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Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer

  • Andrew M. BlakelyEmail author
  • Dayana Chanson
  • F. Lennie Wong
  • Oliver S. Eng
  • Stephen M. Sentovich
  • Kurt A. Melstrom
  • Lily L. Lai
  • Yuman Fong
  • Virginia Sun
Original Article

Abstract

Purpose

Data regarding changes in functional status and health-related quality of life (HRQOL) before and after surgery are lacking. We identified colorectal cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database to evaluate the association between HRQOL and survival.

Methods

HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with HRQOL surveys prior to cancer diagnosis and ≥ 1 year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed in regard to overall survival (OS), disease-specific survival (DSS), and non-DSS.

Results

Of 590 patients included, 55% were female, 75% were Caucasian, and 83% had colonic primary. Disease extent was localized for 52%, regional for 41%, and distant for 7%. Median OS was 83 months. Decreased OS was independently associated with age ≥ 75 (HR 1.7, p < 0.0001), male sex (HR 1.4, p = 0.011), advanced disease (regional—HR 2.0, p < 0.0001; distant—HR 7.0, p < 0.0001), and decreased mental HRQOL (HR 1.4, p = 0.005). Decreased DSS was independently associated with advanced disease (regional—HR 4.1, p < 0.0001; distant—HR 16.5, p < 0.0001) and rectal primary (HR 1.6, p = 0.047). Decreased non-DSS was independently associated with age ≥ 75 (HR 2.2, p < 0.0001), male sex (HR 1.4, p = 0.03), decreased mental HRQOL (HR 1.4, p = 0.02), and increased comorbidities (HR 1.4, p = 0.04).

Conclusions

The potential overall survival benefit of oncologic surgery is diminished by declines in physical and mental health. Early identification of older surgical patients at risk for functional and HRQOL declines may improve survival following colorectal cancer surgery.

Keywords

Quality of life Functional status Geriatric oncology Colorectal cancer 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or funding sources to report in relation to this work.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of Graduate Medical Education and Clinical TrainingCity of Hope National Medical CenterDuarteUSA
  3. 3.Department of Population SciencesCity of Hope National Medical CenterDuarteUSA
  4. 4.Section of General Surgery and Surgical OncologyUniversity of ChicagoChicagoUSA

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