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Impairment of Activities of Daily Living is an Independent Risk Factor for Recurrence and Mortality Following Curative Resection of Stage I–III Colorectal Cancer

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

With aging of the population, the number of colorectal cancer patients with impairment of activities of daily living (ADLs) has increased. The Barthel index is a validated tool for assessing functional levels of ADLs. In this retrospective study, we aimed to examine associations of Barthel index scores with recurrence and mortality after curative resection of colorectal cancer.

Methods

We retrospectively analyzed data of 815 consecutive patients who had undergone curative resection of stage I–III colorectal adenocarcinoma between January 2009 and December 2017. Preoperative functional levels of ADLs were assessed prospectively using the Barthel index (range, 0 to 100; higher scores indicate greater independence). Recurrence-free survival (RFS) and overall survival (OS) were compared according to Barthel index scores. The Cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders.

Results

Of the 815 patients, Barthel index scores were 40 or lower in 129 (16%), 41–85 in 110 (13%), and 86 or more in 576 (71%). In multivariable analyses adjusting for potential confounders including age and disease stage, scores of 85 or lower on the Barthel index were independently associated with shorter RFS (multivariable HR: 1.74, 95% confidence interval: 1.28–2.37, P<0.001) and OS (multivariable HR: 2.10, 95% confidence interval: 1.45–3.04, P<0.001).

Conclusions

Lower scores on the Barthel index are associated with shorter RFS and OS following resection of nonmetastatic colorectal cancer. Further studies are needed to establish treatment strategies for colorectal cancer patients with poor functional capacity.

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Acknowledgements

We thank Dr. Trish Reynolds, MBBS, FRACP, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript. This study was not preregistered. Data can be made available upon reasonable request to the corresponding author.

Funding

This study was supported by a grant from JSPS KAKENHI (grant number 20K17658). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, 860-8556, Kumamoto, Japan

    Kosuke Mima & Hideo Baba

  2. Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Kosuke Mima, Keisuke Kosumi, Nobutomo Miyanari, Takuya Tajiri, Kosuke Kanemitsu, Toru Takematsu, Mitsuhiro Inoue, Takao Mizumoto & Tatsuo Kubota

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  1. Kosuke Mima
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Correspondence to Kosuke Mima.

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Supplementary Information

Figure S1.

Kaplan–Meier curves for recurrence-free (a, b) and overall survival (c, d) according to Barthel index scores in patients aged <75 years and ≥75 years. The P value was calculated by the log-rank test (two-sided). (PNG 657 kb)

High Resolution (TIF 1547 kb)

Figure S2.

Kaplan–Meier curves for recurrence-free (a, b, c) and overall survival (d, e, f) according to Barthel index scores in patients with stage I, II, and III disease. The P value was calculated by the log-rank test (two-sided). (PNG 868 kb)

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Mima, K., Kosumi, K., Miyanari, N. et al. Impairment of Activities of Daily Living is an Independent Risk Factor for Recurrence and Mortality Following Curative Resection of Stage I–III Colorectal Cancer. J Gastrointest Surg 25, 2628–2636 (2021). https://doi.org/10.1007/s11605-021-04990-7

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