Bowel Cancer and Quality of Life

Thanks to enhanced diagnosis and therapy, sixty percent of colorectal cancer patients survive by now for at least five years after tumor diagnosis. But how does the disease affect their health-related quality of life in the long term? The German Cancer Research Center (DKFZ) in Heidelberg now reports the results of a long-term study showing that even ten years after diagnosis bowel cancer patients still suffer from health limitations. However, their impact varies depending on the age of those affected.

Associate Professor (PD) Dr. Volker Arndt and Professor Dr. Hermann Brenner of DKFZ, jointly with colleagues of the Epidemiological Cancer Register of Saarland, have surveyed 117 colorectal cancer patients over a period of ten years. Study subjects were questioned at regular intervals about their health status and the data obtained were compared with those of controls of the same age.

It was not at all surprising to find that colorectal cancer and its treatment leave traces. All of those affected reported long-term handicaps, particularly digestive problems such as diarrhea and constipation. Effects on the quality of life in cognitive, social and emotional respects, however, were dependent on people’s age at first diagnosis.

In the youngest patient group, comprising patients whose tumor was discovered under age 60, quality of life tended to be restricted most by mental and social problems. Many cited work, hobbies and everyday activities to be affected by limitations. Subjects also complained about problems concentrating, fatigue and sleeping disorders. Although such symptoms improved during the first years following diagnosis, they were still present ten years after.

By contrast, the eldest patients, who had been diagnosed with cancer after age 70, reported that their health status during the first few years after diagnosis was comparable or even better than that of persons of the same age not affected by bowel cancer. However, five to ten years after diagnosis, they reported similar health limitations as younger patients, including shortness of breath in many cases.

However, despite these particular limitations, bowel cancer survivors rate their general health and quality of life as comparable to that of control persons.

The researchers surmise that elderly patients have better strategies for coping with a sudden diagnosis of bowel cancer. They also consider it possible that different treatment methods during the first years play a role, since elderly patients receive less chemotherapy and radiotherapy.

The DKFZ researchers now consider it particularly important to investigate which factors besides age have an impact on the long-term effects of cancer. Moreover, it is mandatory to continue care of cancer survivors after treatment has ended. Volker Arndt: “From our point of view, psychological care of patients is of particular importance, because most limitations appear in the psycho-social sphere.”

Lina Jansen, Antje Herrmann, Christa Stegmaier, Susanne Singer, Hermann Brenner, Volker Arndt,: Health-Related Quality of Life During 10 Years After Diagnosis of Colorectal Cancer: A Population-Based Study. Journal of Clinical Oncology 18 July 2011; DOI: 10.1200/JCO.2010.31.4013