To Örebro University

Introduction: Treatment for rectal cancer is associated with urinary and sexual dysfunction. Few studies describe urinary and sexual function after neoadjuvant (chemo)radiotherapy and a watch and wait (WoW) approach. This study aimed to evaluate the prevalence and change over time in patient-reported urinary and sexual dysfunction in patients within the Swedish watch and wait study.

Method: The Swedish Watch and Wait (WoW) study is a multicenter prospective cohort study including patients with clinical complete response (cCR) after (chemo)radiotherapy for rectal cancer. A total of 211 patients with cCR (stage I-III rectal cancer) were included between January 2017 and February 2023. Questionnaires were collected at baseline, 6 months, 1 year, and 2 years post-treatment.

Result: Questionnaire data were available for 173 patients at baseline and 136 at two years. The median age was 66 years (60% male). Neoadjuvant treatment was given as short-course radiotherapy (SCRT) (27.5%), SCRT combined with chemotherapy (66.5%), long-course chemoradiotherapy (4.9%) and other treatments (1.1%).

Urinary incontinence during daytime increased from 9,2 % at baseline to 14,7% two years after treatment. Erectile dysfunction was stable: 24,0 % at baseline and 23,5 % at two years follow-up. In women, sexual function including arousal, lubrication and orgasm decreased during follow-up.

Discussion: Urinary and sexual dysfunction is seen in patients treated with neoadjuvant therapy without subsequent surgery. Urinary incontinence slightly increased during follow-up. Female sexual function decreased, whereas erectile dysfunction remained stable during follow-up. The results are encouraging but also indicate that dysfunction is present, albeit to a lesser extent than if surgery is part of the treatment.