Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a German cohort study

Romina di Giuseppe,Ilka Ratjen,Greta Burmeister,Clemens Schafmayer,Sabina Waniek,Ute Nöthlings,Manja Koch,Wolfgang Lieb,Janna Enderle,Sabrina Schlesinger,Jochen Hampe

doi:10.1186/s12885-018-5075-1

Abstract

BackgroundThe group of colorectal cancer (CRC) survivors continues to grow worldwide. Understanding health-related quality of life (HRQOL) determinants and consequences of HRQOL impairments in long-term CRC survivors may help to individualize survivorship care plans. We aimed to i) examine the HRQOL status of CRC long-term survivors, ii) identify cross-sectional sociodemographic and clinical correlates of HRQOL, and iii) investigate the prospective association of HRQOL after CRC diagnosis with all-cause mortality.MethodsWe assessed HRQOL within a Northern German cohort of 1294 CRC survivors at a median of 6 years after CRC diagnosis using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Cross-sectional correlates of different HRQOL dimensions were analyzed using multivariable-adjusted logistic regression models with HRQOL as a binary variable. With multivariable-adjusted Cox proportional hazards regression models, hazard ratios (HR) of all-cause mortality were estimated per 10-point-increments of an HRQOL summary score, a global quality of life scale, and HRQOL functioning and symptom domains.ResultsThe median HRQOL summary score was 87 (interquartile range: 75–94). Sex, age, education, tumor location, metastases, other cancers, type of therapy, and current stoma were identified as correlates of different HRQOL scales. After a median follow-up time of 7 years after HRQOL assessment, 175 participants had died. Nearly all HRQOL domains, except for cognitive functioning and diarrhea, were significantly associated with all-cause mortality. A 10-point-increment in the summary score decreased the risk of death by 24% (HR: 0.76; 95% CI: 0.70–0.82).ConclusionsHRQOL in CRC survivors appeared to be relatively high in the long term. Various clinical and sociodemographic factors were cross-sectionally associated with HRQOL in long-term CRC survivors. Lower HRQOL was associated with increased all-cause mortality. Individualized healthcare programs for CRC survivors (including psychosocial screening and interventions) are needed to detect decreased HRQOL and to further improve long-term HRQOL and survival.

Highlights

The group of colorectal cancer (CRC) survivors continues to grow worldwide
Participants with a higher health-related quality of life (HRQOL) had a lower Body mass index (BMI), were more likely to have had a tumor located in the colon, were less likely to have had a diagnosis of metastases or other cancers, were more likely to have had no additional therapy to surgery, and were less likely to have undergone chemotherapy and radiation combined (Table 1)
In the present analyses, we describe in detail the HRQOL in long-term survivors of CRC, assess cross-sectional correlates of this HRQOL, and evaluate the prospective association of HRQOL with all-cause mortality in these CRC survivors

Summary

Introduction

The group of colorectal cancer (CRC) survivors continues to grow worldwide. Understanding healthrelated quality of life (HRQOL) determinants and consequences of HRQOL impairments in long-term CRC survivors may help to individualize survivorship care plans. With respect to factors influencing QOL, different clinical, sociodemographic, and lifestyle factors, including age, sex, tumor location, body mass index (BMI), stoma, and physical activity, were associated with HRQOL of CRC survivors in previous epidemiological studies [8, 21,22,23], even though findings were partially inconsistent in terms of their effect sizes and effect directions. We have examined the relation between selected lifestyle factors (diet, BMI, physical activity, and smoking status), modeled as a lifestyle index, and HRQOL in our CRC survivor cohort [24] and observed that a favorable diet, more physical activity, and lower BMI were significantly associated with higher HRQOL. Only one study examined the association between HRQOL and mortality in long-term CRC survivors and provided initial evidence for an inverse relation between physical and mental component scores and mortality risk [22]

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