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

Francesca Ligori Malcolm,Alisha Gupta,Denyse Whitehead,Alfred Adiamah,David J Humes,Joe West,Ayan Banerjea

doi:10.1111/codi.15393

Francesca Ligori Malcolm, Alisha Gupta + Show 5 more

Open Access

https://doi.org/10.1111/codi.15393

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Abstract

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. 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. A total of 428 respondents were included, with a mean age of 71years (SD 10.1years) and a median RFU time of 2.6years [interquartile range (IQR) 1.6-4.8years]. '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. 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.

Highlights

Colorectal cancer (CRC) is the 3rd most common malignancy in the UK; in excess of 41,000 new cases are diagnosed each year[1]
QLQ-C30 health related quality of life (HRQoL) scores were seen in stoma patients, median 66.6 (IQR: 58.3-83.3, p=0.0029)
This study found that females, right-sided resections and patients with stomas may require additional clinical reviews

Summary

Introduction

Colorectal cancer (CRC) is the 3rd most common malignancy in the UK; in excess of 41,000 new cases are diagnosed each year[1]. The randomised Followup After Colorectal Surgery trial (FACS) found that CEA monitoring (initially 3 monthly for 2 years, 6 monthly for 3 years) and CTCAP (6 monthly for 2 years, annually for 3 years) resulted in improved detection of potentially curable recurrence[3]. Clinician led follow-up requires patients to attend regular clinic appointments over 5 years[7]. This method is resource heavy and increasing survival rates can overwhelm outpatient services[8]. Meta-analysis of randomised controlled trials has found no evidence that face-to-face follow-up is required for effective surveillance[9] and attendance at clinical appointment has been recognised to increase patient anxiety[10]. Remote follow-up (RFU) after colorectal cancer (CRC) surgery allows delivery of surveillance tests without the need for regular outpatient clinical appointments. Little is known about health related quality of life (HRQoL) in RFU patients

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