Development and internal validation of prediction models for colorectal cancer survivors to estimate the 1-year risk of low health-related quality of life in multiple domains

Dóra Révész,I Jmert Kant,Fränzel J B Van Duijnhoven,Luc J Smits,Stéphanie O Breukink,Lonneke V Van De Poll-Franse,Floortje Mols,Sandra Beijer,Ellen Kampman,Renate M Winkels,Matty P Weijenberg,Huub Hoofs,Martijn J L Bours,Sander M J Van Kuijk

doi:10.1186/s12911-020-1064-9

Abstract

BackgroundMany colorectal cancer (CRC) survivors experience persisting health problems post-treatment that compromise their health-related quality of life (HRQoL). Prediction models are useful tools for identifying survivors at risk of low HRQoL in the future and for taking preventive action. Therefore, we developed prediction models for CRC survivors to estimate the 1-year risk of low HRQoL in multiple domains.MethodsIn 1458 CRC survivors, seven HRQoL domains (EORTC QLQ-C30: global QoL; cognitive, emotional, physical, role, social functioning; fatigue) were measured prospectively at study baseline and 1 year later. For each HRQoL domain, scores at 1-year follow-up were dichotomized into low versus normal/high. Separate multivariable logistic prediction models including biopsychosocial predictors measured at baseline were developed for the seven HRQoL domains, and internally validated using bootstrapping.ResultsAverage time since diagnosis was 5 years at study baseline. Prediction models included both non-modifiable predictors (age, sex, socio-economic status, time since diagnosis, tumor stage, chemotherapy, radiotherapy, stoma, micturition, chemotherapy-related, stoma-related and gastrointestinal complaints, comorbidities, social inhibition/negative affectivity, and working status) and modifiable predictors (body mass index, physical activity, smoking, meat consumption, anxiety/depression, pain, and baseline fatigue and HRQoL scores). Internally validated models showed good calibration and discrimination (AUCs: 0.83–0.93).ConclusionsThe prediction models performed well for estimating 1-year risk of low HRQoL in seven domains. External validation is needed before models can be applied in practice.

Highlights

Many colorectal cancer (CRC) survivors experience persisting health problems post-treatment that compromise their health-related quality of life (HRQoL)
CRC survivors are often concerned about how long they will survive after treatment and how well they will survive, because after diagnosis and treatment many survivors continue to experience physical and psychosocial problems and long-lasting and late treatment effects that can have a major impact on their healthrelated quality of life (HRQoL) [2, 4,5,6]
Estimation of the future risk of low HRQoL in multiple domains, such as global quality of life and several functioning domains, can offer opportunities for tailoring of appropriate preventive interventions aimed at safeguarding the HRQoL of CRC survivors, for example through health behavioral interventions [7,8,9,10,11,12,13]

Summary

Introduction

Many colorectal cancer (CRC) survivors experience persisting health problems post-treatment that compromise their health-related quality of life (HRQoL). Prediction models are useful tools for identifying survivors at risk of low HRQoL in the future and for taking preventive action. We developed prediction models for CRC survivors to estimate the 1-year risk of low HRQoL in multiple domains. In order to identify CRC survivors at risk of having low HRQoL in the future, accurate risk estimation must be based on relevant predictive factors incorporated in risk prediction models. No models have been developed for predicting future HRQoL in CRC survivors, whilst such prognostic models could be invaluable for identifying individuals at risk of future low HRQoL, preferably in multiple domains to estimate personal risk profiles that can indicate future problems in specific HRQoL domains [22,23,24]

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