Adjuvant treatments do not alter the quality of life in elderly patients with colorectal cancer

Abstract

BACKGROUND. The current study was performed to longitudinally assess the impact of adjuvant treatments on the quality of life (QoL) of elderly colorectal cancer survivors. METHODS. The Burgundy Digestive Cancer Registry was used to select all patients aged ≥75 years who were diagnosed with colorectal cancer between 2003 and 2005. A total of 209 patients were asked to complete questionnaires during the first year after diagnosis: at the time of inclusion in the study (Q0), at 3 months after the initial diagnosis (Q3), at 6 months after the initial diagnosis (Q6), and at 12 months after the initial diagnosis (Q12) using the European Organization for Research and Treatment of Cancer (EORTC) QLQ‐C30. A total of 125 patients (60%) responded. Mixed model analyses of variance for repeated measurement were used to compare QoL scores according to therapeutic schemes. Interactions between time of follow‐up and treatment were tested. RESULTS. Patient sex, age, location of the tumor, and TNM stage of disease did not appear to differ significantly between respondents and nonrespondents. Global Health and Emotional Functioning improved for colon cancer survivors between Q0 and Q12, and were noted to improve between Q3 and Q12 for rectal cancer patients. According to French recommendations, patients who received chemotherapy for stage III colon cancer (P = .176) or radiotherapy for rectal cancer (P = .959) reported no significant changes in Global Health compared with those patients not receiving adjuvant therapies. Patients treated with chemotherapy reported better Physical Functioning than patients who did not received chemotherapy (P = .0113). CONCLUSIONS. To the authors' knowledge, the current study is the first to examine trends over time with regard to the influence of adjuvant treatments for colon and rectal cancers on QoL in a general aged population. Providing evidence that adjuvant chemotherapy for colon cancer has no negative impact on the QoL of elderly patients is of great significance in encouraging clinicians to treat this population. Cancer 2008. © 2008 American Cancer Society.

Treatment-related differences in health related quality of life and disease specific symptoms among colon cancer survivors: Results from the population-based PROFILES registry

“…Also, patients might accept a certain amount of adverse events that may negatively impact their HRQoL, because of the expected health and treatment outcomes related to this therapy. This assumption is in line with previous findings from other studies [9,23,29]. Third, our results could be influenced by a survivorship bias.…”

“…Maybe fear of recurrence of cancer is a more distinct feature in younger cancer patients while elderly patients may be aware that with ageing, one or more diseases will evolve [22]. Most studies on HRQoL among elderly colorectal cancer patients report a decline of HRQoL as age increases [10,[23][24][25][26][27]. Data of a French study suggest a parallel decline of HRQoL in the general healthy population but the authors did not analyse this age-related relationship [28].…”

Patient and Clinical Variables Account for Changes in Health-related Quality of Life and Symptom Burden as Treatment Outcomes in Colorectal Cancer: A Longitudinal Study

“…The improvement of HRQoL over time in patients with colorectal cancer was also shown in a previous study (Bouvier et al, 2008;Hulbert-Williams et al, 2012;Sun et al, 2012). Our results also demonstrated that colorectal cancer patients show deterioration in HRQoL during the treatment period.…”

“…One possible explanation for this is the more severe side effects experienced during treatment. However, Bouvier (2008) documented that adjuvant chemotherapy for colon cancer has no longterm negative impact on the QoL of elderly patients. The increased deterioration in HRQoL during treatment and improvement in the longer-term need to be documented in future population-based studies.…”

Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study

“…Given the wide consensus on its effectiveness since 1990, we did not expect to find that such a strong recommendation would be so poorly followed. Comorbidity and greater toxicity are not valid reasons for the underuse of adjuvant chemotherapy in the elderly: toxicity is not greater24 25 and quality of life is not worse 26…”