Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
J Cancer Res Clin Oncol. 2022 Nov;148(11):3015-3028. doi: 10.1007/s00432-021-03865-3. Epub 2021 Dec 7.
In Germany, almost every other colorectal cancer (CRC) patient undergoes inpatient cancer rehabilitation (ICR), but research on long-term outcomes is sparse. We aimed to assess health-related quality of life (HRQOL), distress, and posttraumatic growth among former rehabilitants and non-rehabilitants as well as respective differences and to estimate disease-related quality of life deficits in both groups.
HRQOL (EORTC-QLQ-C30/CR29), distress (QSC-R10), and posttraumatic growth (PTGI) were assessed according to past ICR in patients 5-year post-CRC-diagnosis in the German DACHS study. Least square mean differences in HRQOL scores and elevated distress levels (QSC-R10 > 14 points) by ICR were estimated by confounder-adjusted linear and logistic regression, respectively. Differences in PTGI scales were tested for statistical significance. EORTC-QLQ-C30 reference scores from population controls were accessed from the LinDE study to estimate disease-related deficits in both treatment groups.
49% of the included 1906 CRC survivors had undergone ICR. Rehabilitants reported lower HRQOL scores than non-rehabilitants in several dimensions of the EORTC-QLQ-C30/CR29. Differences were pronounced among younger survivors (< 70 years). In younger survivors, past ICR also predicted elevated distress. However, rehabilitants showed higher posttraumatic growth. When compared to 934 population controls, non-rehabilitants and older rehabilitants reported HRQOL scores (EORTC-QLQ-C30) similar to controls except higher levels of bowel dysfunctions, whereas younger rehabilitants experienced deficits regarding most scales (13/15).
Our findings suggest a high disease burden 5 years after diagnosis in particular among younger CRC survivors who had undergone ICR. Observed HRQOL deficits are possibly linked to the initial indication for ICR and rehabilitants may benefit from effective follow-up concepts after ICR.
在德国，几乎每一位结直肠癌（CRC）患者都接受住院癌症康复（ICR），但对长期结果的研究却很少。我们旨在评估前康复者和非康复者的健康相关生活质量（HRQOL）、痛苦和创伤后成长，以及两组之间的差异，并估计两组的疾病相关生活质量缺陷。
根据德国 DACHS 研究中 CRC 诊断后 5 年的患者过去是否接受过 ICR，使用 EORTC-QLQ-C30/CR29 评估 HRQOL、QSC-R10 评估痛苦和 PTGI 评估创伤后成长。通过协变量调整的线性和逻辑回归分别估计 ICR 对 HRQOL 评分和升高的痛苦水平（QSC-R10>14 分）的最小平方均数差异。测试了 PTGI 量表之间的差异是否有统计学意义。通过从 LinDE 研究中获取人群对照的 EORTC-QLQ-C30 参考评分，来估计两组患者的疾病相关缺陷。
在纳入的 1906 名 CRC 幸存者中，有 49%接受过 ICR。康复者在 EORTC-QLQ-C30/CR29 的几个维度上报告的 HRQOL 评分低于非康复者。在较年轻的幸存者（<70 岁）中，差异更为明显。在年轻的幸存者中，过去的 ICR 也预测了较高的痛苦。然而，康复者表现出更高的创伤后成长。与 934 名人群对照相比，非康复者和年龄较大的康复者报告的 EORTC-QLQ-C30 评分与对照组相似，除了肠道功能障碍水平较高外，而年轻的康复者在大多数量表上都存在缺陷（13/15）。
我们的研究结果表明，在诊断后 5 年，尤其是在接受过 ICR 的年轻 CRC 幸存者中，疾病负担仍然很高。观察到的 HRQOL 缺陷可能与 ICR 的初始指征有关，康复者可能受益于 ICR 后的有效随访概念。
