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Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials

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Abstract

Goals of work

Health-related quality of life (HRQL) is an important outcome after surgery for colorectal cancer (CRC), and accurate assessment is required to fully inform clinical decision making. The purpose of this review is to summarise randomised surgical trials in CRC with robust HRQL to consider the role of HRQL in surgical decision making.

Materials and methods

A systematic review in Medline and the Cochrane Controlled Trials Register identified randomised surgical trials with HRQL. HRQL assessment was categorised as robust according to predefined criteria, and the clinical implications of HRQL were considered.

Main results

One hundred seventy-seven articles were identified, and a detailed review reduced this to eight trials. Four compared laparoscopic with open surgery, and four evaluated coloanal anastomotic techniques. The most commonly used HRQL instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and HRQL was usually a secondary outcome measure. In four (50%) trials, HRQL assessment was categorised as methodologically robust, although only two trials had sample size calculations based upon a HRQL endpoint. Six trials based the final treatment recommendation in the context of the HRQL outcomes.

Conclusion

In randomised surgical trials in CRC, HRQL assessment informs clinical decision making, and future trials require robust assessment of relevant patient-reported outcomes.

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References

  1. Wilson TR, Alexander DJ, Kind P (2006) Measurement of health-related quality of life in the early follow-up of colon and rectal cancer. Dis Colon Rectum 49:1692–1702

    Article  PubMed  Google Scholar 

  2. Sprangers MA, Taal BG, Aaronson NK, te VA (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38:361–369

    Article  PubMed  CAS  Google Scholar 

  3. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  4. Gujral S, Conroy T, Fleissner C, Sezer O, King PM, Avery KN et al (2007) Assessing quality of life in patients with colorectal cancer: An update of the EORTC quality of life questionnaire. Eur J Cancer 43:1564–1573

    Article  PubMed  CAS  Google Scholar 

  5. Sprangers MAG, te V, Aaronson NK, on behalf of the European Organisation for Research and Treatment of Cancer Study Group on Quality of Life (1999) The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). Eur J Cancer 35:238–247

    Article  PubMed  CAS  Google Scholar 

  6. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A et al (1993) The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol 11:570–579

    PubMed  CAS  Google Scholar 

  7. Ward WL, Hahn EA, Mo F, Hernandex L, Tulsky DS, Cella D (1999) Reliability and validity of the Functional Assessment Of Cancer Therapy Colorectal (FACT-C) quality of life instrument. Qual Life Res 8:181–195

    Article  PubMed  CAS  Google Scholar 

  8. Avery K, Blazeby JM (2006) Quality of life assessment in surgical oncology trials. World J Surg 30:1163–1172

    Article  PubMed  Google Scholar 

  9. Efficace F, Bottomley A, Osoba D, Gotay C, Flechtner H, D’haese S et al (2003) Beyond the development of health-related quality-of-life (HRQOL) measures: a checklist for evaluating HRQOL outcomes in cancer clinical trials—does HRQOL evaluation in prostate cancer research inform clinical decision making? J Clin Oncol 21:3502–3511

    Article  PubMed  Google Scholar 

  10. Blazeby JM, Avery K, Sprangers M, Pikhart H, Fayers P, Donovan J (2006) Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol 24:3178–3186

    Article  PubMed  Google Scholar 

  11. Furst A, Burghofer K, Hutzel L, Jauch KW (2002) Neorectal reservoir is not the functional principle of the colonic J- pouch: the volume of a short colonic J-pouch does not differ from a straight coloanal anastomosis. Dis Colon Rectum 45:660–667

    Article  PubMed  Google Scholar 

  12. Sailer M, Fuchs KH, Fein M, Thiede A (2002) Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction. Br J Surg 89:1108–1117

    Article  PubMed  CAS  Google Scholar 

  13. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  14. King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH et al (2005) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308

    Article  Google Scholar 

  15. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

    Article  PubMed  Google Scholar 

  16. Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW et al (2002) Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 236:49–55

    Article  PubMed  Google Scholar 

  17. Brundage M, Feldman-Stewart D, Leis A, Bezjak A, Degner L, Velji K et al (2005) Communicating quality of life information to cancer patients: a study of six presentation formats. J Clin Oncol 23:6949–6956

    Article  PubMed  CAS  Google Scholar 

  18. de Boer AGEM, van Lanschot JJB, van Sandick JW, Hulscher JBF, Stalmeier PFM, De Haes JCJM et al (2004) Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol 22:4202–4208

    Article  PubMed  Google Scholar 

  19. Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

    Article  PubMed  Google Scholar 

  20. de Kort SJ, Willemse PH, Habraken JM, de Haes HC, Willems DL, Richel DJ (2006) 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 42:835–845

    Article  PubMed  Google Scholar 

  21. Schwenk W, Bohm B, Muller JM (1998) Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial. Surg Endosc 12:1131–1136

    Article  PubMed  CAS  Google Scholar 

  22. Park JG, Lee MR, Lim SB, Hong CW, Yoon SN, Kang SB et al (2005) Colonic J-pouch anal anastomosis after ultralow anterior resection with upper sphincter excision for low-lying rectal cancer. World J Gastroenterol 11:2570–2573

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgery, Head and Neck, United Bristol Healthcare Trust, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK

    Sameer Gujral & Jane M. Blazeby

  2. Clinical Sciences at South Bristol, University of Bristol, Bristol Royal Infirmary, Bristol, BS2 8HW, UK

    Sameer Gujral & Jane M. Blazeby

  3. Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK

    Kerry N. L. Avery & Jane M. Blazeby

  4. Clinical Sciences at South Bristol, Level 7 Research and teaching Floor, United Bristol Healthcare Trust, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK

    Jane M. Blazeby

Authors
  1. Sameer Gujral
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  2. Kerry N. L. Avery
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  3. Jane M. Blazeby
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Correspondence to Jane M. Blazeby.

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Gujral, S., Avery, K.N.L. & Blazeby, J.M. Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials. Support Care Cancer 16, 127–132 (2008). https://doi.org/10.1007/s00520-007-0356-2

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  • DOI: https://doi.org/10.1007/s00520-007-0356-2

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