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CRC survivors in England report positive health-related quality of life
More than one-third of patients surviving 1 to 3 years after a colorectal cancer diagnosis reported being in perfect health, but certain subgroups reported markedly poorer health-related quality of life, according to a national population-based study in England.
Aiming to define the population-level health-related quality of life (HRQL) of 12- to 36-month CRC survivors, and also determine factors associated with poor reported health outcomes, researchers from England evaluated completed questionnaires from 21,802 such adult patients who were diagnosed with colon cancer (62.3%), rectal cancer (30.8%) or rectosigmoid tumors (6.9%) in 2010 or 2011.
The questionnaires included questions related to treatment, disease status, long-term conditions, generic HRQL (EQ-5D), CRC-specific outcomes (FACT), social problems (Social Difficulties Inventory) and experience of care. The EQ-5D recorded problems in five domains, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression, and responses to this survey were matched with those from the Health Survey for England 2011 for comparison with the general population.
Overall, 34.5% of patients reported no problems on any of the EQ-5D domains and 9.6% reported problems in all five. Patients with rectal cancer were more likely to report problems (70.9%) compared with patients with rectosigmoid or colon cancer (63.8% and 63%, respectively; P<.001). Subgroups more likely to report at least one problem included those with active (90.8%) or recurrent (87.9%) disease, those with at least three other long-term conditions (83.3%), those with a stoma (80.3%) and those older than 85 years (79.4%). Multivariate analysis demonstrated that the strongest predictors of at least one reported problem included having at least three long-term conditions (OR=5.56; 95% CI, 5-6.18 compared with none), active disease (OR=5.38; 95% CI, 4.3-6.73 compared with remission) and a stoma (OR=2.34; 95% CI, 2.12-2.59). Reported problems were higher compared with the general population (68.8% vs. 59.9%; P<.001) and this was most significant in those younger than 55 years.
Of patients who did not have a stoma, 16.3% reported no bowel control. Patients with reversal of a stoma reported fewer bowel control problems compared with those who never had a stoma (12% vs. 16.6%; P<.001), but were more likely to report moderate bowel control problems than those who never had a stoma (25.9% vs. 14%; P<.001). Of patients with rectal cancer, 25.1% reported sexual problems compared with 11.2% of patients with colon cancer and 16.1% of patients with rectosigmoid cancer (P<.001).
“This study demonstrated the success of a national patient-reported outcomes survey,” the researchers concluded. “Although one-third of respondents reported no problems on assessment of HRQL, the results identify subgroups that are more likely to report problems. This approach has the potential to support system-wide improvement through the identification of particular challenges faced by individuals after treatment for CRC and those at greatest risk of poor outcomes.”
Disclosure: The researchers report no relevant financial disclosures.