Background

Colorectal cancer (CRC) has the fourth highest incidence of any cancer worldwide. By 2040, around 73% of those living with and beyond CRC will be aged over 65. Despite this, there is a knowledge gap regarding longer-term outcomes in this population. Research typically focusses on younger people and existing studies of older people are often limited by the inclusion of only youngest-old (65-69 years). Here we report factors in older people living with and beyond CRC associated with higher risk of poor quality of life (QoL) and health status in the five years after CRC treatment.

Method

CREW is a UK prospective, longitudinal cohort study investigating factors associated with recovery of health and wellbeing in the five years following curative intent CRC surgery. Questionnaires, including psychosocial measures and sociodemographic questions, were completed by participants pre-surgery (baseline), then at 3, 9, 15, 24, 36, 48 and 60 months post-surgery. Clinical details were also collected. Longitudinal analyses explored the prevalence and pre-surgery risk factors of poor QoL (QLACS-GSS) and health status (EQ-5D: presence/absence of problems in five separate domains) in older (>65 years) participants over 5 years post-surgery.

Results

501 participants aged >65years completed questionnaires pre-surgery; 45% completed questionnaires 5 years later. Baseline higher self-efficacy was significantly associated with better QoL (10-30% lower QLACS-GSS scores for those moderately to very confident compared to those with low self-confidence) and lower odds of having problems in each of the EQ-5D domains over follow-up. Adequate social support at baseline was significantly associated with better QoL (8% lower QLACS-GSS) and lower odds of having problems with usual activities (OR=0.62) and anxiety/depression (OR=0.55). Oldest-old participants reported poorer QoL (18% higher QLACS-GSS) and 2-4 times higher odds of having problems with mobility or usual activities, in comparison with the youngest-old over follow-up.

Conclusion

There are important differences in the outcomes of QoL and health status for the oldest-old during CRC recovery. CREW reveals pre-surgery risk factors that are amenable to intervention including self-efficacy and social support.

Impact statement

The development of tailored interventions to improve outcomes for older people could significantly improve recovery experiences for the oldest CRC patients.