Long-term pain impact after rectal cancer surgery: Trajectories and predictors of patient request for contact from a cohort study

AIM: Rectal cancer (RC) accounts for one third of colorectal cancers worldwide, with survival rates improving due to advances in screening and treatment. However, chronic pain affects approximately 30% of RC survivors, impacting quality of life, physical function and mental health. This study aimed to evaluate chronic pain prevalence, identify risk factors and explore predictors of requesting contact concerning pain management following RC surgery.

METHOD: A prospective cohort study was conducted on RC patients undergoing surgery at three Danish hospitals. Patients completed the Rectal Cancer Pain Score at 3, 12, 24 and 36 months after surgery and indicated if they wished to be contacted to discuss treatment options. Pain trajectories were depicted in a Sankey diagram. A mixed-effects model examined factors influencing changes in pain scores over time.

RESULTS: Among 729 patients, 32% reported pain at 3 months, decreasing to 25% at 36 months. Some patients improved, while others developed increasing symptoms. Seventeen per cent of patients requested contact due to pain. Only 13% of these were referred for further pain treatment, while 58% were referred for the management of other late sequelae to the RC treatment. Female gender (p = 0.001), younger age (p ≤ 0.001), obesity (p ≤ 0.003) and radiotherapy (p ≤ 0.001) were associated with higher pain scores.

CONCLUSION: Chronic pain in RC survivors is dynamic and influenced by identifiable risk factors over time. The findings underscore the need for proactive, tailored pain management strategies.