Elsevier

Surgery

Volume 134, Issue 2, August 2003, Pages 119-125
Surgery

Society of University Surgeons
Surgical complications exert a lasting effect on disease-specific health-related quality of life for patients with colorectal cancer*,**

Presented at the 64th Annual Meeting of the Society of University Surgeons, Houston, Texas, February 12-15, 2003.
https://doi.org/10.1067/msy.2003.212Get rights and content

Abstract

Background. For individual patients with colorectal cancer, health-related quality of life (HRQL) after treatment is a function of several factors that include preexisting medical conditions, the disease burden, and the treatment that is rendered. The purpose of this study was to identify the factors that were associated with posttreatment HRQL. Methods. At baseline and again at 12 months after diagnosis, patients completed the colorectal cancer-specific HRQL survey: Functional Assessment of Cancer Therapy (FACT-C). Univariate and multivariate analyses were performed to test the association between patient-, tumor-, and treatment-related variables and 12-month FACT-C total scores. Results. Seventy-one patients completed the FACT-C at diagnosis and subsequently underwent open surgical removal of their primary tumor; 63 patients completed the 12-month survey. In univariate analysis, only chronic obstructive pulmonary disease at diagnosis or the occurrences of perioperative complications were associated with a reduction in 12-month HRQL scores. Considering both the diagnosis of chronic obstructive pulmonary disease and the occurrence of perioperative complications, along with the patient's FACT-C total score at diagnosis, age, tumor location, and stage of disease in a multivariate model, only the perioperative complications (odds ratio, 10.5; 95% CI, 2.1-52) and FACT-C total score at diagnosis (odds ratio, 1.04; 95% CI, 1.005-1.07) were associated significantly with a lower than median HRQL score at 12 months. Conclusion. For patients who undergo treatment of colorectal cancer, HRQL at 1 year after diagnosis is still influenced significantly and negatively by the occurrence of surgical complications. (Surgery 2003;134:119-25.)

Section snippets

Methods and patients

Patients with biopsy-proven colon or rectal cancer who were candidates for elective surgical resection were asked to participate in an institutional review board-approved prospective study. Seventy-five patients were enrolled over the period from August 1, 1999, to December 30, 2001. For the purpose of the measurement of HRQL, participating patients were asked to complete the Functional Assessment of Cancer Therapy survey for patients with Colorectal cancer (FACT-C) at the time of diagnosis and

Results

Seventy-five patients completed the FACT-C at the time of diagnosis, and at least 12 months had elapsed since the diagnosis of colorectal cancer. All patients had undergone open surgical therapy. Four of these patients, who underwent colostomy only, were excluded from the analysis. Of the remaining 71 patients, 63 completed the 12-month survey (88%); 4 patients (6%) died before the scheduled 12-month survey (cancer progression, 3; surgical complication, 1 [this patient experienced a fatal

Discussion

Although many therapeutic choices for patients with colorectal cancer are based on the predicted impact of therapy on quality of life and not oncologic concerns, little information exists to guide these decisions. Examples of such decisions include local excision of rectal cancer versus radical excision, sphincter preservation for distal rectal cancer versus abdominoperineal resection, and laparoscopic versus open surgical resection of colon cancer. In several cases, preliminary studies have

Conclusion

The present study represents an initial step toward an understanding of the association of perioperative patient-, tumor-, and treatment-related variables with HRQL 12 months after diagnosis for patients with colorectal cancer. Of the factors that were examined, initial score at diagnosis and the occurrence of perioperative complications exhibited the most significant association with eventual HRQL at 12 months. These data suggest that decreasing complications will result in improved HRQL

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*

Reprint requests: Thomas Anthony, MD, Chief, Surgical Services (112), VA North Texas Health Care Institute, 4500 South Lancaster Rd, Dallas, TX 75216.

**

0039-6060/2003/$30.00 + 0

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