Trajectories of health-related quality of life and psychological distress in patients with colorectal cancer: A population-based study

Seyed M Qaderi; Joost A G van der Heijden; Rob H A Verhoeven; Johannes H W de Wilt; Jose A E Custers; PLCRC study group

doi:10.1016/j.ejca.2021.08.050

Trajectories of health-related quality of life and psychological distress in patients with colorectal cancer: A population-based study

Eur J Cancer. 2021 Oct 16:158:144-155. doi: 10.1016/j.ejca.2021.08.050. Online ahead of print.

Authors

Seyed M Qaderi¹, Joost A G van der Heijden², Rob H A Verhoeven³, Johannes H W de Wilt², Jose A E Custers⁴; PLCRC study group

Collaborators

PLCRC study group:
Geerard L Beets⁵, Eric J Th Belt⁶, Maaike Berbée⁷, Frederique H Beverdam⁸, Ruud Blankenburgh⁹, Peter Paul L O Coene¹⁰, Jan Willem B de Groot¹¹, Ignace H J T de Hingh¹², Aad I de Vos¹³, Johannes H W de Wilt¹⁴, Jan Willem T Dekker¹⁵, Frans L G Erdkamp¹⁶, Annebeth W Haringhuizen¹⁷, Helgi H Helgason¹⁸, Mathijs P Hendriks¹⁹, Ronald Hoekstra²⁰, Jan N M Ijzermans²¹, Jan Jansen²², Frank W H Kloppenberg²³, Maartje Los²⁴, Martijn R Meijerink²⁵, Leonie J M Mekenkamp²⁶, Peter Nieboer²⁷, Koen C M J Peeters²⁸, Natascha A J B Peters²⁹, Marco B Polée³⁰, Johannes F M Pruijt³¹, Patricia Quarles van Ufford-Mannesse³², Ron C Rietbroek³³, Anandi H W Schiphorst³⁴, Arjan Schouten van der Velden³⁵, Ruud W M Schrauwen³⁶, Mark P S Sie³⁷, Lieke Simkens³⁸, Dirkje W Sommeijer³⁹, Dirk J A Sonneveld⁴⁰, Leontine E A Spierings⁴¹, Hein B A C Stockmann⁴², Koen Talsma⁴³, Albert J Ten Tije⁴⁴, Frederiek Terheggen⁴⁵, Manuel L R Tjin-A-Ton⁴⁶, Liselot B J Valkenburg-van Iersel⁴⁷, Hester van Cruijsen⁴⁸, Ankie M T van der Velden⁴⁹, Joyce M van Dodewaard-de Jong⁵⁰, Anja U G van Lent⁵¹, Theo van Voorthuizen⁵², Maarten Vermaas⁵³, Wouter J Vles⁵⁴, Jeroen F J Vogelaar⁵⁵, David D E Zimmerman⁵⁶

Affiliations

¹ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgical Oncology, Nijmegen, the Netherlands. Electronic address: [email protected].
² Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgical Oncology, Nijmegen, the Netherlands.
³ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgical Oncology, Nijmegen, the Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Amsterdam UMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, the Netherlands.
⁴ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands.
⁵ Department of Surgery, Nederlands Kanker Instituut - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
⁶ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
⁷ Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands.
⁸ Department of Surgery, Franciscus Gasthuis & Vlietland Hospital, Schiedam, the Netherlands.
⁹ Department of Medical Oncology, Saxenburgh Hospital, Hardenberg, the Netherlands.
¹⁰ Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
¹¹ Department of Medical Oncology, Isala Oncology Center, Zwolle, the Netherlands.
¹² Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
¹³ Department of Medical Oncology, Van Weel-Bethesda Hospital, Dirksland, the Netherlands.
¹⁴ Department of Surgery, Radboud University Medical Center, University of Nijmegen, Nijmegen, the Netherlands.
¹⁵ Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands.
¹⁶ Department of Medical Oncology, Zuyderland Hospital, Heerlen, the Netherlands.
¹⁷ Department of Medical Oncology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands.
¹⁸ Department of Medical Oncology, Haaglanden Medical Center, Den Haag, the Netherlands.
¹⁹ Department of Medical Oncology, Northwest Clinics, Alkmaar, the Netherlands.
²⁰ Department of Medical Oncology, Ziekenhuisgroep Twente, Hengelo, the Netherlands.
²¹ Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
²² Department of Surgery, Admiraal de Ruyter Hospital, Goes, the Netherlands.
²³ Department of Surgery, Treant Hospital, Emmen, the Netherlands.
²⁴ Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, the Netherlands.
²⁵ Department of Radiotherapy, VU Medical Center, Amsterdam, the Netherlands.
²⁶ Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands.
²⁷ Department of Medical Oncology, Wilhelmina Hospital, Assen, the Netherlands.
²⁸ Department of Surgery, Leiden Univresity Medical Center, University of Leiden, Leiden, the Netherlands.
²⁹ Department of Medical Oncology, Sint Jans Hospital, Weert, the Netherlands.
³⁰ Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
³¹ Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
³² Department of Medical Oncology, Haga Hospital, Den Haag, the Netherlands.
³³ Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, the Netherlands.
³⁴ Department of Surgery, Diakonessenhuis Hospital, Utrecht, the Netherlands.
³⁵ Department of Surgery, St. Jansdal Hospital, Harderwijk, the Netherlands.
³⁶ Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, the Netherlands.
³⁷ Department of Medical Oncology, ZorgSaam Hospital, Terneuzen, the Netherlands.
³⁸ Department of Medical Oncology, Maxima Medical Center, Eindhoven, the Netherlands.
³⁹ Department of Medical Oncology, Flevo Hospital, Almere, the Netherlands; Department of Medical Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
⁴⁰ Department of Surgery, Dijklander Hospital, Purmerend, the Netherlands.
⁴¹ Department of Medical Oncology, Alrijne Hospital, Leiderdorp, the Netherlands.
⁴² Department of Surgery, Spaarne Hospital, Haarlem, the Netherlands.
⁴³ Department of Surgery, Deventer Hospital, Deventer, the Netherlands.
⁴⁴ Department of Medical Oncology, Amphia ziekenhuis, Breda, the Netherlands.
⁴⁵ Department of Medical Oncology, Bravis Hospital, Roosendaal, the Netherlands.
⁴⁶ Department of Medical Oncology, Rivierenland Hospital, Tiel, the Netherlands.
⁴⁷ Department of Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands.
⁴⁸ Department of Medical Oncology, Antonius Hospital, Sneek, the Netherlands.
⁴⁹ Department of Medical Oncology, Tergooi Hospital, Hilversum, the Netherlands.
⁵⁰ Department of Medical Oncology, Meander Medical Center, Amersfoort, the Netherlands.
⁵¹ Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Hospital, Amsterdam, the Netherlands.
⁵² Department of Medical Oncology, Rijnstate Hospital, Arnhem, the Netherlands.
⁵³ Department of Surgery, Ijsselland Hospital, Capelle aan den Ijssel, the Netherlands.
⁵⁴ Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands.
⁵⁵ Department of Surgery, Viecuri Hospital, Venlo, the Netherlands.
⁵⁶ Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.

PMID: 34666216
DOI: 10.1016/j.ejca.2021.08.050

Abstract

Background: The aim of this nationwide cohort study was to examine the course of symptoms and trajectories of health-related quality of life (HR-QoL) and psychological distress during follow-up and to identify vulnerable patients.

Methods: Patients with pathological stage I-III colorectal cancer (CRC) between 2013 and 2018 were included. Baseline characteristics were collected from the Netherlands Cancer Registry, and patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30/CR29, Hospital Anxiety and Depression Scale and low anterior resection syndrome (LARS) questionnaires at the baseline and subsequently at 3, 6, 12, 18 and 24 months. Latent class growth and multinomial logistic regression analyses were performed to outline 24-month trajectories in HR-QoL and distress and to identify predictive factors.

Results: A total of 1535 patients with colon cancer or rectal cancer were included. Trajectory analysis of HR-QoL identified three patient classes: high HR-QoL (62.7%), improving HR-QoL (29.0%) and low HR-QoL (8.3%). The following patient groups were identified with having low distress (64.0%), moderate distress (26.9%) and high distress (9.1%). Around 13% of the total cohort had either persistent low HR-QoL or high psychological distress throughout follow-up. Patients belonging to this vulnerable group were significantly more likely to be female, to be younger aged, to have lower education, to have disease stage II-III or to have major LARS.

Conclusions: Although most patients treated for stage I-III CRC fared well, a small but significant proportion of around 13% did not recover during follow-up and reported low HR-QoL and/or high psychological distress levels throughout. This study's findings should be taken into account when organising and selecting patients for tailored follow-up.

Keywords: Cancer; Colorectal cancer; Follow-up; Psychological distress; Quality of life; Surveillance; Symptom burden.