Health-related quality of life and risk of colorectal cancer recurrence and All-cause death among advanced stages of colorectal cancer 1-year after diagnosis

BMC Cancer

Carlos KH Wong²  Wai-Lun Law¹  Yuk-Fai Wan²  Jensen Tung-Chung Poon¹  Cindy Lo-Kuen Lam² 

[1] Department of Surgery, The University of Hong Kong, 2/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Ap Lei Chau, Hong Kong

[2] Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong

关键词: Competing risks;    Recurrence;    Survival;    Prognosis;    Colorectal cancer;    Quality of life;   

Others  :  858821
DOI  :  10.1186/1471-2407-14-337

 received in 2013-09-04, accepted in 2014-05-12,  发布年份 2014

【 摘 要 】

Background

The study aimed to examine the association between health-related quality of life (HRQOL) assessed with overall survival (OS) and recurrence after diagnosis of colorectal cancer (CRC).

Methods

Overall 160 patients with advanced stage CRC were recruited in an observational study and completed the generic and condition-specific HRQOL questionnaires at the colorectal specialist outpatient clinic in Hong Kong, between 10/2009 and 07/2010. Socio-demographic and clinical characteristics including duration since diagnosis, primary tumor location and treatment modality, were collected to serve as predictor variables in regression models. All-cause death or CRC recurrence was the event of interest. Association between HRQOL with OS was assessed using Cox regression. Association between HRQOL and CRC recurrence was further modeled by competing-risks regression adjusted for the competing-risks of death from any cause.

Results

After a median follow-up of 23 months, there were 22 (16.1%) incidents of CRC recurrence and 15 (9.4%) deaths. Decreased physical functioning (hazard ratios, HR = 0.917, 95% CI:0.889-0.981) and general health of domains in SF-12 (HR = 0.846, 95% CI:0.746-0.958) or SF-6D scores (HR = 0.010, 95% CI:0.000-0.573) were associated with an increased risk of death, with adjustment of patients’ characteristics. Increased vitality (HR = 1.151, 95% CI:1.027-1.289) and mental health (HR = 1.128, 95% CI:1.005-1.265) were associated with an increased likelihood of death. In models adjusted for competing-risk of death, those with worse HRQOL was not associated with increased risk of CRC recurrence.

Conclusions

Although self-reported HRQOL was not a significant prognostic factor for CRC recurrence, the HRQOL provided independent prognostic value about mortality in patients with advanced stage of CRC.

【 授权许可】

   
2014 Wong et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Siegel R, Naishadham D, Jemal A: Cancer statistics, 2013. CA Cancer J Clin 2013, 63(1):11-30.
• [2]Cancer Trends Progress Report - 2011/2012 Update, National Cancer Institute, NIH, DHHS, Bethesda, MD, August 2012 [http://progressreport.cancer.gov webcite]
• [3]Edge SB, Compton CC: The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM. Ann Surg Oncol 2010, 17(6):1471-1474.
• [4]Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG: Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005, 23(34):8706-8712.
• [5]Maisey NR, Norman A, Watson M, Allen MJ, Hill ME, Cunningham D: Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer 2002, 38(10):1351-1357.
• [6]Efficace F, Bottomley A, Coens C, Steen KV, Conroy T, Schöffski P, Schmoll H, Cutsem EV, Köhne C-H: Does a patient’s self-reported health-related quality of life predict survival beyond key biomedical data in advanced colorectal cancer? Eur J Cancer 2006, 42(1):42-49.
• [7]You YN, Habiba H, Chang GJ, Rodriguez-bigas MA, Skibber JM: Prognostic value of quality of life and pain in patients with locally recurrent rectal cancer. Ann Surg Oncol 2011, 18(4):989-996.
• [8]Epplein M, Zheng Y, Zheng W, Chen Z, Gu K, Penson D, Lu W, Shu XO: Quality of life after breast cancer diagnosis and survival. J Clin Oncol 2011, 29(4):406-412.
• [9]Kenne Sarenmalm E, Oden A, Ohlen J, Gaston-Johansson F, Holmberg SB: Changes in health-related quality of life may predict recurrent breast cancer. Eur J Oncol Nurs 2009, 13(5):323-329.
• [10]Dancourt V, Quantin C, Abrahamowicz M, Binquet C, Alioum A, Faivre J: Modeling recurrence in colorectal cancer. J Clin Epidemiol 2004, 57(3):243-251.
• [11]Wong CKH, Lam CLK, Poon JTC, Kwong DLW: Clinical correlates of health preference and generic health-related quality of life in patients with colorectal neoplasms. PLoS One 2013, 8(3):e58341.
• [12]Wong CKH, Lam CLK, Rowen D, McGhee SM, Ma KP, Law WL, Poon JTC, Chan P, Kwong DLW, Tsang J: Mapping the functional assessment of cancer therapy-general or -colorectal to SF-6D in Chinese patients with colorectal neoplasm. Value Health 2012, 15(3):495-503.
• [13]Wong CKH, Mulhern B, Wan YF, Lam CLK: Responsiveness was similar between direct and mapped SF-6D in Chinese colorectal cancer patients who declined. J Clin Epidemiol 2014, 67(2):220-228.
• [14]Wong CKH, Lam CLK, Wan YF, Rowen D: Predicting SF-6D from the European organization for treatment and research of cancer quality of life questionnaire scores in patients with colorectal cancer. Value Health 2013, 16(2):373-384.
• [15]Wong CKH, Lam CLK, Law WL, Poon JTC, Kwong DLW, Tsang J, Wan YF: Condition-specific measure was more responsive than generic measure in colorectal cancer: All but social domains. J Clin Epidemiol 2013, 66(5):557-565.
• [16]Yang Y, Wong MY, Lam CLK, Wong CKH: Improving the mapping of condition-specific health-related quality of life onto SF-6D score. Qual Life Res 2014. In Press. doi:10.1007/s11136-014-0668-x
• [17]Wong CKH, Lam CLK, Mulhern B, Law WL, Poon JTC, Kwong DLW, Tsang J: Measurement invariance of the functional assessment of cancer therapy-colorectal quality-of-life instrument among modes of administration. Qual Life Res 2013, 22(6):1415-1426.
• [18]Wong CKH, Lam CLK, Law WL, Poon JTC, Chan P, Kwong DLW, Tsang J: Validity and reliability study on traditional Chinese FACT-C in Chinese patients with colorectal neoplasm. J Eval Clin Pract 2012, 18(6):1186-1195.
• [19]Lam CLK, Tse EYY, Gandek B: Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Qual Life Res 2005, 14(2):539-547.
• [20]McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, Ho A: Quality-adjusted life years: population-specific measurement of the quality component. Hong Kong Med J 2011, 17(Suppl 6):17-21.
• [21]Lam CLK, Brazier J, McGhee SM: Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population. Value Health 2008, 11(2):295-303.
• [22]Mauer ME, Bottomley A, Coens C, Gotay C: Prognostic factor analysis of health-related quality of life data in cancer: a statistical methodological evaluation. Expert Rev Pharmacoecon Outcomes Res 2008, 8(2):179-196.
• [23]Jason PF, Gray RJ: A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999, 94(446):496-509.
• [24]Harrell FE, Lee KL, Mark DB: Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996, 15(4):361-387.
• [25]Efficace F, Innominato PF, Bjarnason G, Coens C, Humblet Y, Tumolo S, Genet D, Tampellini M, Bottomley A, Garufi C, Focan C, Giacchetti S, Lévi F, Chronotherapy Group of the European Organisation for Research and Treatment of Cancer: Validation of Patient’s self-reported social functioning as an independent prognostic factor for survival in metastatic colorectal cancer patients: results of an international study by the chronotherapy group of the European organisation for research and treatment of cancer. J Clin Oncol 2008, 26(12):2020-2026.
• [26]Comella P, Casaretti R, Manzo R, Sandomenico C, Licenziato M, Avallone A, Franco L, Southern Italy Cooperative Oncology Group Investigators: Baseline physical functioning status of metastatic colorectal cancer patients predicts the overall survival but not the activity of a front-line oxaliplatin-fluoropyrimidine doublet. Acta Oncol 2010, 49(1):50-56.
• [27]Braun DP, Gupta D, Grutsch JF, Staren ED: Can changes in health related quality of life scores predict survival in stages III and IV colorectal cancer? Health Qual Life Outcomes 2011, 9(1):62. BioMed Central Full Text
• [28]Camilleri-Brennan J, Steele RJ: Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg 2001, 88(12):1617-1622.
• [29]Allen-Mersh TG, Earlam S, Fordy C, Abrams K, Houghton J: Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases. Lancet 1994, 344(8932):1255-1260.
• [30]Earlam S, Glover C, Fordy C, Burke D, Allen-Mersh TG: Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases. J Clin Oncol 1996, 14(1):171-175.
• [31]Ribaudo HJ, Thompson SG, Allen-Mersh TG: A joint analysis of quality of life and survival using a random effect selection model. Stat Med 2000, 19(23):3237-3250.
• [32]Lis CG, Gupta D, Granick J, Grutsch JF: Can patient satisfaction with quality of life predict survival in advanced colorectal cancer? Support Care Cancer 2006, 14(11):1104-1110.
• [33]Wang J, Hassett JM, Dayton MT, Kulaylat MN: Lymph node ratio: role in the staging of node-positive colon cancer. Ann Surg Oncol 2008, 15(6):1600-1608.
• [34]Rosenberg R, Friederichs J, Schuster T, Gertler R, Maak M, Becker K, Grebner A, Ulm K, Hofler H, Nekarda H, Siewert JR: Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg 2008, 248(6):968-978.
• [35]Lee HY, Choi HJ, Park KJ, Shin JS, Kwon HC, Roh MS, Kim C: Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol 2007, 14(5):1712-1717.
• [36]Law WL, Poon JT, Fan JK, Lo SH: Comparison of outcome of open and laparoscopic resection for stage II and stage III rectal cancer. Ann Surg Oncol 2009, 16(6):1488-1493.
• [37]Law WL, Poon JT, Fan JK, Lo OS: Survival following laparoscopic versus open resection for colorectal cancer. Int J Colorectal Dis 2012, 27(8):1077-1085.