Correspondence (reply): In Reply

We thank our colleagues for their critical interest in our article, “Sexual impairment and its effects on quality of life in patients with rectal cancer.”

We wish to respond individually to the criticisms expressed by Professor Otto et al and Dr Herrmann.

Of course, any clinical study that includes large numbers of patients (a total of 519 in our study) encounters the same problem – namely, that not all parameters can be controlled. However, we believe that following up patients’ quality of life over 2 years yields more representative results than a more detailed evaluation by means of interviews with very few patients at a particular point in time. Let’s go into this in some more detail.

Firstly, as we mentioned in our original article, our guiding principle in this study was the idea that our patients should be put under as little strain and stress as possible. The relevant considerations led us to unequivocally decide against using the International Prostate Symptom Score (IPSS) or other sex specific indices. We therefore added to the validated quality of life questionnaire only those questions relating to sexuality that had been found in several preliminary studies to be reliable and, above all, acceptable for patients.

Secondly, we believe that any comments about sexual impairment after rectal surgery can only be interpreted in the context of patients’ overall quality of life and on an age-specific basis and have presented our results accordingly.

Also, we agree with Professor Otto and Dr Herrmann that longer observation periods would have been required in order to draw any definite conclusions about the (adverse) effects of radiotherapy, and that further important variables would have merited investigation. At the same time, our study covered the longest observation period that we were able to identify in the German language literature with regard to the overall topic of quality of life in patients with rectal cancer.