Health related quality of life in colorectal cancer patients: state of the art
© Marventano et al; licensee BioMed Central Ltd. 2013
Published: 8 October 2013
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females with a progressive increase in prevalence in industrialized countries. The loss of health due to the cancer and/or the consequence of the treatment may result in psychophysical, functional and social impairment; all of these affect health-related quality of life (QoL).
The most frequently CRC-specific QoL questionnaires is the FACT-C. QoL is not only important for the well-being of cancer patient but it also influences survival and response to therapy. Many studies investigated various determinants involved in the assessment of QoL in CRC, suggesting that symptoms, surgical procedures and the number of comorbidity significantly affected QoL.
Despite that CRC patients have a relatively good QoL compared with the general population, a wide range of intervention could be undertaken to improve their QoL. The finding of this review may be useful for cancer clinicians in taking therapy and surveillance-related decisions. However, future research should be directed to large-scale prospective studies using well validated QoL instruments to facilitate comparison of results.
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females, with over 1.2 million new cancer cases . In the past two decades incidence rates for CRC have remained largely unchanged, instead mortality rates have fallen due to improvements in early detection and cancer treatment [2, 3]. Survival at 5 years is 56% in Europe and 66% in the United States of America . Moreover, Baade et al. concluded that survival expectations increase the longer they survive, reaching 93.2 % at 5 years after diagnosis . This leads to a rising prevalence of patient living with CRC with an estimated worldwide prevalence of more than 3 million persons within 5 years of diagnosis in 2008 . The rise of patients living with the consequence of CRC and its treatment has increased greatly the interest of their impact on health-related quality of life (QoL) . The loss of health due to the cancer and/or the consequence of the treatment may result in psychophysical or functional impairment or disruption of social and family interactions, all of these affect QoL . Several studies assess prospectively the impact of CRC in the patient's QoL, both in short-term [9, 10] and long-term periods .
In the present article, we review the studies in colorectal cancer that have incorporated previously validated instruments.
Quality of life: definition and assessment
QoL is a multimensional, dynamic, subjective and centered on patient construct, comprising physical, functional, emotional, and social/family well-being . Therefore, QoL is an important outcome for evaluating the full impact of the disease on the individuals, their family and their community .
List of QoL tools frequently used in oncology
Determinant of quality of life
QoL in colorectal cancer patients is associated with a several number of factors. To simplify the discussion, we divided these factors into five broad categories: socio-demographic characteristics; health-related factors; cancer-related and surgical procedures factors; lifestyle factors; and other factors.
Gender has not been reported as significant determinant in patients' QoL . However, this is not true for specific problems like sexual functioning in man  or physical problems and pains in woman .
Results on age and CRC QoL are controversial. Forsberg et al. reported that age did not play a significant role in patients' QoL . Nevertheless, in some studies QoL increase with age [30, 31], whereas others reported a lower QoL with increasing age [32, 33]. This controversy is present for both physical and psychological aspect of QoL .
Education level is not a determinant for QoL, because its role is subordinated to income . With regards to income, there is evidence that low income correlates with worse physical, social and emotional well-being dimensions of QoL[11, 31, 35]. Also, home ownership was an independent predictor of QoL score .
The presence of a wide social network is positively related to patient's QoL . Patients living alone reported a lower perceived well-being than those who live with family , but marital status was not associated with a higher QoL .
Patient with CRC reported significantly more comorbidity conditions and poorer physical and mental QoL compared with patients without cancer and a worse effect was found in patient with two or more comorbidities or those who had recent diagnosis . Some specific diseases, such as heart disease , anxiety/depression  or urinary disorder  had a significant role on overall QoL. In particular, the higher prevalence of depression, compared to the general population of similar age  could be partially explained by the worries of a recurrence or of a second cancer, even after 5 or more years after diagnosis of cancer .
Concerning the association between body mass index and QoL, healthy-weight and overweight cancer survivors reported better scores in physical functioning, general health and vitality than obese cancer survivors .
Cancer-related and surgical procedures factors
The stage and site of colorectal cancer at diagnosis are important in determining QoL, as they determine symptoms, treatment modalities and therapy duration [41, 42]. Patient with stage I experienced a progressive positive trend in QoL; on the contrary patient with stage IV experienced a negative one. Instead, an initial QoL decrease, followed by better QoL scores, was experienced by those with stage II and stage III . A possible explanation could be the perception (or re-conceptualization) of QoL after CRC diagnosis . Nevertheless other studies reported no association between tumor stage and QoL [11, 30].
Surgical procedures can affect various aspects of QoL due to physical and psychological consequences. Patients undergoing surgical procedures experimented a rapid QoL decline after surgery with a gradually restore about 3 month after . Moreover, older patients are slower to restore their QoL .
Lower QoL both in laparoscopic and open surgery was found in older patient compared to the younger one , but only short-term QoL differences were found between open and laparoscopic surgery . A possible reason may be the different occurrence of complications between the two surgical techniques . Furthermore, baseline QOL was an important predictor of postoperative overall QOL and all QOL subdomains with a higher risk for difficult postoperative courses and auxiliary services associated with poor baseline QoL .
An important consequence of colorectal surgery is stoma. The presence of stoma influenced negatively the QOL if compared with patients undergoing a sphincter-saving resection , but not all authors found a significant difference [9, 51]. The most important aspect influenced by the presence of stoma was the social component of QoL as assessed by a recent systematic review conducted on 10 studies .
The physical and psychological disorders resulting from stoma vary by gender. In female patients, a worse psychological  and physical  QoL score was reported. On the contrary, a reduction in mental health  and sexual functioning  was found in man. These and other problems related to stoma, such as worse fatigue, dyspnea, loss of appetite and changing in body image perception, gradually reduce a person's confidence and his social relations . However, the impact of stoma could be influenced negatively by low income and problems in paying for stoma supplies , and positively by receiving therapy support with stoma-education programs and counseling [56, 57].
Symptoms induced by cancer or its treatment are also very important. Many prospective studies investigated the role of bowel symptoms such as diarrhea, fecal control and constipation [58, 59], but also fatigue and loss of appetite are very common and affected significantly QoL in CRC .
Some lifestyle factors such as physical activities, diet, alcohol intake and smoke were associated to QoL. A moderate or intense physical activity is correlated to a higher physical QoL due to lower levels of fatigue and distress . A quality diet (rich in fruit and vegetables, and low in fat) and the administration of probiotics reduced bowel dysfunction, which can markedly decrease QoL [61–64]. Smoking was associated with a lower QoL , and controversy to alcohol intake . Multiple behaviors changes have a better cumulative effect on QoL than single lifestyle modifications [63, 66].
Intervention to improve QoL in CRC
In order to improve QoL in CRC patients it is important to, first identify the patient with a higher risk to have a low QoL and then intervene to the modifiable factors.
Fixed factors such as age or sex have only a marginal role in QoL and others are potentially modifiable. Therefore, a wide range of interventions have been developed to improve QoL in CRC survivors. We can improve QoL by reducing psychological morbidity and facilitating crisis adaptation with educational programs, self-help groups, psychosocial interventions, cognitive behavioral therapy, coping, and certainly drugs. For example, a randomized trial on 200 with cancer found an improvement in depression and anxiety by physical exercise, intervention group therapy and antidepressants . A moderate physical activities should be suggested, when possible, to reduce some symptoms such as fatigue, pain and insomnia . Bowel symptoms could be reduced with modification of diet and the use of probiotics [62–64].
Psychosocial interventions can be classified in educational programs and psychotherapeutic interventions. Educational problems improve the cancer-related knowledge, its treatment and the emotional reactions to it. Psychotherapeutic interventions, individual or in groups, covers a wide range of approaches including assistance in expressing emotions, increasing patients' sense of coherence, enhancing personal resources, improving communication, gaining control and improving coping skills. These interventions help to decrease somatic symptoms and psychosocial sequelae of CRC and its treatment, and improving QoL as showed on a prospective study .
This is also true for surgery consequences. Specific training, like anal training after rectal resections by reducing stool frequency, improves both general and specific QoL . A cross-sectional study and a recent systematic review found that education of patient living with stoma helped to deal with sexual difficulties, dietary and physical activity restriction and in general with their lifestyle [57, 70]. Furthermore, in a prospective longitudinal study was showed that groups' activities by sharing personal experiences helps to reduce the isolation and the feelings of loneliness leading by stoma .
Relationship to survival
QoL is also known to be an independent predictor of survival and response to therapy in cancer patients [72, 73]. Broun et al. found that a 10-point increase in baseline global QoL scores (using EORTC QLQ-C30) was associated with a 7% decreased risk of death . This result was also showed for other types of cancer [75, 76]. Some authors proposed a theory according to which QoL could have a direct influence on tumor behavior and survival [77, 78], others suggested that QoL had a direct influence on therapy adherence and consequently on survival . Moreover, a recent 18-month trial suggested that baseline QoL influenced CRC patient's survival .
Discussion and conclusion
Various determinants of QoL in CRC had been investigated and the results mainly shown that physical problems linked to symptoms and surgical procedures, such as bowel problems and stoma are the most common. On the socio-demographic characteristics, only the socioeconomic status seems to have a well determined role, probably due to the better access to medical care. The presence of a higher comorbidity number was the most important health-related factor, but it must be considered that some of them could be a consequence of CRC. Moreover, a significant higher prevalence of distress, depression and anxiety were reported in CRC patients than the general population.
Findings on CRC stage by determining symptoms, treatment procedure and consequently overall survival showed the importance of disease stage on QoL. Its role is essential both for the clinical aspect and the psychological consequences that affect QoL after diagnosis .
When comparing the effect of different surgical procedures on QoL, only short-term benefits were found for laparoscopy. This could be explained by less post-operative complications with laparoscopic procedure [2, 46]. Similarly, higher QoL score for the younger patient was linked to the number and the severity of postoperative and late complications occurred after both open and laparoscopic surgery [46, 48].
The importance of symptoms has been reported in many studies since they affect directly and indirectly QoL in CRC survival. In fact the presence of diarrhea, incontinence, fatigue and pain in addition to having direct effects on QoL influenced the daily activities and hobbies, and interfere with family and social life [36, 59].
Despite specific physical and psychological problems, the overall QoL in CRC patient is good both in short  and long-term survivors [11, 27]. Several theories can be called upon to explain these findings.
One could be the process of internal recalibration and the shift in personal values to new understanding, known as reframing/response shift. This changes the patient's internal standards leading to a different estimation of their QoL .
Other two constructs of positive consequences after cancer diagnosis/treatment describe the change following a so stressful experience, benefit finding (BF) and post-traumatic growth (PTG). These two concepts are slightly different, but sometimes have been used interchangeably . BF is defined as an individual process in which the patient perceives that major positive changes have occurred as a result of challenging life events. In contrast, PTG refers to benefits associated with changes in appreciation of life, interpersonal relationship, and self-perception often manifested through personal strength, spiritual change and globally as life perspective. Moreover, these two concepts are temporally different. BF start immediately after diagnosis, instead PTG can be developed even years after the cancer diagnosis .
The limitations of a literature review of this nature are the lack of systematic research of articles and lack of a gold standard for measuring QoL. Very heterogeneous instruments and different statistical analyses were used, making difficult a comparison across studies. However, all studies used well-validated instruments. Other shortcomings of the exanimated studies which may introduce a bias when comparing QoL results are: data acquisition, low response rates, non-random drop-out, small sample size and the different correction for confounding factors. Furthermore role of chemotherapy and radiotherapy treatment was not investigated.
Despite some limitations, this review is useful for a better understanding of QoL and its determinants in CRC patients. Due to the burden of this disease and the higher survival rate, both for early diagnosis and new treatment, the QoL in survivors of CRC should be a priority for public health research. The knowledge about the determinants of QoL could help to identify survivors with special needs. Moreover these findings may be useful for cancer clinicians in taking therapy and surveillance-related decisions in order to enhance the QoL of people with CRC.
Finally, although patients have a good QoL compared with the general populations, a significant number of determinants are potentially modifiable variable. Future intervention studies are needed to improve certain aspects of quality of care to determine whether those changes lead to increased QoL. Moreover, research should be directed to large-scale prospective studies using well validated QoL instruments to facilitate the comparison of results.
Giuseppe Grosso was supported by the International Ph.D. Program in Neuropharmacology, University of Catania Medical School, Catania, Italy. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Funding for this article has come from University funds.
This article has been published as part of BMC Surgery Volume 13 Supplement 2, 2013: Proceedings from the 26th National Congress of the Italian Society of Geriatric Surgery. The full contents of the supplement are available online at http://www.biomedcentral.com/bmcsurg/supplements/13/S2
- Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA: a cancer journal for clinicians. 2011, 61 (2): 69-90.Google Scholar
- Biondi A, Grosso G, Mistretta A, Marventano S, Toscano C, Gruttadauria S, Basile F: Laparoscopic-assisted versus open surgery for colorectal cancer: short- and long-term outcomes comparison. Journal of laparoendoscopic & advanced surgical techniques Part A. 2013, 23 (1): 1-7.View ArticleGoogle Scholar
- Biondi A, Tropea A, Basile F: Clinical rescue evaluation in laparoscopic surgery for hepatic metastases by colorectal cancer. Surgical laparoscopy, endoscopy & percutaneous techniques. 2010, 20 (2): 69-72.View ArticleGoogle Scholar
- Verdecchia A, Francisci S, Brenner H, Gatta G, Micheli A, Mangone L, Kunkler I: Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. The lancet oncology. 2007, 8 (9): 784-796.View ArticlePubMedGoogle Scholar
- Baade PD, Youlden DR, Chambers SK: When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects. Medical Journal of Australia. 2011, 194: 73-PubMedGoogle Scholar
- GLOBOCAN 2002: cancer incidence, mortality and prevalence worldwide. IARC CancerBase No. 5. version 2.0, [http://www-dep.iarc.fr]
- Donaldson GW, Moinpour CM: Individual differences in quality-of-life treatment response. Medical care. 2002, 40 (6 Suppl): III39-53.PubMedGoogle Scholar
- Frazzetto P, Vacante M, Malaguarnera M, Vinci E, Catalano F, Cataudella E, Drago F, Malaguarnera G, Basile F, Biondi A: Depression in older breast cancer survivors. BMC surgery. 2012, 12 (Suppl 1): S14-PubMed CentralView ArticlePubMedGoogle Scholar
- Smith-Gagen J, Cress RD, Drake CM, Romano PS, Yost KJ, Ayanian JZ: Quality-of-life and surgical treatments for rectal cancer--a longitudinal analysis using the California Cancer Registry. Psycho-oncology. 2010, 19 (8): 870-878.PubMed CentralView ArticlePubMedGoogle Scholar
- Wilson TR, Alexander DJ, Kind P: Measurement of healthrelated quality of life in the early follow-up of colon and rectal cancer. Dis Colon Rectum. 2006, 49: 1692-1702.View ArticlePubMedGoogle Scholar
- Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR: Quality of life in long term survivors of colorectal cancer. The American journal of gastroenterology. 2002, 97 (5): 1228-1234.View ArticlePubMedGoogle Scholar
- Cella DF, Tulsky DS: Quality of life in cancer: definition, purpose, and method of measurement. Cancer investigation. 1993, 11 (3): 327-336.View ArticlePubMedGoogle Scholar
- Sahay TB, Gray RE, Fitch M: A qualitative study of patient perspectives on colorectal cancer. Cancer practice. 2000, 8 (1): 38-44.View ArticlePubMedGoogle Scholar
- Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical care. 1992, 30 (6): 473-483.View ArticlePubMedGoogle Scholar
- Ware J, Kosinski M, Keller SD: A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical care. 1996, 34 (3): 220-233.View ArticlePubMedGoogle Scholar
- Brooks R: EuroQol: the current state of play. Health Policy. 1996, 37 (1): 53-72.View ArticlePubMedGoogle Scholar
- Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J, et al: The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 1993, 11 (3): 570-579.Google Scholar
- Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK: The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 1993, 2 (4): 287-295.View ArticleGoogle Scholar
- Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, Johnson CD, Pilkington SA, Arraras J, Ben-Josef E, et al: Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer. 2009, 45 (17): 3017-3026.View ArticlePubMedGoogle Scholar
- Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D: Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 1999, 8 (3): 181-195.View ArticleGoogle Scholar
- Cella D, Hernandez L, Bonomi AE, Corona M, Vaquero M, Shiomoto G, Baez L: Spanish language translation and initial validation of the functional assessment of cancer therapy quality-of-life instrument. Medical care. 1998, 36 (9): 1407-1418.View ArticlePubMedGoogle Scholar
- Yoo HJ, Kim JC, Eremenco S, Han OS: Quality of life in colorectal cancer patients with colectomy and the validation of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), Version 4. Journal of pain and symptom management. 2005, 30 (1): 24-32.View ArticlePubMedGoogle Scholar
- Rotonda C, Conroy T, Mercier M, Bonnetain F, Uwer L, Miny J, Montcuquet P, Leonard I, Adenis A, Breysacher G, et al: Validation of the French version of the colorectal-specific quality-of-life questionnaires EORTC QLQ-CR38 and FACT-C. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2008, 17 (3): 437-445.View ArticleGoogle Scholar
- Wong CK, Lam CL, Law WL, Poon JT, Chan P, Kwong DL, Tsang J: Validity and reliability study on traditional Chinese FACT-C in Chinese patients with colorectal neoplasm. Journal of evaluation in clinical practice. 2012, 18 (6): 1186-1195.View ArticlePubMedGoogle Scholar
- Webster K, Cella D, Yost K: The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health Qual Life Outcomes. 2003, 1: 79-PubMed CentralView ArticlePubMedGoogle Scholar
- Dibble SL, Padilla GV, Dodd MJ, Miaskowski C: Gender differences in the dimensions of quality of life. Oncology nursing forum. 1998, 25 (3): 577-583.PubMedGoogle Scholar
- Phipps E, Braitman LE, Stites S, Leighton JC: Quality of life and symptom attribution in long-term colon cancer survivors. Journal of evaluation in clinical practice. 2008, 14 (2): 254-258.View ArticlePubMedGoogle Scholar
- Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, Baldwin CM, McMullen CK, Rawl SM, Matayoshi E, et al: Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009, 27 (28): 4664-4670.View ArticleGoogle Scholar
- Forsberg C, Bjorvell H, Cedermark B: Well-being and its relation to coping ability in patients with colo-rectal and gastric cancer before and after surgery. Scandinavian journal of caring sciences. 1996, 10 (1): 35-44.View ArticlePubMedGoogle Scholar
- Hamashima C: Long-term quality of life of postoperative rectal cancer patients. Journal of gastroenterology and hepatology. 2002, 17 (5): 571-576.View ArticlePubMedGoogle Scholar
- Klemm P, Miller MA, Fernsler J: Demands of illness in people treated for colorectal cancer. Oncology nursing forum. 2000, 27 (4): 633-639.PubMedGoogle Scholar
- Sapp AL, Trentham-Dietz A, Newcomb PA, Hampton JM, Moinpour CM, Remington PL: Social networks and quality of life among female long-term colorectal cancer survivors. Cancer. 2003, 98 (8): 1749-1758.View ArticlePubMedGoogle Scholar
- Trentham-Dietz A, Remington PL, Moinpour CM, Hampton JM, Sapp AL, Newcomb PA: Health-related quality of life in female long-term colorectal cancer survivors. The oncologist. 2003, 8 (4): 342-349.View ArticlePubMedGoogle Scholar
- Vacante M, D'Agata V, Motta M, Malaguarnera G, Biondi A, Basile F, Malaguarnera M, Gagliano C, Drago F, Salamone S: Centenarians and supercentenarians: a black swan. Emerging social, medical and surgical problems. BMC surgery. 2012, 12 (Suppl 1): S36-PubMed CentralView ArticlePubMedGoogle Scholar
- Lundy JJ, Coons SJ, Wendel C, Hornbrook MC, Herrinton L, Grant M, Krouse RS: Exploring household income as a predictor of psychological well-being among long-term colorectal cancer survivors. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2009, 18 (2): 157-161.View ArticleGoogle Scholar
- Gray NM, Hall SJ, Browne S, Macleod U, Mitchell E, Lee AJ, Johnston M, Wyke S, Samuel L, Weller D, et al: Modifiable and fixed factors predicting quality of life in people with colorectal cancer. British journal of cancer. 2011, 104 (11): 1697-1703.PubMed CentralView ArticlePubMedGoogle Scholar
- Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, Bierman AS, Hays RD: Cancer, comorbidities, and health-related quality of life of older adults. Health care financing review. 2008, 29 (4): 41-56.PubMed CentralPubMedGoogle Scholar
- Ko CY, Maggard M, Livingston EH: Evaluating health utility in patients with melanoma, breast cancer, colon cancer, and lung cancer: a nationwide, population-based assessment. The Journal of surgical research. 2003, 114 (1): 1-5.View ArticlePubMedGoogle Scholar
- Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B: Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-oncology. 2006, 15 (4): 306-320.View ArticlePubMedGoogle Scholar
- Blanchard CM, Stein K, Courneya KS: Body mass index, physical activity, and health-related quality of life in cancer survivors. Medicine and science in sports and exercise. 2010, 42 (4): 665-671.View ArticlePubMedGoogle Scholar
- Paika V, Almyroudi A, Tomenson B, Creed F, Kampletsas EO, Siafaka V, Gkika S, Mavreas V, Pavlidis N, Hyphantis T: Personality variables are associated with colorectal cancer patients' quality of life independent of psychological distress and disease severity. Psycho-oncology. 2010, 19 (3): 273-282.View ArticlePubMedGoogle Scholar
- Cardin F, Andreotti A, Zorzi M, Terranova C, Martella B, Amato B, Militello C: Usefulness of a fast track list for anxious patients in a upper GI endoscopy. BMC Surgery. 2012, 12 (Suppl 1): S11-PubMed CentralView ArticlePubMedGoogle Scholar
- Ramsey SD, Andersen MR, Etzioni R, Monipour CM: Quality of life in survivors of colorectal carcinoma. Cancer investigation. 1999, 88 (6): 1294-1303.Google Scholar
- Sprangers MA, Schwartz CE: Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 1999, 48 (11): 1507-1515.View ArticlePubMedGoogle Scholar
- Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B: Ten-year historic cohort of quality of life and sexuality in patients with rectal cancer. Dis Colon Rectum. 2005, 48 (3): 483-492.View ArticlePubMedGoogle Scholar
- Scarpa M, Di Cristofaro L, Cortinovis M, Pinto E, Massa M, Alfieri R, Cagol M, Saadeh L, Costa A, Castoro C, et al: Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients. Surgical endoscopy. 2013Google Scholar
- Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G: Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA : the journal of the American Medical Association. 2002, 287 (3): 321-328.View ArticlePubMedGoogle Scholar
- Grosso G, Biondi A, Marventano S, Mistretta A, Calabrese G, Basile F: Major postoperative complications and survival for colon cancer elderly patients. BMC surgery. 2012, 12 (Suppl 1): S20-PubMed CentralView ArticlePubMedGoogle Scholar
- Stucky CC, Pockaj BA, Novotny PJ, Sloan JA, Sargent DJ, O'Connell MJ, Beart RW, Skibber JM, Nelson H, Weeks JC: Long-term follow-up and individual item analysis of quality of life assessments related to laparoscopic-assisted colectomy in the COST trial 93-46-53 (INT 0146). Annals of surgical oncology. 2011, 18 (9): 2422-2431.PubMed CentralView ArticlePubMedGoogle Scholar
- Rispoli C, Rocco N, Iannone L, Amato B: Developing guidelines in geriatric surgery:role of the grade system. BMC Geriatrics. 2009, 9 (SUPPL.1): A99-Google Scholar
- De Campos-Lobato LF, Alves Ferreira PC, Lavery IC, Kira RP: Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer. Clinics. 2001, 66 (6): 1035-1040.View ArticleGoogle Scholar
- Jansen L, Koch L, Brenner H, Arndt V: Quality of life among long-term (>/ = 5 years) colorectal cancer survivors--systematic review. Eur J Cancer. 2010, 46 (16): 2879-2888.View ArticlePubMedGoogle Scholar
- Guren MG, Eriksen MT, Wiig JN, Carlsen E, Nesbakken A, Sigurdsson HK, Wibe A, Tveit KM: Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2005, 31 (7): 735-742.View ArticleGoogle Scholar
- Dabirian A, Yaghmaei F, Rassouli M, Tafreshi MZ: Quality of life in ostomy patients: a qualitative study. Patient preference and adherence. 2010, 5: 1-5.PubMed CentralPubMedGoogle Scholar
- Coons SJ, Chongpison Y, Wendel CS, Grant M, Krouse RS: Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis. Medical care. 2007, 45 (9): 891-895.View ArticlePubMedGoogle Scholar
- Celasin H, Karakoyun R, Yilmaz S, Elhan AH, Erkek B, Kuzu MA: Quality of life measures in Islamic rectal carcinoma patients receiving counselling. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2011, 13 (7): e170-175.View ArticleGoogle Scholar
- Danielsen AK, Burcharth J, Rosenberg J: Patient education has a positive effect in patients with a stoma: a sytematic review. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2013Google Scholar
- Steginga SK, Lynch BM, Hawkes A, Dunn J, Aitken J: Antecedents of domain-specific quality of life after colorectal cancer. Psycho-oncology. 2009, 18 (2): 216-220.View ArticlePubMedGoogle Scholar
- Pan LH, Tsai YF: Quality of life in colorectal cancer patients with diarrhoea after surgery: a longitudinal study. Journal of clinical nursing. 2012, 21 (156): 2357-2366.View ArticlePubMedGoogle Scholar
- Buffart LM, Thong MS, Schep G, Chinapaw MJ, Brug J, van de Poll-Franse LV: Self-reported physical activity: its correlates and relationship with health-related quality of life in a large cohort of colorectal cancer survivors. PloS one. 2012, 7 (5): e36164-PubMed CentralView ArticlePubMedGoogle Scholar
- Uccello M, Malaguarnera G, Basile F, D'Agata V, Malaguarnera M, Bertino G, Vacante M, Drago F, Biondi A: Potential role of probiotics on colorectal cancer prevention. BMC surgery. 2012, 12 (Suppl 1): S35-PubMed CentralView ArticlePubMedGoogle Scholar
- Ohigashi S, Hoshino Y, Ohde S, Onodera H: Functional outcome, quality of life, and efficacy of probiotics in postoperative patients with colorectal cancer. Surgery today. 2011, 41 (9): 1200-1206.View ArticlePubMedGoogle Scholar
- Amato B, Rispoli C, Iannone L, Testa S, Compagna R, Rocco N: Surgical margins of resection for breast cancer: Current evidence. Minerva Chirurgica. 2012, 67 (5): 445-452.PubMedGoogle Scholar
- Grimmett C, Bridgewater J, Steptoe A, Wardle J: Lifestyle and quality of life in colorectal cancer survivors. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2011, 20 (8): 1237-1245.View ArticleGoogle Scholar
- Blanchard CM, Stein KD, Baker F, Dent MF, Denniston MM, Courneya KS, Nehl E: Association between current lifestyle behaviors and health-related quality of life in breast, colorectal, and prostate cancer survivors. Psychology & Health. 2004, 19 (1): 1-13.View ArticleGoogle Scholar
- Blanchard CM, Courneya KS, Stein K: Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008, 26 (13): 2198-2204.View ArticleGoogle Scholar
- Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J, McHugh G, Walker A, Sharpe M: Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet. 2008, 372 (9632): 40-48.View ArticlePubMedGoogle Scholar
- Pugliese P, Perrone M, Nisi E, Garufi C, Giannarelli D, Bottomley A, Terzoli E: An integrated psychological strategy for advanced colorectal cancer patients. Health Qual Life Outcomes. 2006, 4: 9-PubMed CentralView ArticlePubMedGoogle Scholar
- Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y: Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012, 14 (10): 1231-1237.View ArticleGoogle Scholar
- Anaraki F, Vafaie M, Behboo R, Maghsoodi N, Esmaeilpour S, Safaee A: Quality of life outcomes in patients living with stoma. Indian journal of palliative care. 2012, 18 (3): 176-180.PubMed CentralView ArticlePubMedGoogle Scholar
- Altuntas YE, Kement M, Gezen C, Eker HH, Aydin H, Sahin F, Okkabaz N, Oncel M: The role of group education on quality of life in patients with a stoma. European journal of cancer care. 2012, 21 (6): 776-781.View ArticlePubMedGoogle Scholar
- Roychowdhury DF, Hayden A, Liepa AM: Health-related quality-of-life parameters as independent prognostic factors in advanced or metastatic bladder cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2003, 21 (4): 673-678.View ArticleGoogle Scholar
- Maisey NR, Norman A, Watson M, Allen MJ, Hill ME, Cunningham D: Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer. 2002, 38 (10): 1351-1357.View ArticlePubMedGoogle Scholar
- Braun DP, Gupta D, Grutsch JF, Staren ED: Can changes in health related quality of life scores predict survival in stages III and IV colorectal cancer?. Health and quality of life outcomes. 2011, 9: 62-PubMed CentralView ArticlePubMedGoogle Scholar
- Meyer F, Fortin A, Gelinas M, Nabid A, Brochet F, Tetu B, Bairati I: Health-related quality of life as a survival predictor for patients with localized head and neck cancer treated with radiation therapy. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009, 27 (18): 2970-2976.View ArticleGoogle Scholar
- Luoma ML, Hakamies-Blomqvist L, Sjostrom J, Pluzanska A, Ottoson S, Mouridsen H, Bengtsson NO, Bergh J, Malmstrom P, Valvere V, et al: Prognostic value of quality of life scores for time to progression (TTP) and overall survival time (OS) in advanced breast cancer. Eur J Cancer. 2003, 39 (10): 1370-1376.View ArticlePubMedGoogle Scholar
- Coates AS, Hurny C, Peterson HF, Bernhard J, Castiglione-Gertsch M, Gelber RD, Goldhirsch A: Quality-of-life scores predict outcome in metastatic but not early breast cancer. International Breast Cancer Study Group. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2000, 18 (22): 3768-3774.Google Scholar
- Dancey J, Zee B, Osoba D, Whitehead M, Lu F, Kaizer L, Latreille J, Pater JL: Quality of life scores: an independent prognostic variable in a general population of cancer patients receiving chemotherapy. The National Cancer Institute of Canada Clinical Trials Group. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 1997, 6 (2): 151-158.View ArticleGoogle Scholar
- Andreyev HJ, Norman AR, Oates J, Cunningham D: Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?. Eur J Cancer. 1998, 34 (4): 503-509.View ArticlePubMedGoogle Scholar
- Rispoli C, Rocco N, Iannone L, Amato B: Developing guidelines in geriatric surgery:role of the grade system. BMC Geriatrics. 2009, 9 (SUPPL.1): A99-Google Scholar
- Bernhard J, Lowy A, Mathys N, Herrmann R, Hurny C: Health related quality of life: a changing construct?. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2004, 13 (7): 1187-1197.View ArticleGoogle Scholar
- Sumalla EC, Ochoa C, Blanco I: Posttraumatic growth in cancer: reality or illusion?. Clinical psychology review. 2009, 29 (1): 24-33.View ArticlePubMedGoogle Scholar
- Calhoun LG, Tedeschi RG: Post-traumatic growth: future directions. Posttraumatic Growth: Positive Changes in the Aftermath of Crisis. 1998, Mahwaj, NJ: Lawrence Erlbaum AssociatesGoogle Scholar
- Ferrell BR, Dow KH, Grant M: Measurement of the quality of life in cancer survivors. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 1995, 4 (6): 523-531.View ArticleGoogle Scholar
- Grant M, Ferrell B, Dean G, Uman G, Chu D, Krouse R: Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2004, 13 (8): 1445-1457.View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.