Date Published: March 13, 2013
Publisher: Public Library of Science
Author(s): Carlos K. H. Wong, Cindy L. K. Lam, Jensen T. C. Poon, Dora L. W. Kwong, Hamid Reza Baradaran. http://doi.org/10.1371/journal.pone.0058341
The aims of the study were to assess the health preference and health-related quality of life (HRQOL) in patients with colorectal neoplasms (CRN), and to determine the clinical correlates that significantly influence the HRQOL of patients.
Five hundred and fifty-four CRN patients, inclusive of colorectal polyp or cancer, who attended the colorectal specialist outpatient clinic at Queen Mary Hospital in Hong Kong between October 2009 and July 2010, were included. Patients were interviewed with questionnaires on socio-demographic characteristics, and generic and health preference measures of HRQOL using the SF-12 and SF-6D Health Surveys, respectively. Clinical information on stage of disease at diagnosis, time since diagnosis, primary tumour site was extracted from electronic case record. Mean HRQOL and health preference scores of CRN patients were compared with age-sex matched controls from the Chinese general population using independent t-test. Multiple linear regression analyses were conducted to explore the associations of clinical characteristics with HRQOL measures with the adjustment of socio-demographic characteristics.
Cross-sectional data of 515 eligible patients responded to the whole questionnaires were included in outcome analysis. In comparison with age-sex matched normative values, CRN patients reported comparable physical-related HRQOL but better mental-related HRQOL. Amongst CRN patients, time since diagnosis was positively associated with health preference score whilst patients with rectal neoplasms had lower health preference and physical-related HRQOL scores than those with sigmoid neoplasms. Health preference and HRQOL scores were significantly lower in patients with stage IV colorectal cancer than those with other less severe stages, indicating that progressive decline from low-risk polyp to stage IV colorectal cancer was observed in HRQOL scores.
In CRN patients, a more advanced stage of disease was associated with worse HRQOL scores. Despite potentially adverse effect of disease on physical-related HRQOL, the mental-related HRQOL of CRN patients were better than that of Chinese general population.
Colorectal neoplasms (CRN) represent a wide spectrum of disease transition from precancerous colorectal polyps to colorectal cancer. In the past, disease management was principally evaluated by the effectiveness in prolonging survival and reducing disease-related complications and presentation of symptoms. The maintenance of health-related quality of life (HRQOL) following screening and treatment has driven an important new direction in research and clinical practice for patients with CRN. The assessment of HRQOL on CRN has also increased the understanding in the treatment efficiency and effectiveness, and service needs of rehabilitation for the interest of patients and clinicians, and subsequently facilitated the clinical decision makings.
This is the first study, to our knowledge, to compare the HRQOL in Chinese patients with CRN with the general population and to highlight the HRQOL differences among stage of disease at the time of diagnosis. CRN patients reported similar physical-related HRQOL and better mental-related HRQOL compared to matched controls from the Chinese general population. Among all socio-demographic and clinical factors, stage of disease at diagnosis was the only significant and influential factor correlated to generic and health preference scores of HRQOL outcomes. Compared to sigmoid neoplasms, rectal neoplasms were associated with poorer outcomes on generic and health preference although mental-related HRQOL showed a non-significant decline. The effect of time since diagnosis on HRQOL was positive but significant for health preference scores only. Socio-demographic factors such as educational level, marital status, working status, household income, smoking status and drinking status were not significant correlates of HRQOL outcomes.
Stage of disease at initial diagnosis was the most significant clinical correlate for all HRQOL outcomes in patients with CRN. Specificity, those CRN patients who simultaneously had rectum as primary tumor site and severe stage of disease at diagnosis, indicated suboptimal HRQOL in relation to physical aspect of HRQOL and health preference scores. Based on available Chinese data on health preference scores, the QALYs is estimated for the cost-effectiveness analysis of CRN-related interventions in economics evaluation.