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.