SURVIVAL FOLLOWING TREATMENT FOR COLORECTAL CANCER MAY DEPEND ON A PATIENT'S PHYSICAL QUALITY OF LIFE

Chicago - The overall quality of a person's physical health may affect survival after treatment for colorectal cancer. According to a study presented at the 2003 Clinical Congress of the American College of Surgeons, fewer patients with impaired physical quality of life were alive 36 months after treatment for colorectal cancer in contrast to the survival rate of their healthier counterparts. The difference in survival was particularly evident among patients with Stage II disease, who typically are considered to be at low risk for mortality or cancer recurrence. Among Stage II patients, just a little over half (55 percent) of patients with a lower physical quality of life score were alive at 36 months compared with 83 percent of patients with a higher score. Among Stage I patients, 90 percent who had a lower health-related physical quality of life score were alive at 36 months compared with 100 percent of patients with a higher score.

The implications from the study are twofold. First, assessing a patient's health-related quality of life may provide another method, in addition to cancer staging, for stratifying risk and making treatment decisions. "A patient with Stage II colon cancer wouldn't traditionally be considered for adjuvant chemotherapy. But if a Stage II patient scored low on the physical component of health-related quality of life, that patient might be more likely to develop disease recurrence and might benefit from adjuvant therapy," said Thomas Anthony, MD, FACS, associate professor of surgery at the University of Texas Southwestern, Dallas, and chief of surgical services at VA North Texas Health Care System, Dallas.

Second, if further studies show that health-related quality of life directly affects survival, surgeons may look for ways of improving a patient's overall health status before instituting treatment. "A patient might have a better chance of survival with an intervention, such as occupational or physical therapy or some other means of influencing quality of life," Dr. Anthony explained.

In the study, 135 patients with colorectal cancer completed two quality of life assessment surveys, the Short Form 36 (SF-36) and the Functional Assessment of Cancer Therapy for Colorectal Cancer (FACT-C), before they received treatment. The SF-36 is a general health-related quality of life measurement tool that can be used with many disease processes. It has two parts. The physical component assesses the effects of a patient's physical problems on his or her ability to perform activities of daily living (ADL) - carry groceries, bend over, kneel, climb stairs, and walk. The mental component measures overall mental health status and social functioning.

The SF-36 has some drawbacks in the evaluation of patients with colorectal cancer because it does not measure health issues specifically associated with the disease or its treatment, such as changes in bowel habits, body image, and sexual function. The FACT-C is directed specifically at issues surrounding colorectal cancer and its management.

Surgeons at the University of Texas Southwestern tabulated the median scores for both the physical and mental component of the SF-36, as well as the FACT-C, and compared survival rates for patients with SF-36 and FACT-C scores that were higher or lower than the median.

The surgeons found that patients with health-related quality of life scores below the median for the physical component of the SF-36 were less likely to survive for 36 months following treatment. The difference was statistically significant for all patients in the study (p=0.04) and for patients with Stage I or Stage II colorectal cancer (p=0.03). Findings related to the mental component of the SF-36 trended in the same direction, but they did not reach statistical significance. Most of the patients in the study (83 percent) had Stage I or Stage II colorectal cancer, which usually have five-year survival rates of 90 percent and 75 percent, respectively.

At this point, clinical data are not strong enough to base treatment decisions on quality of life scores or to conclude that pretreatment quality of life status predicts survival. Nevertheless, Dr. Anthony suggested that health-related quality of life tools, such as the SF-36 and FACT-C, may be more effective than standard methods of workup for capturing information about the comorbid medical conditions that may compromise treatment for colorectal cancer. "As surgeons, we tend to think about comorbidities in isolation. We tend to put a patient's coexisting diseases, such as cardiac disease, chronic obstructive pulmonary disease, or diabetes, in individual categories. We don't summarize them in any particular way. Health-related quality of life takes all of these conditions into account and summarizes how all of them in total have diminished a patient's sense of well-being," he said.

The SF-36 quality of life survey also may signal undiagnosed or undetected comorbidities. "This tool captures the impact of all comorbidities directly or indirectly on overall well-being. It is a fairly robust measure of that construct."

Dr. Anthony's colleagues in this study were Joshua W. Long, BA; George Sarosi, Jr., MD, FACS; Fiemu Nwariaku, MBBS, FACS; Linda Hynan, PhD; Betty Parker, RN; Charlene Jones, RN; Vernice Willis, RN; Merinda White, RN.

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