Skip to main content

Advertisement

SpringerLink
Log in

A Prospective Study Evaluating Health-Related Quality of Life Following a Multimodal Treatment for Colorectal Cancer

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

The major improvements in the diagnosis and treatment of colorectal cancer (CRC) over the past decades increased the patients’ survival rates. Despite this, patients and clinicians still need to address the long-term physical and psychosocial effects over time. This paper aims to prospectively assess CRC patients’ HR-QoL psychological distress and sexual functioning and identify clinical, demographic, and psychological predictors.

Methods

In total, 55 patients were evaluated from diagnosis to 5-year follow-up with the following instruments: EORTC QLQ-C30 and QLQ-C38 for QoL and sexuality; HADS for psychological distress; and specific questions to detect psychological variables.

Results

QoL worsened after diagnosis and returned to baseline values after 5 years. Sexual function significantly deteriorated over time (with no recovery, especially in women), while borderline/severe anxiety and depression decreased. A better HR-QoL at baseline was associated with better physical, social and sexual functioning, positive body image and sexual pleasure after 5 years.

Conclusion

HR-QoL allows the early detection of patients at risk, favoring prompt patient-centered interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Material

Data will be provided upon reasonable request.

Abbreviations

CRC:

Colorectal cancer

HR-QoL:

Health-related quality of life

CR:

Chemoradiation

CT:

Chemotherapy

EORTC:

European Organization for Research and Treatment of Cancer

GLM:

Generalized linear model

AR:

Anterior resection

References

  1. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14:89–103.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Jarrett N, Scott I, Addington-Hall J, Amir Z, Brearley S, Hodges L, Richardson A, Sharpe M, Stamataki Z, Stark D, Siller C, Ziegler L, Foster C. Informing future research priorities into the psychological and social problems faced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs. 2013;17(510):20. https://doi.org/10.1016/j.ejon.2013.03.003.

    Article  Google Scholar 

  3. Shapiro CL. Cancer Survivorship. N Engl J Med. 2018;379:2438–50. https://doi.org/10.1056/NEJMra1712502.

    Article  PubMed  Google Scholar 

  4. Arraras JI, Suárez J, Arias-de-la-Vega F, Vera R, Ibáñez B, Asin G, Viudez A, Zarandona U, Rico M, Hernández I. Quality of life assessment by applying EORTC questionnaires to rectal cancer patients after surgery and neoadjuvant and adjuvant treatment. Rev Esp Enferm Dig. 2013;105:255–61. https://doi.org/10.4321/s1130-01082013000500003.

    Article  PubMed  Google Scholar 

  5. Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg. 2003;238:203–13. https://doi.org/10.1097/01.sla.0000080823.38569.b0.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Milbury K, Cohen L, Jenkins R, Skibber JM, Schover LR. The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer. 2013;21:793–802. https://doi.org/10.1007/s00520-012-1582-9.

    Article  PubMed  Google Scholar 

  7. Phipps E, Braitman LE, Stites S, Leighton JC. Quality of life and symptom attribution in long-term colon cancer survivors. J Eval Clin Pract. 2008;14:254–8. https://doi.org/10.1111/j.1365-2753.2007.00842.x.

    Article  PubMed  Google Scholar 

  8. 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;21:1551–64. https://doi.org/10.1007/s11136-011-0067-5.

    Article  PubMed  Google Scholar 

  9. Benedict C, Philip EJ, Baser RE, Carter J, Schuler TA, Jandorf L, DuHamel K, Nelson C. Body image and sexual function in women after treatment for anal and rectal cancer. Psychooncology. 2016;25:316–23. https://doi.org/10.1002/pon.3847.

    Article  PubMed  Google Scholar 

  10. Sideris L, Zenasni F, Vernerey D, Dauchy S, Lasser P, Pignon JP, Elias D, Di Palma M, Pocard M. Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum. 2005;48:2180–91. https://doi.org/10.1007/s10350-005-0155-0.

    Article  PubMed  Google Scholar 

  11. Dunn J, Ng SK, Holland J, Aitken J, Youl P, Baade PD, Chambers SK. Trajectories of psychological distress after colorectal cancer. Psychooncology. 2013;22:1759–65. https://doi.org/10.1002/pon.3210.

    Article  PubMed  Google Scholar 

  12. 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;29:3263–9. https://doi.org/10.1200/JCO.2010.31.4013.

    Article  PubMed  Google Scholar 

  13. Bailey CE, Tran Cao HS, Hu CY, Chang GJ, Feig BW, Rodriguez-Bigas MA, Nguyen ST, Skibber JM, You YN. Functional deficits and symptoms of long-term survivors of colorectal cancer treated by multimodality therapy differ by age at diagnosis. J Gastrointest Surg. 2015;19:180–8. https://doi.org/10.1007/s11605-014-2645-7.

    Article  PubMed  Google Scholar 

  14. Qin F, Ye X, Wei H, Wen Y, Shi L, Zhen L, Zhi M, Zhang L. Sexual experience and stigma among Chinese patients with an enterostomy: a cross-sectional, descriptive study. Wound Manag Prev. 2019;65:22–30.

    Article  PubMed  Google Scholar 

  15. Frankland J, Wheelwright S, Permyakova NV, Wright D, Collaço N, Calman L, Winter J, Fenlon D, Richardson A, Smith PW, Foster C. Prevalence and predictors of poor sexual well-being over 5 years following treatment for colorectal cancer: results from the ColoREctal Wellbeing (CREW) prospective longitudinal study. BMJ Open. 2020;10:e038953. https://doi.org/10.1136/bmjopen-2020-038953.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pietrangeli A, Pugliese P, Perrone M, Sperduti I, Cosimelli M, Jandolo B. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study. J Exp Clin Cancer Res. 2009;28:128. https://doi.org/10.1186/1756-9966-28-128.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76. https://doi.org/10.1093/jnci/85.5.365.

    Article  CAS  PubMed  Google Scholar 

  18. Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC Colorectal Cancer Specific Quality-of-Life questionnaire Module (the QLQ-CR 38). Eur J Cancer. 1999;35:238–47.

    Article  CAS  PubMed  Google Scholar 

  19. Bjelland I, Dahl AA, Neckelmann HD. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  20. Carroll BT, Kathol RG, Noyes R Jr, Wald TG, Clamon GH. Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry. 1993;15:69–74. https://doi.org/10.1016/0163-8343(93)90099-a.

    Article  CAS  PubMed  Google Scholar 

  21. Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L. Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer. 1994;30A:37–40. https://doi.org/10.1016/s0959-8049(05)80015-2.

    Article  CAS  PubMed  Google Scholar 

  22. Razavi D, Delvaux N, Farvacques C, Robaye E. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry. 1990;156:79–83. https://doi.org/10.1192/bjp.156.1.79.

    Article  CAS  PubMed  Google Scholar 

  23. Shih CL, Chen CH, Sheu CF, Lang HC, Hsieh CL. Validating and improving the reliability of the EORTC qlq-c30 using a multidimensional Rasch model. Value Health. 2013;16:848–54. https://doi.org/10.1016/j.jval.2013.05.004.

    Article  PubMed  Google Scholar 

  24. Traa MJ, De Vries J, Roukema JA, Den Oudsten BL. Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol. 2012;23:19–27. https://doi.org/10.1093/annonc/mdr133.

    Article  CAS  PubMed  Google Scholar 

  25. Pugliese P, Cosimelli M, Marcellini M, Nisi E, Pietrangeli A, Perrone M. Interdisciplinary evaluation of sexual cancer patients. Psycooncology. 2000;9:S69.

    Google Scholar 

  26. Sánchez R, Alexander-Sierra F, Oliveros R. Relationship between quality of life and clinical status in patients with gastrointestinal cancer. Rev Esp Enferm Dig. 2012;104:584–91. https://doi.org/10.4321/s1130-01082012001100006.

    Article  PubMed  Google Scholar 

  27. Mosher CE, Winger JG, Given BA, Helft PR, O’Neil BH. Mental health outcomes during colorectal cancer survivorship: a review of the literature. Psychooncology. 2016;25:1261–70. https://doi.org/10.1002/pon.3954.

    Article  PubMed  Google Scholar 

  28. Arraras Urdaniz JI, Arias de la Vega F, Vera García R, Manterola Burgaleta A, Martínez Aguillo M, Villafranca Iturre E, Salgado Pascual E. Quality of Life assessment through the EORTC questionnaires of locally advanced rectal cancer patients treated with preoperative chemo-radiotherapy. Clin Transl Oncol. 2006;8:423–9. https://doi.org/10.1007/s12094-006-0196-4.

    Article  PubMed  Google Scholar 

  29. 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;46:2879–88. https://doi.org/10.1016/j.ejca.2010.06.010.

    Article  CAS  PubMed  Google Scholar 

  30. Urso E, Serpentini S, Pucciarelli S, De Salvo GL, Friso ML, Fabris G, Lonardi S, Ferraro B, Bruttocao A, Aschele C, Nitti D. Complications, functional outcome and quality of life after intensive preoperative chemoradiotherapy for rectal cancer. Eur J Surg Oncol. 2006;32:1201–8. https://doi.org/10.1016/j.ejso.2006.07.003.

    Article  CAS  PubMed  Google Scholar 

  31. Bernhard J, Lowy A, Mathys N, Herrmann R, Hürny C. Health related quality of life: a changing construct? Qual Life Res. 2004;13:1187–97. https://doi.org/10.1023/B:QURE.0000037485.59681.7d.

    Article  PubMed  Google Scholar 

  32. Salsman JM, Segerstrom SC, Brechting EH, Carlson CR, Andrykowski MA. Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing. Psychooncology. 2009;18:30–41. https://doi.org/10.1002/pon.1367.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cabilan CJ, Hines S. The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review. JBI Database System Rev Implement Rep. 2017;15:517–66. https://doi.org/10.11124/JBISRIR-2016003282.

    Article  CAS  PubMed  Google Scholar 

  34. Gavaruzzi T, Giandomenico F, Del Bianco P, Lotto L, Perin A, Pucciarelli S. Quality of life after surgery for rectal cancer. Recent Results Cancer Res. 2014;203:117–49. https://doi.org/10.1007/978-3-319-08060-4_10.

    Article  PubMed  Google Scholar 

  35. Rauch P, Miny J, Conroy T, Neyton L, Guillemin F. Quality of life among disease-free survivors of rectal cancer. J Clin Oncol. 2004;22:354–60. https://doi.org/10.1200/JCO.2004.03.137.

    Article  PubMed  Google Scholar 

  36. Schaube J, Scharf P, Herz R. Lebensqualität nach karzinombedingter Rektumexstirpation [The quality of life after extirpation of the rectum for carcinoma]. Dtsch Med Wochenschr. 1996;121:153–7. https://doi.org/10.1055/s-2008-1042987.

    Article  CAS  PubMed  Google Scholar 

  37. Filiberti A, Audisio RA, Gangeri L, Baldini MT, Tamburini M, Belli F, Parc R, Leo E. Prevalence of sexual dysfunction in male cancer patients treated with rectal excision and coloanal anastomosis. Eur J Surg Oncol. 1994;20:43–6.

    CAS  PubMed  Google Scholar 

  38. Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E. A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery. 2002;131:368–72. https://doi.org/10.1067/msy.2002.122371.

    Article  PubMed  Google Scholar 

  39. Breukink SO, Donovan KA. Physical and psychological effects of treatment on sexual functioning in colorectal cancer survivors. J Sex Med. 2013;10(Suppl 1):74–83. https://doi.org/10.1111/jsm.12037.

    Article  CAS  PubMed  Google Scholar 

  40. Bruheim K, Tveit KM, Skovlund E, Balteskard L, Carlsen E, Fosså SD, Guren MG. Sexual function in females after radiotherapy for rectal cancer. Acta Oncol. 2010;49:826–32. https://doi.org/10.3109/0284186X.2010.486411.

    Article  PubMed  Google Scholar 

  41. Ho VP, Lee Y, Stein SL, Temple LK. Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum. 2011;54(1):113–25. https://doi.org/10.1007/DCR.0b013e3181fb7b82.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Editorial assistance was provided by Barbara Bartolini, PhD, Sara di Nunzio, PhD, Simonetta Papa, PhD, Fabio Perversi and Aashni Shah (Polistidutium SRL, Milan, Italy). Internal funds supported this assistance.

Author information

Authors and Affiliations

  1. Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy

    Maria Perrone, Chiara Falcicchio, Alessandro Bonucci, Luana Fotia & Patrizia Pugliese

  2. Medical Oncology, Azienda Ospedaliera San Camillo Forlanini Roma, Rome, Italy

    Carlo Garufi

  3. Colon Rectal Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, S.C. Oncological 2 , Milan, Italy

    Maurizio Cosimelli

  4. Department of Surgery, IRCCS Regina Elena Cancer Institute, Rome, Italy

    Franco Graziano

  5. Biostatistics Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy

    Diana Giannarelli

  6. Polistudium SRL, Milan, Italy

    Luca Giacomelli

  7. Scientific Direction, IRCCS Regina Elena Cancer Institute, Rome, Italy

    Gennaro Ciliberto

Authors
  1. Maria Perrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Garufi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Cosimelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franco Graziano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiara Falcicchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandro Bonucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luana Fotia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Diana Giannarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luca Giacomelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gennaro Ciliberto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Patrizia Pugliese
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Maria Perrone; Patrizia Pugliese; collection and interpretation of data: Chiara Falcicchio, Alessandro Bonucci, Luana Fotia; Maurizio Cosimelli; Franco Graziano. statistical analysis: Diana Giannarelli; manuscript drafting: Maria Perrone; Patrizia.Pugliese; Luca Giacomelli; manuscript editing: Luca Giacomelli; approval to submit: Maria Perrone; Patrizia Pugliese; Gennaro Filiberto.

Corresponding author

Correspondence to Maria Perrone.

Ethics declarations

Ethics Approval and Consent to Participate

The study was approved by the Ethical Committee of the Institute “Regina Elena”. Informed consent was provided. Appropriate information on the design, purpose and duration of the study was provided. Written informed consent was provided. Appropriate information on the design, purpose and duration of the study was provided.

Consent for Publication

All authors gave their approval for publication.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perrone, M., Garufi, C., Cosimelli, M. et al. A Prospective Study Evaluating Health-Related Quality of Life Following a Multimodal Treatment for Colorectal Cancer. J Gastrointest Canc 54, 117–125 (2023). https://doi.org/10.1007/s12029-022-00802-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-022-00802-6

Keywords

Search

Navigation