Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer
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.
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.
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).
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.
KeywordsQuality of life Functional status Geriatric oncology Colorectal cancer
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest or funding sources to report in relation to this work.
- 11.Cummings A, Grimmett C, Calman L et al (2018) Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: results from the ColoREctal well-being (CREW) cohort study. Psychooncology 27:2427–2435. https://doi.org/10.1002/pon.4845 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Kent EE, Malinoff R, Rozjabek HM et al (2016) Revisiting the surveillance epidemiology and end results cancer registry and Medicare health outcomes survey (SEER-MHOS) linked data resource for patient-reported outcomes research in older adults with cancer. J Am Geriatr Soc 64:186–192. https://doi.org/10.1111/jgs.13888 CrossRefPubMedGoogle Scholar