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Work Ability in Patients With Stage I-IV Colon Cancer: Results of the Dutch Prospective Colorectal Cancer Cohort.

21 oktober 2021

Background: Colon cancer affects a patient's ability to work. Many colon cancer patients are employed at the time of diagnosis.

Objective: We evaluated work ability during the first two years after colon cancer diagnosis.

Design: This study is a national prospective study, the Prospective Dutch ColoRectal Cancer cohort, including clinical data and patient reported outcomes.

Settings: Data were collected in 59 medical centers in the Netherlands.

Patients: Patients <67 years, with stage I-IV colon cancer, who completed work ability index questionnaires, were selected.

Main outcome measures: Work ability was assessed at baseline, 3, 6, 12, 18, and 24 months. The work ability index (ranging from 0-49) was evaluated using linear mixed models. Outcomes were matched to population controls without cancer.

Results: Of 390 patients, 84% had paid employment. Work ability of stage I-IV patients was significantly lower at time of diagnosis compared to matched population controls (31±8.2 and 41±5.6, respectively). Patients with stage I-III disease receiving surgery only regained work ability index scores comparable to matched population controls at 18 months. Patients receiving adjuvant systemic treatment initially demonstrated a decrease in work ability with improvements from 6 months onwards and normalization at 24 months. Stage IV patients did not demonstrate improvements in work ability outcomes over time. Work ability scores were negatively influenced by the administration of systemic treatment and ≥1 comorbidities.

Limitations: Only patients with patient reported outcomes and work at baseline were included in this analysis. Also, questionnaire response rates decreased over time.

Conclusion: Work ability in colon cancer patients is decreased for a prolonged time. Recovery depends on disease stage, type of treatment and comorbidity. Patients with stage I-III disease treated with curative surgery alone are first to regain work ability, followed by patients who receive adjuvant chemotherapy. Stage IV disease patients do not regain work ability. See Video Abstract at

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Trajectories of health-related quality of life and psychological distress in patients with colorectal cancer: A population-based study

29 augustus 2021

Background: The aim of this nationwide cohort study was to examine the course of symptoms and trajectories of health-related quality of life (HR-QoL) and psychological distress during follow-up and to identify vulnerable patients.
Methods: Patients with pathological stage IeIII colorectal cancer (CRC) between 2013 and 2018 were included. Baseline characteristics were collected from the Netherlands Cancer Registry, and patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30/CR29, Hospital Anxiety and Depression Scale and low anterior resection syndrome (LARS) questionnaires at the baseline and subsequently at 3, 6, 12, 18 and 24 months. Latent class growth and multinomial logistic regression analyses were performed to outline 24-month trajectories in HR-QoL and distress and to identify predictive factors.
Results: : A total of 1535 patients with colon cancer or rectal cancer were included. Trajectory analysis of HR-QoL identified three patient classes: high HR-QoL (62.7%), improving HRQoL (29.0%) and low HR-QoL (8.3%). The following patient groups were identified with having low distress (64.0%), moderate distress (26.9%) and high distress (9.1%). Around 13% of the total cohort had either persistent low HR-QoL or high psychological distress throughout follow-up. Patients belonging to this vulnerable group were significantly more likely to befemale, to be younger aged, to have lower education, to have disease stage II-III or to have major LARS.
Conclusions: Although most patients treated for stage I-III CRC fared well, a small but significant proportion of around 13% did not recover during follow-up and reported low HRQoL and/or high psychological distress levels throughout. This study’s findings should be
taken into account when organising and selecting patients for tailored follow-up.

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Transanal total mesorectal excision and low anterior resection syndrome

1 augustus 2021


Bowel dysfunction after rectal cancer surgery is common, with some experiencing low anterior resection syndrome (LARS) is common after rectal cancer surgery. This study examined if transanal total mesorectal excision (TaTME) has a similar risk of LARS and altered quality of life (QoL) as patients who undergo low anterior resection (LAR).


Patients who underwent TaTME or traditionally approached total mesorectal excision in a prospective colorectal cancer cohort study (2014–2019) were propensity score matched in a 1 : 1 ratio. LARS and QoL scores were assessed before and after surgery with a primary endpoint of major LARS at 12 months analysed for possible association between factors by logistic regression.


Of 61 TaTME and 317 LAR patients eligible, 55 from each group were propensity score matched. Higher LARS scores (30.6 versus 25.4, P = 0.010) and more major LARS (65 versus 42 per cent, P = 0.013; OR 2.64, 95 per cent c.i. 1.22 to 5.71) were reported after TaTME. Additionally, QoL score differences (body image, bowel frequency, and embarrassment) were worse in the TaTME group.


TaTME may be associated with more severe bowel dysfunction than traditional approaches to rectal cancer.

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Colorectal Cancer Care and Patients' Perceptions Before and During COVID-19: Implications for Subsequent SARS-CoV-2 Infection Waves

13 mei 2021

Background: Changes in colorectal cancer (CRC) care planning because of the coronavirus disease 2019 (COVID-19) pandemic and associated health-related quality of life (HRQoL) and well-being of patients with CRC are unknown. We report changes in CRC care and patient-reported outcomes including HRQoL, distress, and loneliness during the first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: In April 2020, 4984 patients included in the nationwide Prospective Dutch Colorectal Cancer cohort were invited to complete a COVID-19-specific questionnaire, together with the validated European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), De Jong Gierveld, and Hospital Anxiety and Depression Scale. Clinical data were obtained from the Netherlands Cancer Registry. Scores were compared with the year prior to COVID-19 and with an age- and sex-matched control population during COVID-19.

Results: In total, 3247 (65.1%) patients responded between April and June 2020. Of the patients, 17% had canceled, postponed, or changed hospital visits to a telephone or video consult, and 5.3% had adjusted, postponed, or canceled treatment. Compared with controls, patients reported worse HRQoL but comparable distress and less social loneliness (patients = 21.2%; controls = 32.9%). Compared with pre-COVID-19, clinically meaningful deterioration of HRQoL was more prevalent in patients with changes in cancer care planning than in patients without changes. Prior to undergoing or currently undergoing treatment and infection worries were associated with lower HRQoL.

Conclusions: CRC patients reported equal anxiety and depression but worse HRQoL than the control population. Changes in care planning were associated with deterioration of HRQoL and increased anxiety. In case of 1 or more risk factors, health-care specialists should discuss (mental) health status and possible support during future SARS-CoV-2 infection waves or comparable pandemics.

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Longitudinal effects of adjuvant chemotherapy and related neuropathy on health utility in stage II and III colon cancer patients: A prospective cohort study

6 april 2021

Patient's quality of life should be included in clinical decision making regarding the administration of adjuvant chemotherapy (ACT) in stage II/III colon cancer. Therefore, quality of life, summarized as health utility (HU), was evaluated for patients treated with and without ACT. Furthermore, the role of chemotherapy–induced peripheral neuropathy (CIPN) on HU was evaluated. Patients diagnosed with stage II/III colon cancer between 2011 and 2019 and participating in the Prospective Dutch ColoRectal Cancer cohort were included (n = 914). HU scores were assessed with the EQ‐5D‐5L at baseline, 3, 6, 12, 18, and 24 months. Patients treated with ACT received mainly capecitabine and oxaliplatin (57%) or capecitabine monotherapy (40%) (average duration: 3.5 months). HU 3 to 18 months after diagnosis (potential ACT period + 12 months follow‐up) was compared between patients treated with and without ACT using a mixed model adjusted for age, sex and education level. Subsequently, the CIPN sensory, motor and autonomy scales, measured using the EORTC QLQ‐CIPN20, were independently included in the model to evaluate the impact of neuropathy. Using a mixed model, a significant difference of −0.039 (95% confidence interval: −0.062; −0.015) in HU was found between patients treated with and without ACT. Including the CIPN sensory, motor and autonomy scales decreased the difference with 0.019, 0.015 and 0.02, respectively. HU 3 to 18 months after diagnosis is significantly lower in patients treated with ACT vs without ACT. This difference is on the boundary of clinical relevance and appears to be partly related to the sensory and motor neuropathy‐related side effects of ACT.

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The Prospective Dutch Colorectal Cancer (PLCRC) cohort: real‑world data facilitating research and clinical care

18 februari 2021

Real-world data (RWD) sources are important to advance clinical oncology research and evaluate
treatments in daily practice. Since 2013, the Prospective Dutch Colorectal Cancer (PLCRC) cohort,
linked to the Netherlands Cancer Registry, serves as an infrastructure for scientific research
collecting additional patient-reported outcomes (PRO) and biospecimens. Here we report on
cohort developments and investigate to what extent PLCRC reflects the “real-world”. Clinical and
demographic characteristics of PLCRC participants were compared with the general Dutch CRC
population (n = 74,692, Dutch-ref). To study representativeness, standardized differences between
PLCRC and Dutch-ref were calculated, and logistic regression models were evaluated on their ability
to distinguish cohort participants from the Dutch-ref (AU-ROC 0.5 = preferred, implying participation
independent of patient characteristics). Stratified analyses by stage and time-period (2013–2016
and 2017–Aug 2019) were performed to study the evolution towards RWD. In August 2019, 5744
patients were enrolled. Enrollment increased steeply, from 129 participants (1 hospital) in 2013 to
2136 (50 of 75 Dutch hospitals) in 2018. Low AU-ROC (0.65, 95% CI: 0.64–0.65) indicates limited ability
to distinguish cohort participants from the Dutch-ref. Characteristics that remained imbalanced in
the period 2017–Aug’19 compared with the Dutch-ref were age (65.0 years in PLCRC, 69.3 in the
Dutch-ref) and tumor stage (40% stage-III in PLCRC, 30% in the Dutch-ref). PLCRC approaches to
represent the Dutch CRC population and will ultimately meet the current demand for high-quality
RWD. Efforts are ongoing to improve multidisciplinary recruitment which will further enhance PLCRC’s
representativeness and its contribution to a learning healthcare system.

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Perceived Care and Well-being of Patients With Cancer and Matched Norm Participants in the COVID-19 Crisis: Results of a Survey of Participants in the Dutch PROFILES Registry

1 februari 2021


Importance: As the resolution of the coronavirus disease 2019 (COVID-19) crisis is unforeseeable, and/or a second wave of infections may arrive in the fall of 2020, it is important to evaluate patients' perspectives to learn from this.

Objective: To assess how Dutch patients with cancer perceive cancer treatment and follow-up care (including experiences with telephone and video consultations [TC/VC]) and patients' well-being in comparison with a norm population during the COVID-19 crisis.

Design, setting, and participants: Cross-sectional study of patients participating in the Dutch Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES) registry and a norm population who completed a questionnaire from April to May 2020.

Main outcomes and measures: Logistic regression analysis assessed factors associated with changes in cancer care (treatment or follow-up appointment postponed/canceled or changed to TC/VC). Differences in quality of life, anxiety/depression, and loneliness between patients and age-matched and sex-matched norm participants were evaluated with regression models.

Results: The online questionnaire was completed by 4094 patients (48.6% response), of whom most were male (2493 [60.9%]) and had a mean (SD) age of 63.0 (11.1) years. Of these respondents, 886 (21.7%) patients received treatment; 2725 (55.6%) received follow-up care. Treatment or follow-up appointments were canceled for 390 (10.8%) patients, whereas 160 of 886 (18.1%) in treatment and 234 of 2725 (8.6%) in follow-up had it replaced by a TC/VC. Systemic therapy, active surveillance, or surgery were associated with cancellation of treatment or follow-up appointment. Younger age, female sex, comorbidities, metastasized cancer, being worried about getting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and receiving supportive care were associated with replacement of a consultation with a TC/VC. Patients and norm participants reported that the COVID-19 crisis made them contact their general practitioner (852 of 4068 [20.9%] and 218 of 979 [22.3%]) or medical specialist/nurse (585 of 4068 [14.4%] and 144 of 979 [14.7%]) less quickly when they had physical complaints or concerns. Most patients who had a TC/VC preferred a face-to-face consultation, but 151 of 394 (38.3%) were willing to use a TC/VC again. Patients with cancer were more worried about getting infected with SARS-CoV-2 compared with the 977 norm participants (917 of 4094 [22.4%] vs 175 of 977 [17.9%]). Quality of life, anxiety, and depression were comparable, but norm participants more often reported loneliness (114 of 977 [11.7%] vs 287 of 4094 [7.0%]) than patients with cancer (P = .009).

Conclusions and relevance: Among patients with cancer in the Netherlands, 1 in 3 reported changes in cancer care in the first weeks of the COVID-19 crisis. Long-term outcomes need to be monitored. The crisis may affect the mental well-being of the general population relatively more than that of patients with cancer.

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