Quality of Life Outcomes in Stage IV Colorectal Cancer

Abstract

With improvements across the colorectal cancer care continuum, from screening and earlier detection to better systemic options, patients are living longer with the disease. Given these improvements over the last several decades, quality of life outcomes have become important components when evaluating treatment efficacy and adverse effects. This article reviews quality of life measurement generally, discusses tools currently being used in colorectal cancer patients, and reviews outcomes following both surgical and nonsurgical management from clinical trials, observational studies, and meta-analyses.

Keywords

quality of life - colorectal cancer - metastatic

Publication History

Article published online:
08 February 2023

• References

• 1 Cella DF, Tulsky DS. Quality of life in cancer: definition, purpose, and method of measurement. Cancer Invest 1993; 11 (03) 327-336
• 2 Roila F, Cortesi E. Quality of life as a primary end point in oncology. Ann Oncol 2001; 12 (suppl (Suppl. 03) S3-S6
• 3 Herdman M, Gudex C, Lloyd A. et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20 (10) 1727-1736
• 4 Brazier JE, Harper R, Jones NMB. et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305 (6846): 160-164
• 5 Cella DF, Tulsky DS, Gray G. et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993; 11 (03) 570-579
• 6 Sprangers MAG, Cull A, Groenvold M, Bjordal K, Blazeby J, Aaronson NK. EORTC Quality of Life Study Group. The European Organization for Research and Treatment of Cancer approach to developing questionnaire modules: an update and overview. Qual Life Res 1998; 7 (04) 291-300
• 7 Ferrell BR, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res 1995; 4 (06) 523-531
• 8 Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Qual Life Res 1999; 8 (03) 181-195
• 9 Sprangers MA, te Velde A, Aaronson NK. European Organization for Research and Treatment of Cancer Study Group on Quality of Life. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). Eur J Cancer 1999; 35 (02) 238-247
• 10 Ganesh V, Agarwal A, Popovic M. et al. Comparison of the FACT-C, EORTC QLQ-CR38, and QLQ-CR29 quality of life questionnaires for patients with colorectal cancer: a literature review. Support Care Cancer 2016; 24 (08) 3661-3668
• 11 Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 2012; 255 (05) 922-928
• 12 Grant M, Ferrell B, Dean G, Uman G, Chu D, Krouse R. Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire. Qual Life Res 2004; 13 (08) 1445-1457
• 13 Lim CYS, Laidsaar-Powell RC, Young JM, Kao SCH, Zhang Y, Butow P. Colorectal cancer survivorship: a systematic review and thematic synthesis of qualitative research. Eur J Cancer Care (Engl) 2021; 30 (04) e13421
• 14 Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10 (04) 407-415
• 15 Ringash J, O'Sullivan B, Bezjak A, Redelmeier DA. Interpreting clinically significant changes in patient-reported outcomes. Cancer 2007; 110 (01) 196-202
• 16 Cocks K, King MT, Velikova G, Martyn St-James M, Fayers PM, Brown JM. Evidence-based guidelines for determination of sample size and interpretation of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. J Clin Oncol 2011; 29 (01) 89-96
• 17 Gao X, Kahl AR, Goffredo P. et al. Treatment of stage IV colon cancer in the United States: a patterns-of-care analysis. J Natl Compr Canc Netw 2020; 18 (06) 689-699
• 18 Eyl RE, Xie K, Koch-Gallenkamp L, Brenner H, Arndt V. Quality of life and physical activity in long-term (≥5 years post-diagnosis) colorectal cancer survivors - systematic review. Health Qual Life Outcomes 2018; 16 (01) 112
• 19 Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in “chronic” cancer survivors: a meta-analysis. J Cancer Surviv 2020; 14 (04) 504-517
• 20 Adams SV, Ceballos R, Newcomb PA. Quality of life and mortality of long-term colorectal cancer survivors in the Seattle Colorectal Cancer Family Registry. PLoS One 2016; 11 (06) e0156534
• 21 Quinten C, Martinelli F, Coens C. et al; Patient Reported Outcomes and Behavioral Evidence (PROBE) and the European Organization for Research and Treatment of Cancer (EORTC) Clinical Groups. A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer 2014; 120 (02) 302-311
• 22 Bonnetain F, Borg C, Adams RR. et al. How health-related quality of life assessment should be used in advanced colorectal cancer clinical trials. Ann Oncol 2017; 28 (09) 2077-2085
• 23 Efficace F, Bottomley A, Coens C. et al. 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 (01) 42-49
• 24 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 (01) 171-175
• 25 de Kort SJ, Willemse PHB, Habraken JM, de Haes HCJM, Willems DL, Richel DJ. Quality of life versus prolongation of life in patients treated with chemotherapy in advanced colorectal cancer: a review of randomized controlled clinical trials. Eur J Cancer 2006; 42 (07) 835-845
• 26 Ringash J, Au HJ, Siu LL. et al; NCIC Clinical Trials Group; Australasian Gastrointestinal Trials Group. Quality of life in patients with K-RAS wild-type colorectal cancer: the CO.20 phase 3 randomized trial. Cancer 2014; 120 (02) 181-189
• 27 Seymour MT, Thompson LC, Wasan HS. et al; FOCUS2 Investigators; National Cancer Research Institute Colorectal Cancer Clinical Studies Group. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet 2011; 377 9779 1749-1759
• 28 D'Amico TA, Bandini LAM, Balch A. et al. Quality measurement in cancer care: a review and endorsement of high-impact measures and concepts. J Natl Compr Canc Netw 2020; 18 (03) 250-259
• 29 Andre T, Amonkar M, Norquist JM. et al. Health-related quality of life in patients with microsatellite instability-high or mismatch repair deficient metastatic colorectal cancer treated with first-line pembrolizumab versus chemotherapy (KEYNOTE-177): an open-label, randomised, phase 3 trial. Lancet Oncol 2021; 22 (05) 665-677
• 30 Yoshino T, Watanabe J, Shitara K. et al. Panitumumab (PAN) plus mFOLFOX6 versus bevacizumab (BEV) plus mFOLFOX6 as first-line treatment in patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC): Results from the phase 3 PARADIGM trial. J Clin Oncol 2022; 40 (17) , suppl); LBA1-LBA1
• 31 Avallone A, Giuliani F, Nasti G. et al. Randomized intermittent or continuous panitumumab plus FOLFIRI (FOLFIRI/PANI) for first-line treatment of patients (pts) with RAS/BRAF wild-type (wt) metastatic colorectal cancer (mCRC): The IMPROVE study. J Clin Oncol 2022; 40 (16) , suppl): 3503-3503
• 32 Rausa E, Kelly ME, Bonavina L, O'Connell PR, Winter DC. A systematic review examining quality of life following pelvic exenteration for locally advanced and recurrent rectal cancer. Colorectal Dis 2017; 19 (05) 430-436
• 33 Quyn AJ, Solomon MJ, Lee PM, Badgery-Parker T, Masya LM, Young JM. Palliative pelvic exenteration: clinical outcomes and quality of life. Dis Colon Rectum 2016; 59 (11) 1005-1010
• 34 Wei AC, Coburn NG, Devitt KS. et al. Survival following resection of intra- and extra-hepatic metastases from colorectal cancer: a phase II trial. Ann Surg Oncol 2016; 23 (08) 2644-2651
• 35 Wanis KN, Ardiles V, Alvarez FA. et al. Intermediate-term survival and quality of life outcomes in patients with advanced colorectal liver metastases undergoing associating liver partition and portal vein ligation for staged hepatectomy. Surgery 2018; 163 (04) 691-697
• 36 Heise D, Bayings W, Tuinhof A. et al. Long-term outcome and quality of life after initial and repeat resection of colorectal liver metastasis: a retrospective analysis. Int J Surg 2017; 48 (November): 281-285
• 37 Seretis C, Youssef H. Quality of life after cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: a systematic review. Eur J Surg Oncol 2014; 40 (12) 1605-1613
• 38 Juul T, Ahlberg M, Biondo S. et al. International validation of the low anterior resection syndrome score. Ann Surg 2014; 259 (04) 728-734
• 39 Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2012; 12: CD004323
• 40 Maguire B, Clancy C, Connelly TM. et al. Quality of life meta-analysis following coloanal anastomosis versus abdominoperineal resection for low rectal cancer. Colorectal Dis 2022; 24 (07) 811-820