Supportive Care in Cancer

, Volume 24, Issue 4, pp 1463–1471 | Cite as

Effects of adjuvant chemotherapy on recurrence, survival, and quality of life in stage II colon cancer patients: a 24-month follow-up

  • Cari Lewis
  • Pengcheng Xun
  • Ka He
Original Article



The purpose of this cohort study was to investigate the association of adjuvant chemotherapy with quality of life (QoL), survival, and recurrence over the 24 months following diagnosis in stage II colon cancer patients.


Overall, 453 patients were recruited from North Carolina from 2009 to 2011 and interviewed with a closed-ended survey detailing quality of life, health behaviors, treatment, and cancer recurrence at three times points: diagnosis, 12-, and 24-months post-diagnosis; mortality was obtained via the National Death Index.


In sum, 265 patients received chemotherapy. Receipt of chemotherapy exhibited an inverse association with total Functional Assessment of Cancer Treatment (FACT)-General (P < 0.01), FACT-Colorectal (P < 0.01), physical (P < 0.01), emotional (P = 0.02), and functional (P < 0.01) well-being; the inverse association between receiving chemotherapy and emotional well-being persisted for Caucasians but not African Americans (P interaction = 0.049). Those who received chemotherapy demonstrated significantly higher odds of cancer recurrence (odds ratio (OR) 2.74; 95 % confidence interval (CI) 1.18, 6.35) and all-cause mortality (OR: 1.95; 95 % CI: 1.05, 3.62).


In this study, stage II colon cancer patients who received chemotherapy treatment were more likely to have poor QoL, recurrence, and all-cause mortality after 24 months compared to those who did not receive chemotherapy. Future research focusing on subtypes of chemotherapy treatment, as well as a longer follow-up period, is needed.


Colon cancer Chemotherapy Quality of life Survival Recurrence 



Quality of life


Functional assessment of cancer therapy-colorectal


Medical outcomes short form 12


Functional assessment of cancer therapy-general


Physical, social, emotional, and functional well-being


Colorectal cancer subscale


Trial outcome index-physical/functional/colorectal


Physical component score of SF-12


Mental component score of SF-12



This work was supported by a research grant from American Cancer Society (RSGT-08-094-CPPB).

The sponsors were not involved in the design of the study or in the data analyses or manuscript elaboration.

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Altekruse S, Kosary C, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner M, Lewis D, Chen H, Feuer E, Cronin K (2012) SEER cancer statistics review, 1975–2009. Nat Cancer Inst. Accessed February 13 2013
  2. 2.
    Des Guetz G, Schischmanoff O, Nicolas P, Perret G-Y, Morere J-F, Uzzan B (2009) Does microsatellite instability predict the efficacy of adjuvant chemotherapy in colorectal cancer? A systematic review with meta-analysis. Eur J Cancer 45(10):1890–1896CrossRefPubMedGoogle Scholar
  3. 3.
    Stillwell A, Buettner P, Ho Y (2010) Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg 34(4):797–807CrossRefPubMedGoogle Scholar
  4. 4.
    Golfinopoulos V, Salanti G, Pavlidis N, Ioannidis JP (2007) Survival and disease-progression benefits with treatment regimens for advanced colorectal cancer: a meta-analysis. Lancet Oncol 8(10):898–911CrossRefPubMedGoogle Scholar
  5. 5.
    O’Connor ES, Greenblatt DY, LoConte NK, Gangnon RE, Liou J-I, Heise CP, Smith MA (2011) Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol 29(25):3381–3388PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Allegra C, Yothers G, O’Connell M, Sharif S, Petrelli N, Colangelo L, Wolmark N (2011) Overall survival (OS) and updated disease-free survival (DFS) results of the NSABP C-08 trial assessing bevacizumab (B) in stage II and III colon cancer. In: J Clin Oncol (Meeting Abstracts) 15(suppl) 3508Google Scholar
  7. 7.
    Yothers G, Allegra C, O’Connell M, George T, Sharif S, Petrelli N, Lopa S, Wolmark N (2011) The efficacy of oxaliplatin (Ox) when added to 5-fluorouracil/leucovorin (FU/L) in stage II colon cancer. J Clin Oncol 29 (suppl):abstr 3507Google Scholar
  8. 8.
    McKenzie S, Nelson R, Mailey B, Lee W, Chung V, Shibata S, Garcia‐Aguilar J, Kim J (2011) Adjuvant chemotherapy improves survival in patients with american joint committee on cancer stage II colon cancer. Cancer 117(24):5493–5499CrossRefPubMedGoogle Scholar
  9. 9.
    Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370(9604):2020CrossRefPubMedGoogle Scholar
  10. 10.
    Figueredo A, Charette ML, Maroun J, Brouwers MC, Zuraw L (2004) Adjuvant therapy for stage II colon cancer: a systematic review from the cancer care Ontario program in evidence-based care’s gastrointestinal cancer disease site group. J Clin Oncol 22(16):3395–3407CrossRefPubMedGoogle Scholar
  11. 11.
    Benson AB, Bekaii-Saab T, Chan E, Chen Y-J, Choti MA, Cooper HS, Engstrom PF, Enzinger PC, Fakih MG, Fenton MJ, Fuchs CS, Grem JL, Hunt S, Kamel A, Leong LA, Lin E, May KS, Mulcahy MF, Murphy K, Rohren E, Ryan DP, Saltz L, Sharma S, Shibata D, Skibber JM, Small W, Sofocleous CT, Venook AP, Willett CG, Gregory KM, Freedman-Cass DA (2013) Metastatic colon cancer, version 3.2013: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 11(2):141–152Google Scholar
  12. 12.
    Benson AB, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, Krzyzanowska MK, Maroun J, McAllister P, Van Cutsem E, Brouwers M, Charette M, Haller DG (2004) American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22(16):3408–3419. doi: 10.1200/jco.2004.05.063 CrossRefPubMedGoogle Scholar
  13. 13.
    O’Connell MJ, Laurie JA, Kahn M, Fitzgibbons R, Erlichman C, Shepherd L, Moertel CG, Kocha WI, Pazdur R, Wieand HS (1998) Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol 16(1):295–300PubMedGoogle Scholar
  14. 14.
    Efficace F, Bottomley A, Coens C, Van Steen K, Conroy T, Schöffski P, Schmoll H, Van Cutsem E, Köhne C-H (2006) Does a patient’s self-reported health-related quality of life predict survival beyond key biomedical data in advanced colorectal cancer? Eur J Cancer 42(1):42–49CrossRefPubMedGoogle Scholar
  15. 15.
    Gotay CC, Kawamoto CT, Bottomley A, Efficace F (2008) The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol 26(8):1355–1363CrossRefPubMedGoogle Scholar
  16. 16.
    Maione P, Perrone F, Gallo C, Manzione L, Piantedosi F, Barbera S, Cigolari S, Rosetti F, Piazza E, Robbiati SF (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced Non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23(28):6865–6872CrossRefPubMedGoogle Scholar
  17. 17.
    Eton DT, Fairclough DL, Cella D, Yount SE, Bonomi P, Johnson DH (2003) Early change in patient-reported health during lung cancer chemotherapy predicts clinical outcomes beyond those predicted by baseline report: results from eastern cooperative oncology group study 5592. J Clin Oncol 21(8):1536–1543CrossRefPubMedGoogle Scholar
  18. 18.
    Stommel M, Given BA, Given CW (2002) Depression and functional status as predictors of death among cancer patients. Cancer 94(10):2719–2727CrossRefPubMedGoogle Scholar
  19. 19.
    Hack TF, Degner LF, Watson P, Sinha L (2006) Do patients benefit from participating in medical decision making? Longitudinal follow‐up of women with breast cancer. Psycho-Oncology 15(1):9–19CrossRefPubMedGoogle Scholar
  20. 20.
    Glimelius B, Hoffman K, Graf W, Påhlman L, Sjödén PO (1994) Quality of life during chemotherapy in patients with symptomatic advanced colorectal cancer. Cancer 73(3):556–562CrossRefPubMedGoogle Scholar
  21. 21.
    Quasar Collaborative Group (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370(9604):2020–2029CrossRefGoogle Scholar
  22. 22.
    McCollum AD, Catalano PJ, Haller DG, Mayer RJ, Macdonald JS, Benson AB, Fuchs CS (2002) Outcomes and toxicity in African-American and Caucasian patients in a randomized adjuvant chemotherapy trial for colon cancer. J Natl Cancer Inst 94(15):1160–1167CrossRefPubMedGoogle Scholar
  23. 23.
    Lynch HT, Lynch JF (2000) Hereditary nonpolyposis colorectal cancer. In: Seminars in surgical oncology. Wiley Online Library, 4:305–313Google Scholar
  24. 24.
    Half E, Bercovich D, Rozen P (2009) Familial adenomatous polyposis. Orphanet J Rare Dis 4(1):22PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Howlader N, Noone A, Krapcho M, Garshell J, Neyman N, Altekruse S, Kosary C, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis D, Chen H, Feuer E, Cronin K (2013) SEER cancer statistics review, 1975–2010. National Cancer Institute, Bethesda
  26. 26.
    Lewis C, Xun P, He K (2014) Physical activity in relation to quality of life in newly diagnosed colon cancer patients: a 24-month follow-up. Qual Life Res 23:2235–2246CrossRefPubMedGoogle Scholar
  27. 27.
    Choi B (2003) Computer assisted telephone interviewing (CATI) for health surveys in public health surveillance: methodological issues and challenges ahead. Chronic Dis Can 25(2):21–27Google Scholar
  28. 28.
    Yoo HJ, Kim JC, Eremenco S, Han OS (2005) 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 30(1):24–32CrossRefGoogle Scholar
  29. 29.
    Ware JE Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233CrossRefPubMedGoogle Scholar
  30. 30.
    White E, Patterson RE, Kristal AR, Thornquist M, King I, Shattuck AL, Evans I, Satia-Abouta J, Littman AJ, Potter JD (2004) VITamins and lifestyle cohort study: study design and characteristics of supplement users. Am J Epidemiol 159(1):83–93CrossRefPubMedGoogle Scholar
  31. 31.
    De Marco M, Janssen-Heijnen M, Van der Heijden L, Coebergh J (2000) Comorbidity and colorectal cancer according to subsite and stage: a population-based study. Eur J Cancer 36(1):95–99CrossRefPubMedGoogle Scholar
  32. 32.
    Hou JK, Abraham B, El-Serag H (2011) Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 106(4):563–573CrossRefPubMedGoogle Scholar
  33. 33.
    Pischon T, Lahmann PH, Boeing H, Friedenreich C, Norat T, Tjønneland A, Halkjaer J, Overvad K, Clavel-Chapelon F, Boutron-Ruault M-C (2006) Body size and risk of colon and rectal cancer in the European prospective investigation into cancer and nutrition (EPIC). J Natl Cancer Inst 98(13):920–931CrossRefPubMedGoogle Scholar
  34. 34.
    Marcella S, Miller JE (2001) Racial differences in colorectal cancer mortality: the importance of stage and socioeconomic status. J Clin Epidemiol 54(4):359–366CrossRefPubMedGoogle Scholar
  35. 35.
    Din FV, Theodoratou E, Farrington SM, Tenesa A, Barnetson RA, Cetnarskyj R, Stark L, Porteous ME, Campbell H, Dunlop MG (2010) Effect of aspirin and NSAIDs on risk and survival from colorectal cancer. Gut 59(12):1670–1679CrossRefPubMedGoogle Scholar
  36. 36.
    Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P (2008) Smoking and colorectal cancer: a meta-analysis. JAMA 300(23):2765–2778CrossRefPubMedGoogle Scholar
  37. 37.
    Fedirko V, Tramacere I, Bagnardi V, Rota M, Scotti L, Islami F, Negri E, Straif K, Romieu I, La Vecchia C (2011) Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Ann Oncol 22(9):1958–1972CrossRefPubMedGoogle Scholar
  38. 38.
    Giovannucci E (2003) Diet, body weight, and colorectal cancer: a summary of the epidemiologic evidence. J Women’s Health 12(2):173–182CrossRefGoogle Scholar
  39. 39.
    NCI national cancer institute risk factor monitoring and methods branch, division of cancer control and population sciencesGoogle Scholar
  40. 40.
    Subar A, Thompson F, Kipnis V, Midthune D, Hurwitz P, McNutt S, McIntosh A, Rosenfeld S (2001) Comparative validation of the block, Willett, and national cancer institute food frequency questionnaires: the eating at America’s table study. Am J Epidemiol 154(12):1089–1099CrossRefPubMedGoogle Scholar
  41. 41.
    Tofthagen C, Donovan KA, Morgan MA, Shibata D, Yeh Y (2013) Oxaliplatin-induced peripheral neuropathy’s effects on health-related quality of life of colorectal cancer survivors. Support Care Cancer:1–7Google Scholar
  42. 42.
    Douillard J, Cunningham D, Roth A, Navarro M, James R, Karasek P, Jandik P, Iveson T, Carmichael J, Alakl M (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209):1041–1047CrossRefPubMedGoogle Scholar
  43. 43.
    Borner M, Bernhard J, Dietrich D, Popescu R, Wernli M, Saletti P, Rauch D, Herrmann R, Koeberle D, Honegger H (2005) A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity. Ann Oncol 16(2):282–288CrossRefPubMedGoogle Scholar
  44. 44.
    Heydarnejad M, Hassanpour DA, Solati DK (2012) Factors affecting quality of life in cancer patients undergoing chemotherapy. Afr Health Sci 11(2):266–270Google Scholar
  45. 45.
    Boyd KA, Briggs AH, Paul J, Iveson T, Midgely R, Harkin A, Bates G, Alexander L, Cassidy J (2011) Analysis of adverse events and quality of life data for an economic evaluation of adjuvant chemotherapy in colorectal cancer: when can we stop collecting? Trials 12(Suppl 1):A41PubMedCentralCrossRefGoogle Scholar
  46. 46.
    Tofthagen C (2010) Surviving chemotherapy for colon cancer and living with the consequences. J Palliat Med 13(11):1389–1391CrossRefPubMedGoogle Scholar
  47. 47.
    Culver JL, Arena PL, Antoni MH, Carver CS (2002) Coping and distress among women under treatment for early stage breast cancer: comparing African Americans, Hispanics and non-Hispanic whites. Psycho-Oncology 11(6):495–504CrossRefPubMedGoogle Scholar
  48. 48.
    Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R (2014) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 1 (1)Google Scholar
  49. 49.
    Andersen MR, Bowen DJ, Morea J, Stein KD, Baker F (2009) Involvement in decision-making and breast cancer survivor quality of life. Health Psychol 28(1):29CrossRefPubMedGoogle Scholar
  50. 50.
    Figueredo A, Germond C, Maroun J, Browman G, Walker-Dilks C, Wong S (1997) Adjuvant therapy for stage II colon cancer after complete resection. Provincial gastrointestinal disease site group. Cancer Prev Control 1(5):379PubMedGoogle Scholar
  51. 51.
    Mouradov D, Domingo E, Gibbs P, Jorissen RN, Li S, Soo PY, Lipton L, Desai J, Danielsen HE, Oukrif D (2013) Survival in stage II/III colorectal cancer is independently predicted by chromosomal and microsatellite instability, but not by specific driver mutations. Am J Gastroenterol 108:1785–1793CrossRefPubMedGoogle Scholar
  52. 52.
    Griggs JJ, Sabel MS (2008) Obesity and cancer treatment: weighing the evidence. J Clin Oncol 26(25):4060–4062CrossRefPubMedGoogle Scholar
  53. 53.
    Michaud D, Midthune D, Hermansen S, Leitzmann M, Harlan L, Kipnis V, Schatzkin A (2005) Comparison of cancer registry case ascertainment with SEER estimates and self-reporting in a subset of the NIT-AARP diet and health study. J Registry Manag 32(2):70–75Google Scholar
  54. 54.
    Andrykowski MA, Hunt JW (1993) Positive psychosocial adjustment in potential bone marrow transplant recipients: cancer as a psychosocial transition. Psycho-Oncology 2(4):261–276CrossRefGoogle Scholar
  55. 55.
    Sprangers M, Schwartz C (1999) The challenge of response shift for quality-of-life-based clinical oncology research. Ann Oncol 10(7):747–749CrossRefPubMedGoogle Scholar
  56. 56.
    Bernhard J, Hürny C, Maibach R, Herrmann R, Laffer U (1999) Quality of life as subjective experience: reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy. Ann Oncol 10(7):775–782CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Epidemiology and Biostatistics, School of Public HealthIndiana UniversityBloomingtonUSA

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