Life In Colorectal Cancer Patients Research Articles

P-0186 - Relation of General Self-Efficacy with Stress, Symptoms and Quality of Life in Colorectal Cancer Patients

Background: Symptoms related with colorectal cancer (cc), may increase the psychological and physical status and deteriorate patients quality of life. The purpose of this study was to evaluate symptoms, general self-efficacy, stress and quality of life of cc patients. In addition, our purpose was to investigate correlation between general self-efficacy and other parameters, at baseline and actual modification one year after adjuvant chemotherapy. Conclusions: One year after adjuvant chemotherapy, impairment was observed in all evaluated parameters. Change of general self-efficacy was mainly related to change of stress levels, moderate but equally important related to severity and intervention of symptoms in quality of life and at a minor extent to energy (subscale of LASA) of patients. The results of this study show that general self-efficacy, stress, physical symptoms and energy of patients are crucial factors for cc patients and therefore, physicians should consider these psychological and physical dimensions. Methods: 90 cc patients were included in our study. General self-efficacγ was evaluated with « General Perceived Self-Efficacy scale » (GSE), quality of life was measured with « Linear Analogue Scale Assessment» (LASA), stress was evaluated with the (HAD) scale, impairment and involvement of symptoms were measured with «MD Anderson Symptom Inventory» (MDASI) questionnaire, at the time of diagnosis and one year after adjuvant chemotherapy. Results: Measurements one year after adjuvant chemotherapy showed that general self-efficacy decreased (28.86 + /- 6.42), stress increased (9.56 + /- 4.42), quality of life impairment (6.74 + /- 1.81) following the severity of symptoms (3.24 + /- 2.62). Actual modification at the time of diagnosis and one year after adjuvant chemotherapy showed important negative correlation between general self-efficacy and stress (p < 0.0005). Moderate negative correlation was observed between general self-efficacy and symptoms (MDASI severity of symptoms: p = 0.003, intervention of symptoms: p = 0.002), while low positive correlation was found between self-efficacy and energy LASA scale (p = 0.048). Results: Measurements one year after adjuvant chemotherapy showed that general self-efficacy decreased (28.86 + /- 6.42), stress increased (9.56 + /- 4.42), quality of life impairment (6.74 + /- 1.81) following the severity of symptoms (3.24 + /- 2.62). Actual modification at the time of diagnosis and one year after adjuvant chemotherapy showed important negative correlation between general self-efficacy and stress (p < 0.0005). Moderate negative correlation was observed between general self-efficacy and symptoms (MDASI severity of symptoms: p = 0.003, intervention of symptoms: p = 0.002), while low positive correlation was found between self-efficacy and energy LASA scale (p = 0.048). Conclusion: One year after adjuvant chemotherapy, impairment was observed in all evaluated parameters. Change of general self-efficacy was mainly related to change of stress levels, moderate but equally important related to severity and intervention of symptoms in quality of life and at a minor extent to energy (subscale of LASA) of patients. The results of this study show that general self-efficacy, stress, physical symptoms and energy of patients are crucial factors for cc patients and therefore, physicians should consider these psychological and physical dimensions.

Brain metastases from colorectal cancer: microenvironment and molecular mechanisms.

Colorectal cancer is one of the most common digestive tract malignancies in the world. Owing to the newer and more effective systemic therapies, the life of colorectal cancer patients can be remarkably prolonged, and the incidence of brain metastases is increasing. However, little is known about the underlying mechanisms of brain metastasis from colorectal cancer. Here we review the tumor microenvironment and metastasis associated molecules in brain metastases from colorectal cancer. A further understanding of these mechanisms will help us to propose better strategies for colorectal cancer patients with brain metastasis and improve their life quality.

623 - European Organization for Research and Treatment of Cancer QLQ-C30 and Functional Assessment of Cancer Therapy-General for the Measurement of Quality of Life in Colorectal Cancer Patients who Received Adjuvant Chemotherapy: A Comparison

ABSTRACT Purpose Quality of life (QOL) was measured using the European Organization for Research and Treatment of Cancer QLQ-C30 (QLQ-C30) and Functional Assessment of Cancer Therapy-General (FACT-G) in colorectal cancer patients who received adjuvant chemotherapy with oral uracil/tegafur plus leucovorin, and two QOL measurements were compared. Methods QOL was assessed prospectively at baseline (pretreatment) and at 5-week intervals during treatment, using QLQ-C30 and FACT-G, and were compared with reference to the corresponding scales. Results The study group comprised 58 men and 41 women, with a mean age of 65 years (range, 30 to 80). The disease stage was stage II in 51 patients and stage III in 48. The 99 patients had received a total of 444 treatment cycles (median, 5 cycles; range, 0.1 to 5 cycles). The most common type of toxicity was fatigue. However, the incidence of grade 3 or 4 fatigue was very low. The most common type of hematological toxicity was anemia, which was generally mild. Six patients had grade 3 diarrhea and 6 had grade 3 anorexia. QOL was not evaluated either before or after treatment in 5 of the 99 enrolled patients; both baseline and post-treatment evaluations were available for the other 94 patients. Of 94 patients, the numbers of patients who completed the QOL questionnaires were 90 (96%) at baseline, and 87 (93%), 85 (90%), 88 (94%), 84 (89%), and 81 (86%), consecutively. The mean number of evaluations per patient was 6.2 (range, 3-7). The post-treatment assessments changed significantly from the baseline values and favored post-treatment for all scales except social well-being of the FACT-G. All scales except social well-being in patients with Grade 0-1 toxicities were better than those with Grade 2-3 toxicities. Social well-being in patients with Grade 2-3 toxicities were worse than those with Grade 0-1. When corresponding scales between the two QOL questionnaires were compared, a high correlation for physical domain or emotional domain was found. However, no correlation was noticed for the social domain. Conclusion The social domain of the two QOL questionnaires may evaluate different aspects of QOL each other. Disclosure All authors have declared no conflicts of interest.

A novel serum metabolomics-based diagnostic approach for colorectal cancer.

BackgroundTo improve the quality of life of colorectal cancer patients, it is important to establish new screening methods for early diagnosis of colorectal cancer.Methodology/Principal FindingsWe performed serum metabolome analysis using gas-chromatography/mass-spectrometry (GC/MS). First, the accuracy of our GC/MS-based serum metabolomic analytical method was evaluated by calculating the RSD% values of serum levels of various metabolites. Second, the intra-day (morning, daytime, and night) and inter-day (among 3 days) variances of serum metabolite levels were examined. Then, serum metabolite levels were compared between colorectal cancer patients (N = 60; N = 12 for each stage from 0 to 4) and age- and sex-matched healthy volunteers (N = 60) as a training set. The metabolites whose levels displayed significant changes were subjected to multiple logistic regression analysis using the stepwise variable selection method, and a colorectal cancer prediction model was established. The prediction model was composed of 2-hydroxybutyrate, aspartic acid, kynurenine, and cystamine, and its AUC, sensitivity, specificity, and accuracy were 0.9097, 85.0%, 85.0%, and 85.0%, respectively, according to the training set data. In contrast, the sensitivity, specificity, and accuracy of CEA were 35.0%, 96.7%, and 65.8%, respectively, and those of CA19-9 were 16.7%, 100%, and 58.3%, respectively. The validity of the prediction model was confirmed using colorectal cancer patients (N = 59) and healthy volunteers (N = 63) as a validation set. At the validation set, the sensitivity, specificity, and accuracy of the prediction model were 83.1%, 81.0%, and 82.0%, respectively, and these values were almost the same as those obtained with the training set. In addition, the model displayed high sensitivity for detecting stage 0–2 colorectal cancer (82.8%).Conclusions/SignificanceOur prediction model established via GC/MS-based serum metabolomic analysis is valuable for early detection of colorectal cancer and has the potential to become a novel screening test for colorectal cancer.

P-0219 Chemotherapy Induced Neuropathic Pain, Emotion and Quality of Life in Colorectal Cancer Patients

ABSTRACT Introduction Peripheral neuropathy is a common side effect of chemotherapy that affects the quality of life for many cancer survivors. Severe and debilitating neuropathy negatively impacts both physical and emotional well-being. The purpose of this study was to investigate the relationships of chemotherapy induced neuropathic pain, mood and quality of life among patients with colorectal cancer in Taiwan. Methods 106 colorectal cancer patients who received chemotherapy participated in the study. The data was collected by self-administrated questionnaires. Questionnaires included Neuropathic Pain Symptom Inventory (NPSI), Profiles of Mood States-short form and Functional Assessment Cancer Therapy-C (FACT-C). Results The majority of the patients were male (53.8%) and married (77.4%). The average age was 56.92 years. The majority of patients were stage III (60.4%) and IV (34.0%), had tumor resection and chemotherapy. Patients received oxaliplatin/5-Fu-based chemotherapy (FOLFOX) and experienced a low level of chemotherapy induced neuropathic pain (93.4%), mainly cold induced pain (79.2%), numbness (77.4%), stabbing pain (62.3%), electric pain (38.7%), and Lacerating pain (28.3%). 64.2% of patients had finger neuropathy. Twelve percent of patients indicated that the neuropathy symptom affects their daily activities. In addition, patients reported that neuropathy affects their emotional well-being particular in the domains of vitality, fatigue, confusion, anxiety, depression, and anger. The results indicated that there was a medium positive correlation between neuropathic pain and mood (r=.492, p Conclusion Colorectal cancer survivors who have received oxaliplatin, peripheral neuropathies represent a major threat to quality of life. Mood states of patients play a mediating factor in the relationship between neuropathic pain and quality of life. Prevention and management of chemotherapy induced peripheral neuropathy and negative mood should be a major goal of symptom management to improve the quality of life of colorectal cancer survivors.

Quality of life in colorectal cancer patients with diarrhoea after surgery: a longitudinal study

The purposes of this study were to examine how quality of life in colorectal cancer patients with diarrhoea changes with time after surgery and to identify variables influencing patients' quality of life three months following surgery. Colorectal cancer is one of the most common cancers in the world. Literature that focuses on the impact of the basic attributes, disease characteristics and diarrhoea distress on the quality of life in diarrhoea patients is quite rare. Survey. A longitudinal study design was employed with a three-month tracking period. Data were collected in structured, one-on-one interviews at one week and one, two and three months after surgery. Variance and effects of quality of life were analysed by repeated-measures analysis of variance and generalised estimating equation. Results showed that colorectal cancer patients (n = 35) with diarrhoea after surgery will over time be gradually satisfied with their overall quality of life. Physical health satisfaction is lowest at 1 week after surgery, and it will over time gradually increase. Satisfaction with mental health has the lowest score and does not improve with time. Satisfaction with social relationships is highest between one week and two months after surgery. Satisfaction of environmental relationship will improve with time after surgery. The study results also indicate that patients with lower quality of life satisfaction are younger, women, have had R hemicolectomy and experience higher diarrhoea distress. Colorectal cancer patients with diarrhoea after surgery will become more satisfied with their overall quality of life with time. Physical and environmental satisfaction will all improve with time. Younger patients will be more dissatisfied with their social and environmental health. More severe diarrhoea distress will impact patients' quality of life the most. These results can serve as reference for clinical care providers to patients with colorectal cancer after surgery.

Quality of Life of Colorectal Cancer Patients in Certified Centers versus Non-Certified Hospitals

Background: Since 2006, in Germany colorectal cancer patients can be treated in certified colorectal cancer centers. The aim of this explorative study was to investigate whether there are differences in the quality of life (QoL) of colorectal cancer patients who were treated in certified versus noncertified centers. Patients and Methods: A total of 284 colorectal cancer patients participated in the study: 184 patients from certified colorectal cancer centers and 100 patients from noncertified centers. Data on QoL (using the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC-QLQ C30)), patient satisfaction, mental distress and sociodemographic data were assessed with a questionnaire in a written survey after the hospital stay. The moderating influence of patientrelated characteristics (e.g. age, sex, patient satisfaction, and psychological distress) and cancerrelated factors (Union internationale contre le cancer (UICC) stage) were tested. Results: On a descriptive level, patients from noncertified centers had a higher QoL in 5 subdimensions (higher physical and role functioning and less insomnia, appetite loss and financial difficulties). After adjustment, only 2 differences remained significant: physical functioning (p < 0.01) and role functioning (p = 0.02). Conclusion: Structural improvements in the oncological care are not necessarily reflected in a better QoL of the patients treated in certified colorectal cancer centers. The findings are discussed in the context of the applied study design.

The Effect of Symptom Experience and Resilience on Quality of Life in Patients with Colorectal Cancers

Purpose: This study aimed to investigate the influence of resilience and symptom experience on quality of life. Methods: Seventy five patients in an active treatment stage were recruited from 2 hospitals between October and December 2010. A survey including perceived health status, physical functional status, the symptom experience index, resilience, and the functional assessment of cancer therapy-colorectal (FACT-C) was completed. Results: The level of FACT-C was 86.61 (±18.91), which was higher than for patients with colostomy, but lower than for patients in a rehabilitation stage. Participants without physical functional limitations showed higher level of both resilience and quality of life. Participants with bad health status showed a lower level of both resilience and quality of life and higher level of symptom experience. The quality of life was related to the level of resilience (β=.373), symptom experience (β=-.292), and perceived health status (β=-3.961). Conclusion: Proactive nursing approaches to manage symptoms and to improve perceived health status would enhance the quality of life of colorectal cancer patients. Furthermore, various strategies to strengthen the level of resilience should be developed.

Anxiety, depression, traumatic stress and quality of life in colorectal cancer after different treatments: A study with Portuguese patients and their partners

PurposeThis study examines the impact of different modes of treatment on depression, anxiety, traumatic stress and quality of life in colorectal cancer patients and their partners. MethodsThe sample was comprised of 114 oncology patients and 67 partners. All patients were diagnosed with colorectal cancer. Participants were recruited from an Oncology Hospital in the North of Portugal and had been submitted to three modes of treatment: surgery, surgery plus chemotherapy or surgery followed by radiotherapy. ResultsThe results showed that patients who received only surgery, as treatment, had lower levels of depression, anxiety and traumatic stress symptoms when compared with patients who received surgery and chemotherapy or surgery plus radiotherapy. Partners of surgical patients presented lower levels of state anxiety and traumatic stress symptoms when compared with the other two groups. Patients with more depression had partners also more depressed. No relationship was found between anxiety and traumatic stress symptoms in patients and partners. Patients who received a diagnosis longer than 12 months had more traumatic stress, intrusion and hypervigilance. Patients with illness recurrence showed more traumatic symptoms. Anxiety and depression were the main predictors of patient’s quality of life. Traumatic stress was a predictor of symptom distress - pain/bowel pattern. ConclusionThis study highlights the importance of providing psychological interventions for cancer patients and their partners. Chemotherapy patients and those diagnosed over a year, as well as their partners, are more at risk.

Quality of Life in Colorectal Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy

Purpose: The purpose of this study was to identify the quality of life in colorectal cancer patients with chemotherapy-induced peripheral neuropathy. Methods: A total of 93 patients were recruited in the cross-sectional survey design. Quality of life in colorectal cancer patients were measured by Eu...

Health-related quality of life of colorectal cancer patients receiving oral UFT plus leucovorin compared with those with surgery alone

Adjuvant chemotherapy of oral uracil/ftorafur (UFT) plus leucovorin (LV) has been accepted as the standard of care in the treatment of patients with stage II and III carcinoma of the colon. The objective of the study was to compare HRQOL reported by patients receiving oral UFT plus LV (UFT/LV group) versus no adjuvant treatment (control group) following surgery for colorectal cancer. Ninety nine patients in the UFT/LV group and 83 in the control group participated. HRQOL was assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 and HRQOL data measured longitudinally following surgery were compared between the groups. Eighty-eight percent (87 of 99) received all scheduled doses of UFT plus LV during the first three cycles, and 82 percent (81 of 99) did so for five cycles. The most common type of toxicity in the UFT/LV group was fatigue, which was generally mild. Six patients each had grade 3 diarrhea or anorexia. There were significant differences in the scores for role function, and specific limitations such as fatigue, nausea, and vomiting, dyspnoea, appetite loss, and financial difficulties, which deteriorated in the UFT/LV group. HRQOL in colorectal cancer patients with adjuvant chemotherapy with oral UFT plus LV deteriorated during this phase of treatment compared with those with surgery alone, despite the biased stage of tumor between the groups. Symptom management and social support would improve HRQOL in such a group of patients.

Are gender-associated differences in quality of life in colorectal cancer patients disease-specific?

The purpose of this study was to investigate gender-associated differences in quality of life in colorectal cancer patients and compare such differences to the general population. Colorectal cancer patients attending three oncological centres in Austria were consecutively recruited and assessed with the EORTC QLQ-C30. For the purpose of comparison, a gender- and age-matched healthy control group was drawn from a representative sample of the Austrian general population. About 206 patients (47.1% women; mean age 64.8 years) with colorectal cancer were included and compared with 206 persons from the general population. A two-way analysis of variance showed significant main effects (gender and colorectal cancer vs. healthy) for most EORTC QLQ-C30 scales, but a significant interaction effect was only found for diarrhea. This means that gender-associated differences specific for colorectal cancer patients were only found for diarrhea. The vast majority of studies on gender-associated differences in quality of life compare male and female oncological patients and neglect the issue of the disease-specificity of such differences. Our study revealed that women and men suffering from colorectal cancer scored differently across many aspects of quality of life, but with the exception of diarrhea, these differences were also found in the general population, i.e. they indicated no gender-specific reaction to disease.

Validation of the Japanese version of EORTC QLQ-CR38

The objective of this study was to test the reliability and validity of the Japanese version of the European Organization for Research and Treatment of Cancer (EORTC) Colorectal Cancer-Specific Quality of Life Questionnaire (QLQ-CR38). The questionnaire was tested among 109 colorectal cancer patients on several occasions. The timing was prior to treatment with radiotherapy or chemotherapy, during treatment and 3 months following the second assessment. For purpose of test-retest reliability, a subgroup of patients completed the QLQ-CR38 1 week following the third assessment. Multitrait scaling analysis confirmed the hypothesised scale structure of both the function scales and the symptom scales except female sexual problem scale. Cronbach's alpha coefficients for seven of the nine scales exceeded the 0.7 criterion at one or both assessments. The test-retest reliability for all scales except three symptom scales was 0.67 or higher. On the basis of known-groups comparisons, four of 46 comparisons distinguished between patients differing in disease stage, initial and on-treatment performance status and presence or absence of a stoma. Additionally, these scales detected change over time as a function of change in performance status and treatment-induced change. These preliminary results suggest that the Japanese EORTC QLQ-CR38 may be a reliable and valid supplementary measure of quality of life in colorectal cancer patients.

Quality of life in colorectal cancer patients with hepatic arterial infusion (HAI) pumps

19602 Background: More than half of patients diagnosed with colorectal cancer will develop hepatic metastases. Most patients with hepatic metastases will recur within two years after resection. Hepatic arterial infusion (HAI) pumps deliver regional treatment. However, very few studies quantitatively explore the patient's experience of living with an HAI pump and how this experience impacts HAI-related quality of life (QOL). This study explored the impact of HAI pump treatment on patient's overall QOL within the specific domains of physical, psychological, social, and functional well-being. Methods: Twenty-five colorectal cancer patients treated with HAI pumps completed an HAI pump- specific QOL assessment tool at one data collection time point. The QOL assessment tool items were derived from the investigator's previous QOL research with this patient population [Blair et al., 2002, Annals of Surgical Oncology]. Demographic, disease and QOL data were summarized using descriptive statistics. Results: Of the 25 patients accrued, 32% were receiving treatments through their HAI pump and 68% were not. There were no significant difference in QOL between treatment status, gender, and age (&lt;65 or = 65). Currently treated pump patients experienced more appetite changes (p=0.03), sleep changes (p=0.08), and more restrictions in traveling (p=0.08). Male patients had more concerns with lifting heavy items (p=0.05), while female patients had more concerns with isolation (p=0.17) and changes in the type of clothing worn (p=0.16). Younger patients had more concerns with vigorous activity (p=0.01), bending (p=0.08), and were more self-conscious of their appearance with the pump (p=0.01). Conclusions: Overall, in this study, colorectal cancer patients with HAI pumps reported good QOL and were satisfied with their overall treatment experience. Although there was no comparative statistical analysis performed in this study, several QOL concerns remain worrisome for patients. Defining these specific QOL concerns in HAI patients will enhance clinical understanding of their unique experience with this treatment modality and impact patient management. This will enable further development of educational tools and research to test interventions to support HAI patients and sustain their QOL. No significant financial relationships to disclose.

Quality of life of Danish colorectal cancer patients with and without a stoma

As part of a psychosocial intervention study, we wanted to prospectively assess the quality of life of colorectal cancer patients who were given a stoma at the time of their initial operation for cancer or later and those whose initial stoma was removed. A total of 249 colorectal cancer patients were recruited and responded to a questionnaire 3, 6, 12 and 24 months after the initial operation (26-35% had a stoma during follow-up). Although most of the differences between stoma and non-stoma patients failed to reach significance, 22 out of 27 variables indicated a poorer quality of life for those with a stoma. Patients who currently had a stoma had significantly higher levels of depression (p = 0.013), poorer social functioning (p = 0.0085) and more problems with body image (p = 0.0001), future perspectives (p = 0.0058), micturition (p = 0.018) and side effects from chemotherapy (p = 0.008), but fewer problems with constipation (p = 0.034) than non-stoma patients. Male patients with a stoma had more sexual problems than males without a stoma (p = 0.015). Among those with a current stoma, quality of life seemed poorer among those whose stoma was made during follow-up compared with those with an initial stoma. Trends suggested that having a stoma led to poorer scores in most aspects of quality of life and that having a stoma made some time after the initial operation was more distressing than having a stoma made during the primary cancer operation.

Restrictions in quality of life in colorectal cancer patients over three years after diagnosis: A population based study

Despite the burden and prevalence of colorectal cancer (CRC), there is only limited information regarding quality of life of patients who have survived beyond the first year post treatment. We assessed quality of life in a population-based cohort of 309 patients with CRC from Saarland (Germany) one and three years after diagnosis using the QLQ-C30 questionnaire and the tumour specific module QLQ-CR38. When compared with reference data from the general population, most patients with CRC reported high overall quality of life and only small deficits in physical functioning but deficits in emotional and social functioning persist over years in patients with colorectal cancer. Improvements in quality of life from the first to the third year after diagnosis in patients who remained free of disease were very modest and limited to less financial difficulties, a better future perspective and fewer stoma-related problems.

Anxiety, depression and quality of life in colorectal cancer patients

Few studies have examined psychological distress and its relationship with quality of life (QL) dimensions in colorectal cancer patients. One hundred and twenty-eight outpatients were given psychological tests for anxiety and depression (Hospital Anxiety and Depression Scale; HADS) and QL The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ-C30) on the same occasion. The association between the patients' emotional function (EF) scoring on EORTC QLQ-C30 and their HADS scores was analyzed by multiple linear regression. Statistically significant negative relationships were found between EF and HADS-A (anxiety), HADS-D (depression), and HADS-T (total score), respectively, with the highest correlation coefficient being for HADS-A. However, HADS-D was significantly more highly correlated than HADS-A to other QL dimensions, and depression was more highly correlated than anxiety with reduced QL. The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety. Depression has a stronger impact on the global QL of patients than anxiety; therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with colorectal cancer.

Quality of Life in Colorectal Cancer Patients with Colectomy and the Validation of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), Version 4

The purpose of this study was to determine whether the Functional Assessment of Cancer Therapy-Colorectal (the FACT-C), a disease-specific tool for the assessment of colorectal cancer patients' QOL, is a valid assessment tool for measuring QOL changes. Ninety-eight colorectal cancer patients performed the assessment at baseline and 52 of these patients completed the instrument at one month and six months after colectomy. In addition to the FACT-C, the shortened forms of the Profile of Mood States, the Eastern Cooperative Oncology Group Performance Status Rating, Neuroticism Scale in the Eysenck Personality Questionnaire, and Functional Living Index-Cancer were completed. We found convergent and divergent validity and good reliability of the FACT-C. Patients' overall QOL was lower at one month after colectomy and recovered to the pre-surgery level at six months after colectomy.

Dimensions of quality of life and psychosocial variables most salient to colorectal cancer patients

Colorectal cancer is one of the most common invasive cancers, and is responsible for considerable physical and psychosocial morbidity. Understanding the quality of life experienced by colorectal cancer patients is essential for evaluating the full impact of the disease on individuals, their families and their communities. Patient perspective is essential in establishing a proper understanding of the quality of life of colorectal cancer patients. Despite this, few studies have employed a qualitative methodology to explore quality of life issues for colorectal cancer patients. A review of the literature identified only seven qualitative studies pertaining to quality of life issues for colorectal cancer patients, a surprising finding given the prevalence of this cancer. Accordingly, this study sought to build on the findings of previous qualitative research by providing descriptive data on the quality of life and psychosocial variables most salient to colorectal cancer patients. Six core themes emerged from interview and focus group data: Satisfaction with diagnosis and treatment; support (including information provision); quality of life; benefits of diagnosis; making sense of the cancer experience; and coping strategies. The information derived from this study will help inform the development of supportive care services to address the needs of the increasing number of people diagnosed with colorectal cancer.

Methodological issues in assessing health-related quality of life of colorectal cancer patients in randomised controlled trials

Although health-related quality of life (HRQOL) is increasingly reported as an important endpoint in cancer clinical trials, questions still remain about the quality of its reporting. The aim of this study was to evaluate the level of reporting of HRQOL in randomised controlled trials (RCTs) of colorectal cancer (CRC). A systematic literature search from 1980 to March 2003 was undertaken on a number of databases. Identified eligible studies were selected and then evaluated on a broad set of HRQOL predetermined criteria by four reviewers. Thirty-one randomised controlled trials involving 9683 colorectal cancer patients were identified. Nearly all studies dealt with metastatic patients and principally compared different chemotherapy regimens. The HRQOL tool most often used was the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), which was used in 48% of the studies. Some methodological limitations were identified: 39% of the RCTs did not report HRQOL compliance at baseline and 52% did not give details on missing data. A rationale for using a specific HRQOL measure was given in only 10% of the studies. Whilst HRQOL assessment is a potential valuable source of information in understanding the impact of colorectal cancer, a number of methodological shortcomings have to be further addressed in future studies.