Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a German cohort study

Abstract

BackgroundThe group of colorectal cancer (CRC) survivors continues to grow worldwide. Understanding health-related quality of life (HRQOL) determinants and consequences of HRQOL impairments in long-term CRC survivors may help to individualize survivorship care plans. We aimed to i) examine the HRQOL status of CRC long-term survivors, ii) identify cross-sectional sociodemographic and clinical correlates of HRQOL, and iii) investigate the prospective association of HRQOL after CRC diagnosis with all-cause mortality.MethodsWe assessed HRQOL within a Northern German cohort of 1294 CRC survivors at a median of 6 years after CRC diagnosis using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Cross-sectional correlates of different HRQOL dimensions were analyzed using multivariable-adjusted logistic regression models with HRQOL as a binary variable. With multivariable-adjusted Cox proportional hazards regression models, hazard ratios (HR) of all-cause mortality were estimated per 10-point-increments of an HRQOL summary score, a global quality of life scale, and HRQOL functioning and symptom domains.ResultsThe median HRQOL summary score was 87 (interquartile range: 75–94). Sex, age, education, tumor location, metastases, other cancers, type of therapy, and current stoma were identified as correlates of different HRQOL scales. After a median follow-up time of 7 years after HRQOL assessment, 175 participants had died. Nearly all HRQOL domains, except for cognitive functioning and diarrhea, were significantly associated with all-cause mortality. A 10-point-increment in the summary score decreased the risk of death by 24% (HR: 0.76; 95% CI: 0.70–0.82).ConclusionsHRQOL in CRC survivors appeared to be relatively high in the long term. Various clinical and sociodemographic factors were cross-sectionally associated with HRQOL in long-term CRC survivors. Lower HRQOL was associated with increased all-cause mortality. Individualized healthcare programs for CRC survivors (including psychosocial screening and interventions) are needed to detect decreased HRQOL and to further improve long-term HRQOL and survival.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5075-1) contains supplementary material, which is available to authorized users.

Mental Activity and All-Cause Mortality in Older Adults: A 4-Year Community-Based Cohort

“…We also found that MAI score was associated with lower all-cause mortality in participants without cancer, but not in cancer patients. In fact, many studies showed the bene cial effect of mental activity or social activity on the quality of life which was reported to decreased the risk of breast cancer mortality and recurrence 55 , enhanced the colorectal cancer overall survival 56 , and in uenced the cancer patient outcomes, including physical burden, psychosocial burden, and nancial burden 57 . Hence, we believe that whether from improving the mental health of cancer patients or improving the survival rate of non-cancer patients, mental activity should be concerned in older people health.…”

<p>Risk Factors of Deterioration in Quality of Life Scores in Thyroid Cancer Patients After Thyroidectomy</p>

“…QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), which was originally proposed by Aaronson et al 10 The QLQ-C30 includes 30 items and measures 5 functional scales (i.e., physical, role, emotional, cognitive, and social functioning), global health status, financial difficulties, and 8 symptom scales (i.e., fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, and diarrhea). 11 A summary score was calculated from 13 scales (excluding global QoL and financial difficulties), with the symptom scales being reversed (100-symptom scale) to obtain a uniform direction of all scales, 12,13…”

“…The final model tested consisted of 13 dimensions, 12 which resulted in an initial estimate of 260 individuals. However, we added a loss rate of 20%, thereby increasing the minimum sample size to 286 individuals.…”

Understanding Posttreatment Patient‐Provider Communication and Follow‐Up Care Among Self‐Identified Rural Cancer Survivors in Illinois

“…2 In addition to advancements in cancer treatments, effective patient-provider communication is a major facilitator for optimizing survivorship outcomes. [3][4][5] Communication including, but not limited to, a treatment summary, information on the possible late-term effects of treatment, recommended follow-up screenings to monitor recurrent cancers, and a communication plan between health care providers show promise of improving a patient's understanding of their survivorship care and the potential to improve patientreported survivorship outcomes. 4,5 Consequentially, a poor understanding of the utility of posttreatment survivorship care can be a barrier to adequate survivorship care, as patients may delay the initiation of or reduce adherence to follow-up care screening for recurrent cancers, lack knowledge of the long-term effects of treatment, and have unaddressed psychosocial (ie, emotional and social) supportive care needs.…”

“…[3][4][5] Communication including, but not limited to, a treatment summary, information on the possible late-term effects of treatment, recommended follow-up screenings to monitor recurrent cancers, and a communication plan between health care providers show promise of improving a patient's understanding of their survivorship care and the potential to improve patientreported survivorship outcomes. 4,5 Consequentially, a poor understanding of the utility of posttreatment survivorship care can be a barrier to adequate survivorship care, as patients may delay the initiation of or reduce adherence to follow-up care screening for recurrent cancers, lack knowledge of the long-term effects of treatment, and have unaddressed psychosocial (ie, emotional and social) supportive care needs. [6][7][8][9] Across health care systems and cancer types, posttreatment patient-provider communication is not standardized, and such heterogeneity in communication can increase survivorship risks associated with poor management of posttreatment care.…”