Living beyond a diagnosis of colorectal cancer: what problems are patients faced with?

This study examined the treatments received and health-related quality of life of patients living with and beyond colorectal cancer. They also identified factors that were associated with poor health outcomes.

The numbers of patients living with or beyond the diagnosis of colorectal cancer is increasing worldwide. In the United States alone it is expected that 1.5 million Americans will be living with or beyond a diagnosis of colorectal cancer by 2022. In order to improve aftercare quality for this growing number of patients it is important to determine the problems patients most commonly face.

Evidence suggests that treatment for colorectal cancer can leave patients with bowel, urinary, and sexual problems. However, the majority of this evidence is derived from clinical trials or small scale hospital studies. A larger study would improve the accuracy of these results and could help improve aftercare for patients.

This study included 21,802 Individuals older than 16 years surviving 12 to 36 months after a diagnosis of colorectal cancer. Individuals were sent questionnaires relating to their treatment, disease status, other existing conditions, health-related quality of life, and cancer specific outcomes.

At the time of the questionnaire 76.3% of patients were in remission (decrease in or disappearance of signs and symptoms of cancer) and 4.9% had been treated but the cancer was still present. The most common treatment received was surgery only (46.3%), surgery plus chemotherapy (28.6%) or surgery plus chemoradiation (chemotherapy and radiation; 13.5%).

54.2% of patients did not have a stoma (a surgically created opening from the abdomen to the bowel to eliminate bowel waste). Stomas were more common in patients with rectal cancer (73.3% reported having a current or previous stoma) than patients with colon cancer (16.8% reported having a current or previous stoma).

The health-related quality of life questions focused on patient mobility, self-care, ability to participate in usual activities, pain or discomfort, and depression or anxiety. One or more of these health problems were reported by 65% of patients and 10% of patients responded to problems in all five areas. Certain subgroups of patients were more likely to suffer from these problems: patients younger than 55 or older than 85, patients with other long-term conditions, patients with a stoma, or patients with active or recurrent disease.

The cancer-specific questions were related to bowel control, urinary problems and sexual problems. 16.3% of patients without a stoma reported having no bowel control at all, while 47.6% reported having full bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma.

Overall, 3.8% of patients reported having difficulty urinating, 12.7% reported needing to urinate more frequently and 4.6% reported leaking urine. 15.8% of patients reported difficulties with sexual matters. Sexual difficulties were more common in patients with rectal cancer (25.1%) than patients with colon cancer (11.2%).

The authors concluded that there are subgroups of patients who are more likely to report problems after treatment. They suggest that the results may improve the identification of specific problems faced by individuals after treatment for colorectal cancer. 

This study was only carried out in England. Some differences in treatment and health-related outcomes may exist in other countries.