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Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer

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Abstract

Purpose

Data regarding changes in functional status and health-related quality of life (HRQOL) before and after surgery are lacking. We identified colorectal cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database to evaluate the association between HRQOL and survival.

Methods

HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with HRQOL surveys prior to cancer diagnosis and ≥ 1 year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed in regard to overall survival (OS), disease-specific survival (DSS), and non-DSS.

Results

Of 590 patients included, 55% were female, 75% were Caucasian, and 83% had colonic primary. Disease extent was localized for 52%, regional for 41%, and distant for 7%. Median OS was 83 months. Decreased OS was independently associated with age ≥ 75 (HR 1.7, p < 0.0001), male sex (HR 1.4, p = 0.011), advanced disease (regional—HR 2.0, p < 0.0001; distant—HR 7.0, p < 0.0001), and decreased mental HRQOL (HR 1.4, p = 0.005). Decreased DSS was independently associated with advanced disease (regional—HR 4.1, p < 0.0001; distant—HR 16.5, p < 0.0001) and rectal primary (HR 1.6, p = 0.047). Decreased non-DSS was independently associated with age ≥ 75 (HR 2.2, p < 0.0001), male sex (HR 1.4, p = 0.03), decreased mental HRQOL (HR 1.4, p = 0.02), and increased comorbidities (HR 1.4, p = 0.04).

Conclusions

The potential overall survival benefit of oncologic surgery is diminished by declines in physical and mental health. Early identification of older surgical patients at risk for functional and HRQOL declines may improve survival following colorectal cancer surgery.

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Authors and Affiliations

  1. Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA

    Andrew M. Blakely, Stephen M. Sentovich, Kurt A. Melstrom, Lily L. Lai, Yuman Fong & Virginia Sun

  2. Department of Graduate Medical Education and Clinical Training, City of Hope National Medical Center, Duarte, CA, USA

    Dayana Chanson

  3. Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA

    F. Lennie Wong & Virginia Sun

  4. Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA

    Oliver S. Eng

Authors
  1. Andrew M. Blakely
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  2. Dayana Chanson
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  3. F. Lennie Wong
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  4. Oliver S. Eng
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Correspondence to Andrew M. Blakely.

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SYNOPSIS

Health-related quality of life was assessed among older colorectal cancer surgical patients in the SEER-MHOS dataset. Early identification of older surgical patients at risk for declines in functional and health-related quality of life may optimize oncologic outcomes.

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Blakely, A.M., Chanson, D., Wong, F.L. et al. Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer. Support Care Cancer 28, 2857–2865 (2020). https://doi.org/10.1007/s00520-019-05087-3

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  • DOI: https://doi.org/10.1007/s00520-019-05087-3

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