The authors are to be thanked for dealing with this important topic, for having conducted their study in such a large cohort of patients, and for publishing the results.
In analyzing how multimodal therapies affect the quality of life of patients with rectal cancers, further factors should be investigated in addition to age and sex, so as to obtain as complete a picture as is possible of the harm patterns and their mechanisms. The authors reported that 48% of the 368 patients had received adjuvant radiotherapy. In addition to surgery related morbidity, irradiation of the pelvis can lead to significantly deteriorated anal sphincter function (1) and sexual function (2). In male patients, the testes are affected by scattered radiation, which in turn may harm the Leydig cells and result in chronically subnormal testosterone concentrations (3). This should be borne in mind when investigating or treating posttherapeutic fatigue. Consequently, (neo)adjuvant therapeutic modalities should be described as comprehensively as possible in such studies.
References
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