Long-term Outcome after Colorectal Cancer Resection. Patients’ Self-Reported Quality of Life, Sexual Dysfunction and Surgeons’ Awareness of Patients’ needs

Abstract

Aims and background Current follow-up care programs focus mainly on detection of tumor recurrence or metachronous cancer. Other aspects that affect the quality of life (QoL) of long-term survivors, such as sexual dysfunction, psychological distress or depressive symptoms, have been poorly investigated. We studied these issues, and also investigated the surgeons’ awareness of their patients’ needs in order to determine how to improve follow-up care programs. Methods QoL of 62 colorectal cancer patients was assessed during follow-up using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-C30 and the symptom-specific module (QLQ-CR38). Postoperative sexual problems were evaluated with a 6-item questionnaire. Relevant needs to be examined during follow-up were investigated among patients and surgeons, by filling in the same checklist. Results During long-term follow-up (range, 14–74 months), rectal cancer patients reported lower QoL than colon cancer patients regarding defecation-related problems (P = 0.0001). Sixty-one percent of colon cancer patients reported no sexual dysfunction, whereas only 24% of individuals with rectal cancer reported no problems (P = 0.007). Patients reporting no sexual problems had significantly better QoL than the others, particularly with respect to physical functioning (P = 0.001), social functioning (P = 0.05), financial problems (P = 0.01) and body image (P = 0.0001). Addressing emotional problems during follow-up was important for 26% of the patients, while this was neglected by surgeons (P = 0.03). Conclusions QoL measurement in a clinical setting may help to detect QoL problems that could otherwise go unnoticed in the routine of follow-up care. Specifically, it was useful to detect defecation-related problems, sexual dysfunction and a mismatch in judging the importance of psychological distress between patients and their doctors. Neglecting these issues may cause long-term postoperative dissatisfaction.

Cancer survivorship: Advancing the concept in the context of colorectal cancer

“…When treatment is complete, monitoring for recurrence becomes a priority for HCP's (Brawarsky et al, 2013;Carpentier et al, 2013;Cooper et al, 2008;Esplen et al, 2007;Hu et al, 2011;Salz et al, 2009). Meanwhile, the survivor becomes preoccupied with healing, recovery, adjustment, adaption and coping processes (Appleton et al, 2013;Chambers et al, 2012b;Di Fabio et al, 2008;Esplen et al, 2007;Grant et al, 2011;Loi, 2011;McCaughan et al, 2012;Nikoletti et al, 2008;Serpentini et al, 2011). The recovery process occurs in a manner and pace unique to each individual (Appleton et al, 2013).…”

“…CRC survivors' quality of life (QOL) may be negatively influenced by the presence of an ostomy, level of physical activity and the experience of chronic symptoms including pain, fatigue, anxiety, changes in bowel habit and sexual dysfunction, with some variation in these effects between genders (Chambers et al, 2012b;Di Fabio et al, 2008;Domati et al, 2011;Krouse et al, 2009;Lynch et al, 2007bLynch et al, , 2008aLynch et al, , 2011Milbury et al, 2013;Peddle et al, 2008a;Ristvedt and Trinkaus, 2009;Sun et al, 2015;ThraenBorowski et al, 2013). Despite this, survivors' rate their health and QOL positively, in some cases improving over time, with long-term survivors reporting QOL levels comparable to normative populations (Caravati-Jouvenceaux et al, 2011;Chambers et al, 2012aChambers et al, , 2012bDi Fabio et al, 2008;Jansen et al, 2011;Phipps et al, 2008;Ristvedt and Trinkaus, 2009;Serpentini et al, 2011;Soerjomataram et al, 2012;Steginga et al, 2009;Thong et al, 2011aThong et al, , 2011b.…”

“…Despite this, survivors' rate their health and QOL positively, in some cases improving over time, with long-term survivors reporting QOL levels comparable to normative populations (Caravati-Jouvenceaux et al, 2011;Chambers et al, 2012aChambers et al, , 2012bDi Fabio et al, 2008;Jansen et al, 2011;Phipps et al, 2008;Ristvedt and Trinkaus, 2009;Serpentini et al, 2011;Soerjomataram et al, 2012;Steginga et al, 2009;Thong et al, 2011aThong et al, , 2011b. Several authors suggest positive ratings of QOL are a consequence of response shift, or positive reframing.…”

“…There is a substantial risk that surveillance for cancer recurrence may be prioritized above the management of chronic effects and provision of information and support to survivors (Di Fabio et al, 2008;Phipps et al, 2008;Tofthagen, 2010). Haggstrom et al (2009) reports that just seven percent of CRC survivors attended a medical professional for management of side-effects, compared to eighty-five percent who attend for follow-up tests.…”

“…Like other tumour groups, CRC survivors may experience pain, sleep disturbance and fatigue (Anderson et al, 2013;Domati et al, 2011;Grant et al, 2011;Grimmett et al, 2011;Jansen et al, 2011;McCaughan et al, 2012;Peddle et al, 2008a;Phipps et al, 2008;Schneider et al, 2007;Shun et al, 2011;Sisler et al, 2012;Stein et al, 2009;Thong et al, 2011bThong et al, , 2013. However, side-effects particular to CRC survivors include weight changes; sexual dysfunction (erectile problems, vaginal dryness, dyspareunia), upper gastrointestinal disturbances (food intolerance, nausea, vomiting, loss of appetite), and bowel dysfunction (constipation, diarrhoea, abdominal cramping, flatulence, incontinence, urgency, frequency) (Anderson et al, 2013;Bailey et al, 2015;Caravati-Jouvenceaux et al, 2011;Den Oudsten et al, 2012;Di Fabio et al, 2008;Ellis et al, 2010;Grant et al, 2011;Grimmett et al., 2011;Jansen et al, 2011;Lynch et al, 2008b;McMullen et al, 2008;Milbury et al, 2013;Nikoletti et al, 2008;Phipps et al, 2008;Ramirez et al, 2009;Ristvedt and Trinkaus, 2009;Sanoff et al, 2015;Schneider et al, 2007;Serpentini et al, 2011;Sisler et al, 2012;Thong et al, 2011aThong et al, , 2011b…”