Young survivors of colorectal cancer report low health-related quality of life
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Young adult survivors of colorectal cancer exhibited low overall health-related quality of life scores, with longer-term survivors reporting worse social and functional well-being than those diagnosed more recently.
These findings, presented at Gastrointestinal Cancers Symposium, indicate that appropriate counseling and other targeted interventions may help maintain health-related quality of life among this at-risk population, according to the researchers.
“In recent years, the incidence of colorectal cancer in patients younger than 50 years has risen, and understanding the issues related to quality of life after diagnosis and during survivorship is essential in rehabilitation of these individuals and for their return to a productive life,” Afsaneh Barzi, MD, PhD, director of employer strategy and associate clinical professor in the department of medical oncology and therapeutics research at City of Hope, told Healio.
Barzi and colleagues sought to compare health-related quality of life among 235 colorectal cancer survivors (mean age, 35.6 years; 62% men; 77% white) who were either 6 months to 18 months (n = 157) or 19 months to 36 months (n = 78) out from an initial colorectal cancer diagnosis or relapse.
Researchers administered a cross-sectional survey in collaboration with a national organization for young survivors of colorectal cancer. They used the Functional Assessment of Cancer Therapy — which includes a colorectal cancer-specific scale and emotional, physical, social and functional well-being domains — to measure health-related quality of life. Using t-tests, they compared health-related quality of life of survivors who had been diagnosed or relapsed 6 months to 18 months earlier vs. 19 months to 36 months earlier.
Results showed out of a possible score of 136 points, the mean global health-related quality of life score among all survivors was 68.11 (95% CI, 66.56-69.64), which researchers described as low. Domain scores were highest for physical (15.15 out of 28) and social (14.86 out of 28) well-being and lowest for functional (12.11 out of 28) and emotional (11.84 out of 24) well-being.
Compared with survivors who had been diagnosed 6 to 18 months earlier, those who had been diagnosed 19 to 36 months earlier had higher scores for physical (16.74 vs. 14.39; P < .01) and emotional (12.67 vs. 11.43; P < .01) well-being and a lower score for social well-being (14 vs. 15.24; P < .01). The difference in functional well-being between the groups did not reach statistical significance.
“Our study showed that this younger population has poorer quality of life compared with historical studies with older patients. More importantly, we found that survivors farther out from diagnosis had lower social well-being scores than those closer to diagnosis (within 18 months), suggesting that these survivors may grow more isolated as a result of their diagnosis,” Barzi said.
Poor social and emotional well-being is associated with poor health outcomes and increased mortality, she added.
“Therefore, recognizing these issues can not only help these patients integrate into society, but it will also improve their survival. Recognition and addressing these issues require multidisciplinary teams, inclusive of social workers and psychologists. Oncologists are not trained to elicit or address these issues, so increasing awareness in the oncology community is critical to ensuring appropriate screening and referral. Understanding the attributes of patients who are at greater risk for poor quality of life can provide a venue for personalization of potential interventions,” Barzi said.
The researchers plan to conduct a large-scale, nationwide study of patients with known treatment history to assess the impact of clinical disease attributes, such as stage and tumor location, as well as treatment on the quality of life and its domains.
“This study will pave the way for design of interventions that can address the challenges experienced by these patients. We will specifically examine their social relationships to see what happens after diagnosis, as this is such a critical age and life stage for the formation of social role. Supporting their social development may help ensure better overall quality of life and outcomes,” Barzi said.
Perspective
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Ugo Iroku, MD
Along with the surge in adherence to colorectal cancer screening recommendations in the 1990s, we have witnessed a decline in colorectal cancer incidence in almost all age strata except one — those aged younger than 50 years. CDC data show that colon cancer diagnoses increased nearly 2.7% and deaths increased 1.3% from 2012 to 2016 in young patients, although these rates declined more than 2.5% among patients aged 65 years and older. The American Cancer Society estimated that this year, 12% of all new colon cancer cases — approximately 18,000 — will be diagnosed among patients aged younger than 50 years.
It is more crucial now than ever to examine ways to support this growing new category of colorectal cancer survivors, and this important research addresses this by examining domains of quality of life, showing overall low scores and a decrease in scores in social well-being among long-term vs. short-term survivors. Examination of this phenomenon among an even more diverse patient population than captured in this study would likely reveal useful information to allow for tailored, demographic-specific interventions. It also would be useful to examine these findings over a longer follow-up period to see if they remain true at 5-year time points or greater.
A potential barrier to providing interventions to these quality-of-life findings is access to multidisciplinary teams such as social workers and psychologists. This would be helped by increased insurance coverage for mental health services and by using telemedicine platforms, which aid in accessing providers previously inaccessible to some areas of the country.
Reference:
CDC. Colorectal Cancer, United States — 2007-2016. U.S. Cancer Statistics Data Briefs. No. 6. March 2020. Available at: https://www.cdc.gov/cancer/uscs/about/data-briefs/no16-colorectal-cancer-2007-2016.htm#figure4. Accessed Jan. 29, 2021.
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Miller KA, et al. Abstract 34. Presented at: Gastrointestinal Cancers Symposium (virtual meeting); Jan. 15-17, 2021.
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