Abstract
Purpose
Colorectal cancer (CRC) is the third most common cancer in the USA. The objective of this study was to compare quality of life (QoL) across long-term colorectal cancer survivors and unaffected matched controls while adjusting for comorbidities.
Methods
The National Cancer Institute (NCI)-funded Colon Cancer Family Registry (CCFR) was used to randomly select and recruit CRC survivors (≥ 5 years from diagnosis) and matched controls for a cross-sectional survey. Nine geographically diverse sites in the USA from the CCFR participated in the study. Telephone interviews were conducted using computer-assisted methods to assess QoL.
Results
A total of 403 cases and 401 controls were included in the final sample. Unadjusted comparison revealed no significant difference between CRC survivors and controls with respect to measures of fatigue, social, emotional, functional, and physical well-being. Multivariate logistic regression revealed that case status had a significant negative influence on colorectal cancer-specific QoL measures. Higher comorbidity indices had a significant negative influence on overall QoL regardless of case status.
Conclusions
Quality of life among long-term CRC survivors is similar to control subjects, with the exception of worse CRC-specific QoL measures. Higher comorbidity indices were independently associated with poor QoL for both cases and controls.
Implications for Cancer Survivors
Survivors and healthcare providers should be aware that long-term QoL is comparable to the general population; however, there is potential that digestive tract-specific issues may persist.
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References
Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67(3):177–93.
Cancer.Net. Colorectal cancer: statistics. In: Colorectal cancer guide. American Society of Clinical Oncology. 2018. https://www.cancer.net/cancer-types/colorectal-cancer/statistics. Accessed 15 May 2019.
Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst. 2017;1(8):109.
Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.
Ratjen I, Schafmayer C, Enderle J, di Giuseppe R, Waniek S, Koch M, et al. Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a German cohort study. BMC Cancer. 2018;18(1):1156.
Bloom JR, Petersen DM, Kang SH. Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psycho-Oncology. 2007 Aug;16(8):691–706.
Cella D, Nowinski CJ. Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system. Arch Phys Med Rehabil. 2002;83:S10–7.
Bulpitt CJ. Quality of life as an outcome measure. Postgrad Med J. 1997;73(864):613–6. https://doi.org/10.1136/pgmj.73.864.613.
Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Cancer Netw. 2009;7(8):883–94.
Testa MA, Simonson DC. Assessment of quality-of-life outcomes. NEJM. 1996;334(13):835–40.
Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomark Prev. 2011;20(10):1996–2005.
Jacobsen PB, Jim HS. Consideration of quality of life in cancer survivorship research. Cancer Epidemiol Biomark Prev. 2011;20(10):2035–41.
Chambers SK, Meng X, Youl P, Aitken J, Dunn J, Baade P. A five-year prospective study of quality of life after colorectal cancer. Qual Life Res. 2012;21(9):1551–64.
Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: a population-based study. J Clin Oncol. 2004;22(23):4829–36.
Adams SV, Ceballos R, Newcomb PA. Quality of life and mortality of long-term colorectal cancer survivors in the Seattle Colorectal Cancer Family Registry. PLoS One. 2016;11(6):e0156534.
Ramsey SD, Andersen MR, Etzioni R, Moinpour C, Peacock S, Potosky A, et al. Quality of life in survivors of colorectal carcinoma. Cancer. 2000;88(6):1294–303.
Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR. Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol. 2002;97(5):1228–34.
Jansen L, Herrmann A, Stegmaier C, Singer S, Brenner H, Arndt V. Health-related quality of life during the 10 years after diagnosis of colorectal cancer: a population-based study. J Clin Oncol. 2011;29(24):3263–9.
Caravati-Jouvenceaux A, Launoy G, Klein D, Henry-Amar M, Abeilard E, Danzon A, et al. Health-related quality of life among long-term survivors of colorectal cancer: a population-based study. Oncologist. 2011;16(11):1626–36.
Hart TL, Charles ST, Gunaratne M, Baxter NN, Cotterchio M, Cohen Z, et al. Symptom severity and quality of life among long-term colorectal survivors compared with matched controls: a population based study. Dis Colon Rectum. 2018;61(3):355–63.
Vissers PA, Thong MS, Pouwer F, Zanders MM, Coebergh JW, Van de Poll-Franse LV. The impact of comorbidity on Health-Related Quality of Life among cancer survivors: analyses of data from the PROFILES registry. J Cancer Surviv. 2013;7(4):602–13.
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.
Cella D, Lai JS, Stone A. Self-reported fatigue: one dimension or more? Lessons from the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F) questionnaire. Support Care Cancer. 2011;19(9):1441–50.
Yoo HJ, Kim JC, Eremenco S, Han OS. Quality of life in colorectal cancer patients with colectomy and the validation of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), Version 4. J Pain Symptom Manag. 2005;30(1):24–32.
Chaudhry S, Jin L, Meltzer D. Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care. 2005;1:607–15.
Jansen L, Koch L, Brenner H, Arndt V. Quality of life among long-term (⩾ 5 years) colorectal cancer survivors–systematic review. Eur J Cancer. 2010;46(16):2879–88.
Domati F, Rossi G, Benatti P, Roncucci L, Cirilli C, De Leon MP. Long-term survey of patients with curable colorectal cancer with specific reference to the quality of life. Intern Emerg Med. 2011;6(6):529–35.
Kunitake H, Russell MM, Zheng P, Yothers G, Land SR, Petersen L, et al. Quality of life and symptoms in long-term survivors of colorectal cancer: results from NSABP protocol LTS-01. J Cancer Surviv. 2017;11(1):111–8.
Trentham-Dietz A, Remington PL, Moinpour CM, Hampton JM, Sapp AL, Newcomb PA. Health-related quality of life in female long-term colorectal cancer survivors. Oncologist. 2003;8(4):342–9.
Acknowledgments
The authors are grateful to the Colon Cancer Family Registry for their support. The authors wish to acknowledge and express gratitude for the significant contributions of Dr. Diane Fairclough, who provided insights for the study design and analyses throughout the project.
Funding
This project was supported by a Research Scholar Grant (RSGPB-09-009-01) from the American Cancer Society. Dr. Pate was partially supported by a grant (D33HP31669, Preventive Medicine Residencies) from the Health Resources and Services Administration (HRSA) and a Physician Training Award in Cancer Prevention (PTAPM-18-176-25) from the American Cancer Society.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Pate, A., Lowery, J., Kilbourn, K. et al. Quality of life and the negative impact of comorbidities in long-term colorectal cancer survivors: a population-based comparison. J Cancer Surviv 14, 653–659 (2020). https://doi.org/10.1007/s11764-020-00876-w
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DOI: https://doi.org/10.1007/s11764-020-00876-w