Background
Methods
Study population
Health-related quality of life assessment
Assessment of sociodemographic, clinical, and lifestyle characteristics
Vital status ascertainment
Statistical analyses
Results
Participant characteristics
Participant characteristics | Total sample | Summary score < median | Summary score ≥ median | pa |
---|---|---|---|---|
Total no. of individuals, n | 1294 | 647 | 647 | |
No. of deaths, n (%) | 175 (14) | 117 (18) | 58 (9) | < 0.0001 |
Sex, n (%) | ||||
Men | 740 (57) | 362 (56) | 378 (58) | |
Women | 554 (43) | 285 (44) | 269 (42) | 0.37 |
Age at diagnosis, y | 62 (56–66) | 62 (56–66) | 61 (57–65) | 0.27 |
Age at HRQOL assessment, y | 69 (64–73) | 69 (63–74) | 69 (64–73) | 0.25 |
Time between CRC diagnosis and HRQOL assessment, y | 6 (5–8) | 6 (5–8) | 6 (5–8) | 0.37 |
BMI, kg/m2 | 26.2 (23.9–29.2) | 26.4 (24.0–29.4) | 26.0 (23.7–28.9) | 0.02 |
Physical activity, MET-hours/week | 101 (65–149) | 102 (64–144) | 100 (66–152) | 0.35 |
Education, n (%) | ||||
Low | 597 (46) | 311 (48) | 286 (44) | |
Middle | 393 (30) | 196 (30) | 197 (30) | |
High | 292 (23) | 135 (21) | 157 (24) | |
Unknown | 12 (1) | 5 (1) | 7 (1) | 0.39 |
Family status, n (%) | ||||
Single | 52 (4) | 27 (4) | 25 (4) | |
Married or in a partnership | 991 (77) | 482 (75) | 509 (79) | |
Divorced | 65 (5) | 37 (6) | 28 (4) | |
Widowed | 147 (11) | 76 (12) | 71 (11) | |
Unknown | 39 (3) | 25 (4) | 14 (2) | 0.26 |
Smoking status, n (%) | ||||
Never | 509 (39) | 238 (37) | 271 (42) | |
Former | 649 (50) | 342 (53) | 307 (47) | |
Current | 116 (9) | 56 (9) | 60 (9) | |
Unknown | 20 (2) | 11 (2) | 9 (1) | 0.22 |
Tumor location, n (%) | ||||
Colon | 613 (47) | 278 (43) | 335 (52) | |
Rectum | 552 (43) | 293 (45) | 259 (40) | |
Both | 58 (4) | 39 (6) | 19 (3) | |
Unknown | 71 (5) | 37 (6) | 34 (5) | 0.002 |
Metastases, n (%) | ||||
Yes | 209 (16) | 124 (19) | 85 (13) | |
No | 872 (67) | 429 (66) | 443 (68) | |
Unknown | 213 (16) | 94 (15) | 119 (18) | 0.005 |
Other Cancer, n (%) | ||||
Yes | 270 (21) | 154 (24) | 116 (18) | |
No | 997 (77) | 482 (75) | 515 (80) | |
Unknown | 27 (2) | 11 (2) | 16 (2) | 0.03 |
Therapy, n (%) | ||||
None | 681 (53) | 319 (49) | 362 (56) | |
Chemotherapy | 285 (22) | 135 (21) | 150 (23) | |
Radiation | 40 (3) | 21 (3) | 19 (3) | |
Chemotherapy and radiation | 268 (21) | 164 (25) | 104 (16) | |
Unknown | 20 (2) | 8 (1) | 12 (2) | 0.001 |
Current Stoma, n (%) | ||||
Yes | 151 (12) | 89 (14) | 62 (10) | |
No | 1130 (87) | 551 (85) | 579 (89) | |
Unknown | 13 (1) | 7 (1) | 6 (1) | 0.06 |
Health-related quality of life status in long-term colorectal cancer survivors
QLQ-C30 Scales | Median (IQR) | Symptom prevalence |
---|---|---|
Summary score | 87.3 (75.3–94.4) | |
Global QOL | 75.0 (58.3–83.3) | |
Functioning scales | ||
Physical functioning | 86.7 (73.3–100) | |
Role functioning | 100 (66.7–100) | |
Emotional functioning | 83.3 (66.7–100) | |
Cognitive functioning | 83.3 (66.7–100) | |
Social functioning | 100 (66.7–100) | |
Symptom scales | ||
Fatigue | 22.2 (0–33.3) | 70% |
Nausea and vomiting | 0 (0–0) | 12% |
Pain | 0 (0–33.3) | 44% |
Dyspnea | 0 (0–33.3) | 38% |
Insomnia | 33.3 (0–33.3) | 52% |
Appetite loss | 0 (0–0) | 14% |
Constipation | 0 (0–0) | 24% |
Diarrhea | 0 (0–33.3) | 36% |
Financial difficulties | 0 (0–0) | 23% |
Correlates of health-related quality of life
Characteristics | n | Summary score < median | Global QOL < median | Physical functioning scale <median | Role functioning scale <median | Emotional functioning scale <median | Social functioning scale <median | Cognitive functioning scale <median |
---|---|---|---|---|---|---|---|---|
OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | ||
Sex | ||||||||
Male | 740 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Female | 554 | 1.19 (0.94–1.51) | 0.95 (0.75–1.21) | 1.65 (1.29–2.11) | 0.96 (0.75–1.22) | 1.01 (0.80–1.27) | 0.61 (0.48–0.78) | 0.78 (0.62–0.99) |
Age, years | ||||||||
< 60 | 192 | 1.31 (0.93–1.86) | 1.21 (0.85–1.71) | 0.85 (0.60–1.21) | 1.21 (0.85–1.72) | 1.38 (0.98–1.96) | 1.46 (1.02–2.10) | 1.19 (0.85–1.68) |
60–69 | 520 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
70–79 | 479 | 1.21 (0.94–1.57) | 1.20 (0.93–1.56) | 1.70 (1.31–2.22) | 1.15 (0.89–1.49) | 0.97 (0.75–1.25) | 0.77 (0.59–1.01) | 1.29 (1.00–1.66) |
≥ 80 | 103 | 1.58 (1.00–2.49) | 1.85 (1.15–2.96) | 3.91 (2.34–6.52) | 2.07 (1.30–3.29) | 0.89 (0.57–1.39) | 0.58 (0.36–0.94) | 1.85 (1.17–2.91) |
Education | ||||||||
Low | 597 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Middle | 393 | 0.99 (0.76–1.30) | 0.68 (0.52–0.89) | 0.96 (0.73–1.26) | 0.95 (0.73–1.25) | 0.95 (0.73–1.23) | 1.09 (0.82–1.43) | 1.04 (0.80–1.35) |
High | 292 | 0.86 (0.64–1.16) | 0.58 (0.43–0.78) | 0.67 (0.49–0.91) | 0.87 (0.64–1.17) | 0.89 (0.66–1.19) | 0.75 (0.55–1.02) | 0.79 (0.59–1.06) |
Family status | ||||||||
Single | 52 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Married/in partnership | 991 | 0.96 (0.54–1.72) | 0.87 (0.49–1.57) | 0.73 (0.40–1.34) | 0.86 (0.48–1.54) | 0.98 (0.55–1.74) | 1.14 (0.63–2.09) | 1.16 (0.65–2.07) |
Divorced | 65 | 1.35 (0.63–2.89) | 0.98 (0.46–2.09) | 0.99 (0.45–2.18) | 0.97 (0.45–1.08) | 0.97 (0.46–2.05) | 1.09 (0.49–2.41) | 1.21 (0.57–2.55) |
Widowed | 147 | 0.97 (0.50–1.89) | 1.14 (0.58–2.24) | 0.67 (0.33–1.37) | 0.82 (0.42–1.60) | 0.94 (0.49–1.82) | 1.02 (0.51–2.06) | 1.38 (0.71–2.67) |
Tumor location | ||||||||
Colon | 613 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Rectum | 552 | 1.11 (0.84–1.45) | 1.02 (0.77–1.33) | 1.33 (1.01–1.76) | 1.28 (0.98–1.69) | 1.03 (0.79–1.35) | 1.41 (1.07–1.86) | 0.90 (0.68–1.17) |
Both | 58 | 1.95 (1.08–3.54) | 1.48 (0.82–2.68) | 1.39 (0.77–2.53) | 1.23 (0.69–2.19) | 0.83 (0.47–1.45) | 1.19 (0.66–2.16) | 1.14 (0.65–2.02) |
Metastases | ||||||||
No | 872 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Yes | 209 | 1.43 (1.02–2.01) | 1.11 (0.79–1.55) | 1.29 (0.91–1.83) | 1.04 (0.74–1.46) | 1.14 (0.81–1.59) | 1.47 (1.03–2.10) | 1.33 (0.95–1.86) |
Other Cancer | ||||||||
No | 997 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Yes | 270 | 1.39 (1.05–1.85) | 1.38 (1.03–1.83) | 1.32 (0.99–1.77) | 1.38 (1.04–1.84) | 1.03 (0.78–1.37) | 1.60 (1.20–2.15) | 1.35 (1.02–1.79) |
Therapy | ||||||||
None | 681 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Chemotherapy | 285 | 0.90 (0.66–1.23) | 1.03 (0.75–1.40) | 1.13 (0.82–1.56) | 1.07 (0.78–1.47) | 0.90 (0.66–1.23) | 1.21 (0.88–1.68) | 0.93 (0.68–1.27) |
Radiation | 40 | 1.02 (0.52–1.99) | 1.59 (0.79–3.20) | 0.89 (0.44–1.82) | 0.89 (0.45–1.76) | 0.66 (0.34–1.29) | 1.74 (0.87–3.50) | 0.75 (0.38–1.46) |
Chemotherapy + Radiation | 268 | 1.56 (1.11–2.18) | 1.57 (1.12–2.20) | 0.96 (0.68–1.35) | 1.62 (1.16–2.27) | 1.04 (0.74–1.45) | 2.33 (1.64–3.31) | 1.33 (0.96–1.85) |
Current stoma | ||||||||
No | 1130 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Yes | 151 | 1.11 (0.76–1.62) | 1.30 (0.88–1.92) | 2.13 (1.42–3.20) | 1.87 (1.27–2.77) | 1.46 (1.00–2.14) | 2.44 (1.60–3.71) | 1.03 (0.71–1.50) |
Association between health-related quality of life and all-cause mortality
Age- & sex-adjusted HR (95% CI) | Multivariable-adjustedb HR (95% CI) | |
---|---|---|
Summary scorec | 0.76 (0.70–0.82) | 0.76 (0.70–0.82) |
Global QOLc | 0.80 (0.75–0.85) | 0.80 (0.75–0.86) |
Functioning Scalesc | ||
Physical Functioning | 0.78 (0.74–0.83) | 0.80 (0.75–0.86) |
Role Functioning | 0.86 (0.82–0.90) | 0.87 (0.83–0.91) |
Emotional Functioning | 0.89 (0.84–0.94) | 0.88 (0.83–0.94) |
Social Functioning | 0.86 (0.82–0.90) | 0.87 (0.83–0.91) |
Cognitive Functioning | 0.94 (0.88–1.01) | 0.95 (0.88–1.02) |
Symptom Scalesd | ||
Pain | 1.11 (1.06–1.16) | 1.10 (1.05–1.16) |
Nausea/Vomiting | 1.31 (1.21–1.43) | 1.31 (1.19–1.43) |
Fatigue | 1.21 (1.14–1.27) | 1.19 (1.13–1.26) |
Insomnia | 1.08 (1.04–1.13) | 1.08 (1.03–1.13) |
Dyspnea | 1.14 (1.09–1.19) | 1.13 (1.08–1.19) |
Appetite Loss | 1.19 (1.12–1.27) | 1.18 (1.11–1.26) |
Constipation | 1.08 (1.02–1.14) | 1.09 (1.03–1.15) |
Diarrhea | 1.02 (0.97–1.08) | 1.03 (0.97–1.09) |
Financial Difficulties | 1.09 (1.03–1.15) | 1.07 (1.01–1.14) |
Potential effect modifiers | Total no. of individuals | No. of deaths | Age- & sex-adjusted HR (95% CI) | Multivariable-adjustedb HR (95% CI) | pinteractionc |
---|---|---|---|---|---|
Sex | |||||
Men | 740 | 126 | 0.75 (0.68–0.82) | 0.74 (0.66–0.82) | |
Women | 554 | 49 | 0.78 (0.68–0.89) | 0.75 (0.64–0.86) | 0.48 |
Age at HRQOL assessment, yearsd | |||||
< 69 | 626 | 50 | 0.78 (0.68–0.91) | 0.88 (0.74–1.03) | |
≥ 69 | 668 | 125 | 0.74 (0.68–0.80) | 0.72 (0.66–0.80) | 0.81 |
BMI, kg/m2 | |||||
< 25 | 497 | 72 | 0.68 (0.61–0.77) | 0.67 (0.58–0.77) | |
25- < 30 | 558 | 75 | 0.78 (0.69–0.89) | 0.82 (0.72–0.94) | |
≥ 30 | 239 | 28 | 0.81 (0.68–0.97) | 0.76 (0.60–0.97) | 0.19 |
Education | |||||
Low | 597 | 96 | 0.79 (0.72–0.88) | 0.80 (0.72–0.89) | |
Middle | 393 | 44 | 0.81 (0.68–0.96) | 0.79 (0.65–0.97) | |
High | 292 | 34 | 0.58 (0.48–0.69) | 0.57 (0.46–0.71) | 0.03 |
Family status | |||||
Married/in partnership | 991 | 127 | 0.77 (0.70–0.84) | 0.77 (0.70–0.86) | |
Single, divorced or widowed | 264 | 43 | 0.75 (0.64–0.88) | 0.75 (0.64–0.89) | 0.84 |
Smoking status | |||||
Never | 509 | 53 | 0.81 (0.70–0.94) | 0.81 (0.68–0.95) | |
Former | 649 | 105 | 0.74 (0.67–0.82) | 0.72 (0.65–0.81) | |
Current | 116 | 14 | 0.78 (0.59–1.03) | 0.74 (0.49–1.13) | 0.22 |
Tumor location | |||||
Colon | 613 | 72 | 0.77 (0.68–0.87) | 0.78 (0.68–0.88) | |
Rectum | 552 | 84 | 0.77 (0.69–0.86) | 0.76 (0.67–0.87) | 0.19 |
Therapy | |||||
None | 681 | 95 | 0.68 (0.61–0.76) | 0.67 (0.60–0.76) | |
Chemotherapy or radiation | 325 | 47 | 0.87 (0.75–1.01) | 0.88 (0.73–1.04) | |
Both | 268 | 31 | 0.78 (0.65–0.95) | 0.87 (0.70–1.08) | 0.02 |
Metastases | |||||
Yes | 209 | 50 | 0.76 (0.65–0.89) | 0.78 (0.66–0.92) | |
No | 872 | 95 | 0.76 (0.69–0.85) | 0.75 (0.67–0.85) | 0.71 |
Current stoma | |||||
Yes | 151 | 30 | 0.69 (0.57–0.84) | 0.60 (0.46–0.79) | |
No | 1130 | 145 | 0.78 (0.72–0.85) | 0.79 (0.72–0.86) | 0.08 |