The effect of treatment for colorectal cancer on long-term health-related quality of life

Background: Little information is available on the impact that therapies us ed in the treatment of colorectal cancer (CRC) have on long-term, health-re lated quality of life (HRQL). Knowledge of how HRQL is affected by these th erapies is essential in properly selecting patients for treatment. The purp ose of this study was to determine the long-term impact that surgical and a djuvant therapy for resectable CRC has on patient-reported HRQL in a male v eteran population through a case-control design. Methods: All participating patients had completed therapy at least 6 months before enrollment. One hundred fifty-eight patients were accrued over a 3- year period (January 1, 1997 to December 31, 1999) at a single institution. The impact of CRC surgery on HRQL was measured by comparing a cohort of 61 patients undergoing surgery alone for the treatment of CRC (CRC-S group) w ith 44 patients undergoing surgery for benign colonic disease (BCD group). To study the effect of adjuvant therapy for CRC on HRQL, a third cohort of 53 patients undergoing both surgical and adjuvant treatment (CRC-S/A group) was compared with the CRC-S group. For each group, health status was measu red by a health survey questionnaire, SHORT FORM 36 (SF36). For patients tr eated fur CRC, an additional disease-specific supplemental questionnaire al so was used. Results: Self-reported health status, as measured by mean SF36 score, was s ignificantly reduced for the BCD group compared with CRC-S patients on gene ral health perception (41.9 +/- 3.9 vs. 52.2 +/- 3.0, P = .04) and the stan dardized physical component score (31.2 +/- 1.7 vs. 37.5 +/- 1.5, P < .005) . Despite an increased number of distally located tumors, later stage cance rs, and an increased number of recurrences in the CRC-S/A group compared wi th the CRC-S cohort, no significant differences were identified between the se groups on any of the subscales or standardized scores of SF36. Using the supplemental questions, no differences were identified between the CRC gro ups with respect to appetite, weight, or gastrointestinal or urinary functi oning. Conclusions: Surgical therapy for CRC probably has minimal impact on long-t erm HRQL when compared with surgery for benign colonic processes. Similarly , there does not appear to be a measurable, lasting impact of CRC adjuvant therapy on HRQL when compared with surgery alone. Although overall impact o f therapies for CRC on HRQL appears to be limited, measurement of therapeut ic influence on an individual level and identification of selection criteri a based on estimated impact on HRQL for these therapies requires prospectiv e validation.