The Quality of Life of Patients with Surgically Treated Colorectal Cancer: A Narrative Review

Gender impact on quality of life in colorectal cancer survivors

BACKGROUND

The aim of the study was to evaluate gender-specific differences in the quality of life (QoL) and late effects among colorectal cancer patients during the first two years after treatment, to inform and improve long-term follow-up care and clinical management strategies.

PATIENTS AND METHODS

A total of 239 colorectal cancer patients were included, 56% males and 44% females, mostly in the age range 60-69 years. They were treated at the Institute of Oncology Ljubljana, during the time period from 1st September 2023 to 1st May 2024. In addition to demographic data, we included clinical data on disease and outcomes collected using the standardized quality of life questionnaires of European Organization for Research and Treatment of Cancer (EORTC) named EORTC QLQ-30 and EORTC QLQ-CR29 for colorectal cancer, respectively.

RESULTS

Females were more likely to experience emotional problems (p = 0.002), higher levels of fatigue (p < 0.001), insomnia (p = 0.015), nausea and vomiting (p = 0.007), which may also be associated with poorer appetite in females. Males reported better body image than female (p = 0.047), lower levels of anxiety (p = 0.029), less frequently reported perceived weight loss or gain (p = 0.010). Male reported more stool frequency (p = 0.045), and also had more sever dysuria compared to female (p = 0.008).

CONCLUSIONS

The results provide the opportunity to improve the clinical management of long-term follow-up and care planning, taking into consideration the gender-specific needs of colorectal cancer survivors.

The Influence of Sociodemographic Factors and Clinical Aspects on the Quality of Life of Surgically Treated Patients with Colorectal Cancer

Introduction

Due to the increasing number of cases and the levels of mortality, colorectal cancer is still a major health problem. Therefore, the growing interest in the quality of life of patients and the assessment of the quality of life of patients with colorectal cancer seems to be particularly important. The aim of the study was to investigate and determine factors that have a significant impact on the QoL of patients who were diagnosed with colorectal cancer that was surgically treated in the Surgical Department of the 4th Military Clinical Hospital in Wroclaw.

Methods

102 respondents were enrolled into the study. The QLQ-C30, QLQ-CR29 as well as an original questionnaire regarding the socioeconomic factors were used for the assessment. The information was supplemented with patients' clinical data.

Results

According to the QLQ-C30 questionnaire the average QoL of the respondents was 55%. Factors such as male gender, younger age, higher BMI, no significant weight loss, living with family, lower level of education and being professionally active have significant positive impact on QoL. In contrary, patients with more advanced and malignant cancer with tumor located in the right half of the colon had worse QoL. The particular domains of QoL influenced by these factors were also identified. Determining these factors will allow for more effective treatment, for the shortening of the hospitalization and finally for the reduction of the costs.

Conclusion

The better QoL of the patients with colorectal cancer treated surgically showed younger men, living with family and with the support from close people, professionally active, with primary level of education, and without significant weight loss, ie less than 5% of body weight in the last 6 months. Moreover, patients with cancer located in the left colon, at a lower stage, with a lower grading demonstrated a better QoL.

Impact of Systemic Treatments on Outcomes and Quality of Life in Patients with RAS-Positive Stage IV Colorectal Cancer: A Systematic Review

This systematic review critically evaluates the impact of systemic treatments on outcomes and quality of life (QoL) in patients with RAS-positive stage IV colorectal cancer, with studies published up to December 2023 across PubMed, Scopus, and Web of Science. From an initial pool of 1345 articles, 11 relevant studies were selected for inclusion, encompassing a diverse range of systemic treatments, including panitumumab combined with FOLFOX4 and FOLFIRI, irinotecan paired with panitumumab, regorafenib followed by cetuximab ± irinotecan and vice versa, and panitumumab as a maintenance therapy post-induction. Patient demographics predominantly included middle-aged to elderly individuals, with a slight male predominance. Racial composition, where reported, showed a majority of Caucasian participants, highlighting the need for broader demographic inclusivity in future research. Key findings revealed that the addition of panitumumab to chemotherapy (FOLFOX4 or FOLFIRI) did not significantly compromise QoL while notably improving disease-free survival, with baseline EQ-5D HSI mean scores ranging from 0.76 to 0.78 and VAS mean scores from 70.1 to 74.1. Improvements in FACT-C scores and EQ-5D Index scores particularly favored panitumumab plus best supportive care in KRAS wild-type mCRC, with early dropout rates of 38-42% for panitumumab + BSC. Notably, cetuximab + FOLFIRI was associated with a median survival of 25.7 months versus 16.4 months for FOLFIRI alone, emphasizing the potential benefits of integrating targeted therapies with chemotherapy. In conclusion, the review underscores the significant impact of systemic treatments, particularly targeted therapies and their combinations with chemotherapy, on survival outcomes and QoL in patients with RAS-positive stage IV colorectal cancer, and the need for personalized treatment.

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.

Single-incision robotic assisted surgery: a nonrandomized cohort pilot study on a novel surgical platform in colorectal surgery

BACKGROUND

The technological barriers and steep learning curve of single-incision laparoscopic surgery had kept it from further applications. A literature review had reported that robotic technology could preserve its advantages while simplifying its difficulties. This nonrandomized cohort pilot study aims to evaluate the feasibility and safety of single-incision robotic assisted colorectal surgery based on a novel robotic surgical platform, the SHURUI Endoscopic Surgical Robotic System (SR-ENS-600).

METHOD

This study enrolled 7 patients with colorectal malignancy who underwent single-incision robotic assisted surgery (SIRAS) at a tertiary general surgery center, and retrospectively included 23 patients who underwent robotic assisted surgery from September 2015 to June 2016 and 35 patients who underwent single-incision laparoscopic surgery from June 2017 to March 2018, which were labeled as the initial in-learning-curve attempts from the same surgical team. The technological feasibility and safety of SIRAS were evaluated. Perioperative outcomes, short-term postoperative outcomes, clinicopathologic outcomes, and follow-up were reported.

RESULTS

Six SIRAS operations were completed successfully without eventful intraoperative complications, except for one operation that encountered a large-volume of intraoperative hemorrhage. Two SIRAS cases were converted to multiport laparoscopic surgery because of intraoperative hemorrhage and difficulty in retraction. Postoperative pathology reported satisfactory specimen qualities. There were no short-term postoperative complications, no short-term mortality, no tumor recurrence, or metastasis reported. There was one incisional hernia reported half a year after operation. Patients with advanced staging were sent to standard evaluation and chemotherapy, and follow-up is still on-going.

CONCLUSIONS

SIRAS can be feasibly performed by a skilled surgical team via the SR-ENS-600 platform for strictly-selected patients, which provides preferable instrument maneuverability and stability in confined surgical fields and overcomes the technical difficulty of multisite dissection through a single-incision. Large-volume investigations and high-level evidences are required to further validate its safety and superiority.

Development Trajectories of Fatigue, Quality of Life, and the Ability to Work among Colorectal Cancer Patients in the First Year after Rehabilitation-First Results of the MIRANDA Study

Cancer-related fatigue, low quality of life (QoL), and low ability to work are highly prevalent among colorectal cancer (CRC) patients after tumor surgery. We aimed to analyze their intercorrelations and trajectories in the first year after in-patient rehabilitation in the German multicenter MIRANDA cohort study. Recruitment is ongoing, and we included the first 147 CRC patients in this analysis. Participants filled out questionnaires at the beginning of in-patient rehabilitation (baseline) and at 3, 6, 9, and 12 months after the baseline. The EORTC-QLQ-C30-General-Health-Status (GHS)/QoL, the FACIT-F-Fatigue Scale, and the FACIT-F-FWB-ability-to-work items were used to evaluate QoL, fatigue, and ability to work, respectively. The fatigue and QoL scales were highly correlated (r = 0.606). A moderate correlation was observed between the fatigue and ability to work scales (r = 0.487) and between the QoL and ability to work scales (r = 0.455). Compared to the baseline, a statistically significant improvement in the QoL, ability to work, and fatigue scales were observed at the 3-month follow-up (Wilcoxson signed rank test, all p < 0.0001). The three scales plateaued afterward until the 12-month follow-up. In conclusion, fatigue, QoL, and ability to work were highly interrelated, improved quickly during/after in-patient rehabilitation, and did not change much afterward in German CRC patients.

The Impact of Bevacizumab and Chemotherapy on Quality of Life in Metastatic Colorectal Cancer Patients

Health-related quality is of life of great importance in cancer care. This prospective study aimed to evaluate the impact of chemotherapy and bevacizumab on the activities of daily living, cancer symptoms, and general well-being in 59 metastatic colorectal cancer patients. We gathered information using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. The paired sample t-test, MANOVA test, and Pearson's correlation test were used to analyze the presence of significant differences in mean scores before and after 6 months of treatment. The results revealed significant differences in the functioning and symptoms that influence patients' quality of life after 6 months of treatment: increased pain (p = 0.003), nausea and vomiting (p = 0.003), diarrhea (p = 0.021) and decreased appetite (p = 0.003). At the same time, there were several aspects that improved the quality of life. Increases in emotional function (p = 0.009), cognitive function (p = 0.033), and perception of body image (p = 0.026) were observed after 6 months of treatment. Elderly patients reported a higher frequency of stools (p = 0.028), and young patients had increased concerns about body perception (p = 0.047). Assessing the quality of life of metastatic colorectal cancer patients is an important way to identify and treat symptoms related to both cancer and therapy by establishing a holistic care plan and implementing measures to increase the quality of life.