were similar (Figure 1). Similar trends were observed at 12-month follow-up.

Conclusion/Discussion

Approximately 20-40% of patients had discordant LARS severity and BQoL scores, reinforcing the need for a revised LARS Score that better captures the entirety of LARS symptoms, consequences and their burden. BQoL impairment may be partially explained by the consequences of LARS on patients' ability to perform social roles linked to working status, as well as the severity of individual LARS symptoms.

This presentation discusses the discordance between Low Anterior Resection Syndrome (LARS) severity and Bowel-Related Quality of Life (BQoL) scores among patients undergoing restorative proctectomy for rectal cancer. It will highlight patient, disease and social factors that are most strongly associated to BQoL impairment and discuss the need for a revised LARS Score that better captures the entirety of LARS symptoms, consequences and their burden.

Figure 1: LARS Symptoms and Bowel-Related Quality of Life (BQoL) Impairment Scores