Long‐term health‐related quality of life following colorectal cancer surgery: patient‐reported outcomes in a remote follow‐up population

Abstract

Aim Remote follow‐up (RFU) after colorectal cancer (CRC) surgery allows delivery of surveillance tests without the need for regular outpatient clinical appointments. However, little is known about health‐related quality of life (HRQoL) in RFU patients. The main aim of this study was to quantify HRQoL in our RFU population to identify particular patient groups that may benefit from a more personalised approach to follow‐up, including access to a survivorship clinic. Method EQ‐5D, QLQ‐C30 and QLQ‐C29 questionnaires were distributed to CRC patients enrolled in a RFU programme. The primary outcome of HRQoL scores was analysed by year of RFU, demographics, operation type, stoma and adherence to RFU protocols. Results A total of 428 respondents were included, with a mean age of 71 years (SD 10.1 years) and a median RFU time of 2.6 years [interquartile range (IQR) 1.6–4.8 years]. ‘Perfect health’ was reported by 26.6% of patients. The median EQ‐5D index score was 0.785 (IQR 0.671–1) and the median QLQ‐C30 Global HRQoL score was 75 (IQR 58.3–83.3). Women had a significantly lower EQ‐5D median score of 0.767 (IQR 0.666–0.879, P = 0.0088). Lower QLQ‐C30 HRQoL scores were seen in stoma patients (median 66.6, IQR 58.3–83.3, P = 0.0029). Erectile dysfunction (P = 0.0006) and poor body image (P = 0.001) were also reported more frequently in stoma patients. Patients undergoing right‐sided resection reported a lower median EQ‐5D score of 0.765 (IQR 0.666–0.879, P = 0.028) and higher pain severity (P = 0.0367) compared with left‐sided resections. There were 128 (29.4%) patients who breached RFU protocol and were seen in ad hoc colorectal clinics. However, there was no statistical difference in HRQoL between patients who adhered to or breached RFU protocols. Conclusion Overall HRQoL in patients in RFU is good, with no difference in those strictly followed up remotely. However, women, patients with right‐sided resection and patients with a stoma may require additional clinical reviews.

Quality of life and patient reported symptoms after colorectal cancer in a Swedish population

“…QoL is in concordance of previous findings [6,[32][33][34][35]. However, of bowel symptoms, only frequent bowel movements during night-time reached an OR as high as seen for anxiety and problems with body image.…”

Development of the Korean Version of the Gastrointestinal Quality of Life Index Questionnaire

“…Surgery has a significant impact on the quality of life (QOL) of patients, and in addition to survival outcome, postoperative complication, and recurrence rate, has become an important standard outcome measure of therapeutic effects in clinical care and research [1]. In addition, since life satisfaction has been demonstrated to have a substantial effect on the recovery of patients after surgical operations [2], many randomized studies have evaluated QOL before and after colorectal surgery [3][4][5][6].…”