The impact of co-morbidities on recovery from colorectal cancer within first 2 years after surgery: results from the UK Colorectal Wellbeing (CREW) cohort study


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Joanne Haviland1,Amanda Cummings1,Jane Winter1,Chloe Grimmett1,Lynn Calman1,Jessica Corner1,Amy Din1,Deborah Fenlon1,Christine M. May1,Alison Richardson1,Peter W. Smith1,Claire Foster1
1University of Southampton

Abstract

Background

As the number of cancer survivors increases more people have to deal with the consequences of multiple morbidities. We describe frequencies of co-morbidities in a UK colorectal cancer cohort treated with curative intent and associations with health-related quality of life (HRQoL) outcomes up to two years following surgery.

Method

Cohort study of 872 UK colorectal cancer patients (Duke’s stage A-C) recruited November 2010-March 2012 from 29 centres, awaiting curative intent treatment and consenting to follow-up. Questionnaires were administered at baseline (pre-surgery), 3, 9, 15, 24 months. Co-morbidities were self-reported by participants from 3 months. The EORTC QLQ-C30 and QLQ-CR29 assessed global health/QoL, symptoms and functioning from 3 months onwards. Longitudinal analyses investigated associations between co-morbidities and HRQoL outcomes.

Results

The mean age of participants was 68 years, with 60% male, 65% colon and 35% rectal cancer. Of the 658 participants who completed the co-morbidities questions at 3 months, 28% had none, 32% had one, 23% had two and 17% had 3+ co-morbidities. The most common were high blood pressure (44%), arthritis/rheumatism (33%), anxiety/depression (18%), diabetes/high blood sugar (16%) and asthma (16%). 28% reported that co-morbidities limited their daily activities. An increasing number of co-morbidities was associated with poorer global health/QoL, worse symptoms and poorer functioning on many domains, regardless of cancer site, stage or treatment. Co-morbidities strongly associated with poorer global health/QoL were arthritis/rheumatism, asthma, heart failure, chest pain and anxiety/depression.

Conclusion

Pre-existing co-morbidities are an important determinant of recovery of QoL following colorectal cancer, regardless of cancer stage and treatment. Clinical assessment should prioritise the presence of comorbidities to help identify those patients at risk of reduced QoL. Tailored follow-up, shared-care management of comorbidities and enhancing supported self-management could aid recovery of health and wellbeing in these patients.