gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Persistence of restrictions in quality of life from the first to the third year after diagnosis in patients with colorectal cancer

Meeting Abstract

Suche in Medline nach

  • Volker Arndt - Deutsches Zentrum für Alternsforschung, Heidelberg
  • Christa Stegmaier - Epidemiologisches Krebsregister Saarland, Saarbrücken
  • Hartwig Ziegler - Epidemiologisches Krebsregister Saarland, Saarbrücken
  • Hermann Brenner - Deutsches Zentrum für Alternsforschung, Heidelberg

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds069

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2005/05gmds209.shtml

Veröffentlicht: 8. September 2005

© 2005 Arndt et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background

With over one million new cases each year colorectal cancer (CRC) is one of the most common malignancies in the world. Due to advances in early diagnosis and therapy the prognosis of colorectal cancer has improved over the last decades. Recent 5- and 10- year survival estimates for patients with CRC of 62% and 55%, respectively, indicate that most people diagnosed with CRC today survive the disease [1]. Despite the burden and prevalence of colorectal cancer, there is only limited information regarding quality of life of patients who have survived beyond the first year past treatment.

We recently have found that deficits in emotional and social functioning are main factors hampering quality of life (QOL) in men and women with colorectal cancer one year after diagnosis and seem to affect predominantly younger patients [2]. In addition, specific symptoms like fatigue, dyspnea, insomnia, constipation, diarrhoea, and financial difficulties were of particular concern for colorectal cancer patients, hampering their quality of life. We now address the question whether these detriments persist over a longer period and whether low levels of self-reported quality of life is associated with worse prognosis.

Methods

Quality of life was assessed in a population-based cohort of 309 patients with colorectal cancer from Saarland (Germany) 1 and 3 years after diagnosis using the QLQ-C30 questionnaire and the tumour specific module CR-38, both developed by the European Organization for Research and Treatment of Cancer [3], [4]. Of those who survived, 92% returned the questionnaire. Functional and symptom scores were compared internally and with reference data from the general population [5].

Results

Three years after diagnosis most colorectal cancer survivors reported high overall quality of life and only small deficits in physical functioning, but deficits in emotional and social functioning and specific limitations like fatigue, dyspnea, insomnia, constipation, diarrhoea, and financial difficulties observed one year after diagnosis were found to persist. Younger patients continued to be more strongly affected by the physical and psychosocial sequelae of colorectal cancer even though they regained better than older patients. Overall, improvements in quality of life from the first to the third year after diagnosis were very modest and limited to improvements concerning financial difficulties, a better future perspective and fewer stoma related problems.

Recurrence of colorectal cancer occurred in 26 cancer survivors during the follow-up interval and had a deleterious effect on QOL. Substantial impairments were observed for almost all function scales and all symptoms covered by the QLQ C-30 and the CR-38 questionnaire.

Sixty-eight patients with colorectal cancer (22.1%) died during the follow-up period. Lower physical functioning (p<0.001) and impaired overall quality of life (p<0.01) measured one year after diagnosis were strongly associated with poorer prognosis, irrespective of age, gender and stage of the disease. Mortality increased by 32% and 18% per 10 unit decrease in physical functioning and overall quality of life, respectively.

Conclusions

Although three years after diagnosis most colorectal cancer survivors report a high overall quality of life and only small deficits in physical functioning, the results of our study indicate that deficits in emotional and social functioning and specific limitations like fatigue, dyspnea, insomnia, constipation, diarrhoea, and financial difficulties persist over years. The results also show that younger patients continue to be more strongly affected by the physical and psychosocial sequelae of colorectal cancer even though they appear to regain some functional capacities as time from termination of treatment passes.

Acknowledgement

This study was supported by the German Cancer Foundation (Deutsche Krebshilfe), Project Numbers 70-1816 and 70-2413.


References

1.
Brenner H. Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 2002; 360: 1131-5.
2.
Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: a population-based study. J Clin Oncol 2004; 22: 4829-36
3.
Aaronson NK, Ahmedzai S, Bergman B 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
4.
Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer 1999; 35: 238-47
5.
Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 2001; 37: 1345-51