Outcome Quality After Colorectal Cancer Resection in Certified Colorectal Cancer Centers—Patient-Reported and Short-Term Clinical Outcomes

Abstract

Background: In this observational study, patient-reported outcomes and short-term clinical outcome parameters in patients with colorectal cancer were studied 12 months after the start of treatment. Outcomes were also compared across German Certified Colorectal Cancer Centres.

Methods: Data were collected from 4239 patients with colorectal cancer who had undergone elective tumor resection in one of 102 colorectal cancer centers and had responded to a quality-of-life questionnaire before treatment (EORTC QLQ-C30 and -CR29). 3142 (74.1%) of these patients completed a post-treatment questionnaire 12 months later. Correlation analyses were calculated and case-mix adjusted comparisons across centers were made for selected patient-reported outcomes, anastomotic insufficiency, and 30-day-mortality.

Results: At 12 months, mild improvements were seen in mean quality-of-life scores (66 vs. 62 points), constipation (16 vs. 19), and abdominal pain (15 vs. 17). Worsening was seen in physical function (75 vs. 82) and pain (22 vs. 19). Better patient-reported outcomes at 12 months were associated with better scores before treatment. Better results in at least three of the five scores were associated with male sex, higher educational level, higher age, and private health insurance. Major worsening of fecal incontinence was seen among patients with rectal cancer without a stoma. The largest differences across centers were found with respect to physical function. Anastomotic insufficiency was found in 4.3% of colon cancer patients and 8.2% of rectal cancer patients. 1.9% of patients died within 30 days after their resection.

Conclusion: Clinicians can use these findings to identify patients at higher risk for poorer patient-reported outcomes. The differences among cancer centers that were found imply that measures for quality improvement would be desirable.

Figure 1

Results of multivariable linear regression analyses: estimator (95% confidence intervals [95% CI]) ASA, American Society of Anesthesiologists; EL, Education level; UICC, Union Internationale Contre le Cancer

Figure 2

Case-mix adjustment—point estimator of the centers’ adjusted post-treatment patient-reported outcome (PRO) scores. Only centers with at least 10 post-treatment questionnaires are included. Each dot represents an anonymized center. a) Function score (the higher the score, the better the outcome): physical function (75, 69–79) b) Symptom score (the lower the score, the better the outcome): pain (, – 26) The vertical lines (“antennae”) extending upward and downward represent provisional minimally important differences (MID) as one third of the standard deviation at patient level: physical function 7, pain 10