Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study

Amanda Cummings; Chloe Grimmett; Lynn Calman; Mubarak Patel; Natalia Vadimovna Permyakova; Jane Winter; Jessica Corner; Amy Din; Deborah Fenlon; Alison Richardson; Peter W Smith; Members of CREW Study Advisory Committee; Claire Foster

doi:10.1002/pon.4845

Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study

Psychooncology. 2018 Oct;27(10):2427-2435. doi: 10.1002/pon.4845. Epub 2018 Sep 13.

Authors

Affiliations

¹ Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK.
² Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK.
³ University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁴ Executive Office, University of Nottingham, Nottingham, UK.
⁵ College of Health and Human Sciences, Swansea University, Swansea, UK.
⁶ Health Sciences, University of Southampton, Southampton, UK.

Abstract

Objective: More people are living with the consequences of cancer and comorbidity. We describe frequencies of comorbidities in a colorectal cancer cohort and associations with health and well-being outcomes up to 5 years following surgery.

Methods: Prospective cohort study of 872 colorectal cancer patients recruited 2010 to 2012 from 29 UK centres, awaiting curative intent surgery. Questionnaires administered at baseline (pre-surgery), 3, 9, 15, 24 months, and annually up to 5 years. Comorbidities (and whether they limit activities) were self-reported by participants from 3 months. The EORTC QLQ-C30 and QLQ-CR29 assessed global health/quality of life (QoL), symptoms, and functioning. Longitudinal analyses investigated associations between comorbidities and health and well-being outcomes.

Results: At baseline, the mean age of participants was 68 years, with 60% male and 65% colon cancer. Thirty-two per cent had 1 and 40% had ≥2 comorbidities. The most common comorbidities were high blood pressure (43%), arthritis/rheumatism (32%), and anxiety/depression (18%). Of those with comorbidities, 37% reported at least 1 that limited their daily activities. Reporting any limiting comorbidities was associated with poorer global health/QoL, worse symptoms, and poorer functioning on all domains over 5-year follow-up. Controlling for the most common individual comorbidities, depression/anxiety had the greatest deleterious effect on outcomes.

Conclusions: Clinical assessment should prioritise patient-reported comorbidities and whether these comorbidities limit daily activities, as important determinants of recovery of QoL, symptoms, and functioning following colorectal cancer. Targeted interventions and support services, including multiprofessional management and tailored assessment and follow-up, may aid recovery of health and well-being in these individuals.

Keywords: cancer; colorectal cancer; comorbidities; health and well-being; longitudinal; oncology; quality of life; survivorship.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cancer Survivors / psychology*
Cohort Studies
Colorectal Neoplasms / complications
Colorectal Neoplasms / psychology*
Colorectal Neoplasms / surgery
Comorbidity
Depression / etiology
Depression / psychology*
Female
Humans
Male
Middle Aged
Prospective Studies
Quality of Life / psychology*
Social Support
Socioeconomic Factors
Surveys and Questionnaires
Time Factors