Quality of life following surgery for breast and coloretal cancer

Abstract

Background. Colorectal and breast cancers are two of the commonest malignant diseases. The approach to these two cancers is markedly different with patients suffering from breast cancer having the benefits of screening, specialist nurses and support groups. In contrast, colorectal cancer has received less attention in terms of screening, support and public interest.
Purpose. This study aimed to collect prospective data on presentation, predisposing factors, co-existing morbidity and management of patients with breast and colorectal cancer and make comparisons with national guidelines. It examined patient perceived quality of life in both colorectal and breast cancer groups prior to and following surgery. The groups were further divided by gender and into stoma and non-stoma (colorectal cancer) and mastectomy and breast conserving surgery (breast cancer). In addition, the work compared the life quality between the colorectal and breast cancer groups and evaluated the appropriateness of newly developed disease specific QOL questionnaires on a UK population.
Methods. This study formed a prospective longitudinal repeated measures design. Patients were evaluated at three time points over a six month period starting at the time at which they underwent their cancer surgery. At the first assessment demographic, clinical and QOL data were collected and at 3 and 6 months clinical data was updated and QOL assessed. Clinical data consisted of pathology, adjuvant therapy, morbidity and mortality. QOL was measured at each assessment using the generic cancer EORTC QLQ-C30 instrument. In addition, the colorectal specific module (EORTC QLQ-CR38)
and the breast specific module (EORTC QLQ-BR23) were administered at 3 and 6 months post surgery.
Results. The clinical data was compared with national guidelines for each cancer population. Guidelines for colorectal cancer were not followed closely whereas those for breast cancer were more formally adhered to. Over the study period, patients with colorectal cancer reported an improvement in emotional functioning, gastrointestinal (CI) symptoms, pain and weight gain. Males reported more nausea, vomiting, dyspnoea and pain. They also had greater sexual enjoyment, although reported more sexual problems. The stoma group had decreased social functioning throughout the study, increased 31 symptoms and sexual problems at 3 months. The non-stoma group had increased emotional functioning from surgery to 3 months and improved sleep. Over the study period, patients with breast cancer reported deterioration in pain, fatigue, dyspnoea and sexual enjoyment. Additionally, at 3 months they reported poorer physical functioning, role functioning and social functioning. The breast conserving group reported deterioration in cognitive functioning, emotional functioning and global well-being and worse diarrhoea. The mastectomy group reported better physical functioning, but poorer role
functioning, body image and future perspective. A comparison of the two cancer groups indicated that there were few QOL differences. The colorectal cancer group had worse pain at the time of surgery and reported more 31 symptoms throughout the study. The breast cancer group had better social functioning, role functioning and physical functioning at the time of surgery, but complained of worse pain at 3 months and had poorer emotional functioning throughout the study. It is interesting to note that for both cancer groups there were generally high levels of functioning. There was difficulty in
interpreting some of the data because the questionnaires were not appropriate/sensitive in certain areas for these populations. There were many missing answers to the questions on sexual health.
Conclusions. This work has provided an insight into the management of two common cancers at a time when guidelines were being established. Quality of life measures with greater sensitivity are required so that they can be used in all clinical trials and longitudinal studies to provide comparable information. There is a need to generate meaningful QOL data that can be easily understood by all clinicians involved in cancer care and which can be incorporated into clinical management.