Quality of life and fear of cancer recurrence in T1 colorectal cancer patients treated with endoscopic or surgical tumor resection

BACKGROUND AND AIMS

To optimize therapeutic decision-making in early invasive colorectal cancer (T1 CRC) patients, it is important to elicit the patient's perspective next to considering medical outcome. Because empirical data on patient-reported impact of different treatment options are lacking, we evaluated patients' quality of life, perceived time to recovery, and fear of cancer recurrence after endoscopic or surgical treatment for T1 CRC.

METHODS

In this cross-sectional study, we selected patients with histologically confirmed T1 CRC who participated in the Dutch Bowel Cancer Screening Programme and received endoscopic or surgical treatment between January 2014 and July 2017. Quality of life was measured using the European Organization for Research and Treatment 30-item Core Quality of Life Questionnaire and the 5-level EuroQoL 5-dimension questionnaire. We used the Cancer Worry Scale (CWS) to evaluate patients' fear of cancer recurrence. A question on perceived time to recovery after treatment was also included in the set of questionnaires sent to patients.

RESULTS

Of all 119 eligible patients, 92.4% responded to the questionnaire (endoscopy group, 55/62; surgery group, 55/57). Compared with the surgery group, perceived time to recovery was on average 3 months shorter in endoscopically treated patients after adjustment for confounders (19.9 days vs 111.3 days; P = .001). The 2 treatment groups were comparable with regard to global quality of life, functioning domains, and symptom severity scores. Moreover, patients in the endoscopy group did not report more fear of cancer recurrence than those in the surgery group (CWS score, 0-40; endoscopy 7.6 vs surgery 9.7; P = .140).

CONCLUSIONS

From the patient's perspective, endoscopic treatment provides a quicker recovery than surgery, without provoking more fear of cancer recurrence or any deterioration in quality of life. These results contribute to the shared therapeutic decision-making process of clinicians and T1 CRC patients.

Quality of Life after Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM)

AIM

Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM) may be considered a valid alternative surgical treatment in patients with rectal cancer. Aim of this study is to evaluate the short and medium term Quality of Life (QoL) from prospectively collected data in patients who underwent ELRR by TEM.

MATERIAL OF STUDY

From May 2010 to June 2013, 31 patients with iT1-iT2-iT3N0 rectal cancer were enrolled in this study. Patients with T1 rectal cancer underwent ELRR by TEM. Patients with iT2-iT3 rectal cancer underwent neoadjuvant radio-chemoterapy (n-RCT) before surgery. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires before surgery and 1, 6, and 12 months after surgery.

RESULTS

Mean distance from the anal verge was 5.4 cm (range 1-10). Mean operative time was 145.8 minutes (range 60-300). Pathological staging was as follows: pT0N0 (6), pT1N0 (18), pT2N0 (7). At 1 month after surgery, in QLQC30 questionnaire, significant worsening was observed in Global Health Status (p=0.0028), Physical Functioning (p=0.0016), Role Functioning (p=0.0004), Fatigue (p=0.0024), Pain (p=0.0003) and Dyspnoea (p=0.0192). In QLQCR38 questionnaire significant worsening at 1 month was observed in Defecation Problems (p=0.0005) and Weight Loss (p=0.0008). At six and twelve months after surgery, no significant differences were observed in QLQ-C30 and in QLQCR38 questionnaires.

DISCUSSION

QoL evaluation showed worsening results at 1 month after ELRR by TEM, in QLQ-C30 and in QLQCR38 questionnaires.

CONCLUSIONS

At 6 and 12 months after surgery, no significant differences in QoL as compared to preoperative status were observed.