Late outcomes of colorectal cancer treatment: a FECS-EUROCARE study

Abstract

Colorectal cancer survival has increased in recent years, however, the impact of these cancers and their treatment on long-term survivors has not been extensively investigated at the population level. This pilot study assessed the prevalence of late outcomes in long-term colorectal cancer survivors registered by two European population-based cancer registries (CRs) to determine the feasibility of using the approach on a wider basis in Europe. Long-term survivors diagnosed in 1990 and in 1997 in Côte d'Or (France) and Varese (Italy) CRs were surveyed. Questionnaires to general practitioners (GPs) and survivors investigated a wide range of outcomes. Information on stage at diagnosis, primary treatment, stoma inserted during main surgery, and vital status was available from a previous study. Logistic regression was used to identify associations of late outcomes with sex, age at survey, country, year of diagnosis, and site. Participation was 51.8% (45.2% of French and 56.6% of Italian cases identified). Of the 256 survivors available for analysis, 10% had bowel incontinence, about 70% had other bowel, gastrointestinal, or urination problems, 10% had second primary cancer, 4% had colorectal recurrence, and 10% had stoma. The proportion with stoma reduced by 65% in survivors diagnosed between 1990 and 1997, but no other outcomes reduced in prevalence with time. Most (67%) had optimal GP-assessed ECOG performance status. Around 80% were followed-up with liver imaging or colonoscopy. We identified non-trivial rates of bowel and bladder problems after colorectal treatment, but overall good levels of functioning. High-resolution studies of this kind must be population-based to provide data useful for public health provision. This pilot study encountered difficulties in contacting GPs and suffered from low compliance. However, it is the first to investigate late outcome trends after treatment for colorectal cancer.