Singapore, 1 March 2022 – Patients with advanced cancer are often assumed to have a poorer quality of life compared to those with early cancer. However, a colorectal cancer survivorship study led by the Singapore General Hospital (SGH) showed otherwise.
Quality of life (QOL) is defined as a person’s perceived standard of health, comfort, or happiness. A team of researchers from SGH, Duke-NUS Medical School, and National Cancer Centre Singapore, found that stage 3 colorectal cancer patients who underwent surgery and chemotherapy fared better across multiple aspects of QOL, including physical and cognitive function, compared to those with stage 1 or 2 cancer who had surgery alone.
“This is surprising as patients with advanced cancers generally undergo a longer treatment period with chemotherapy in addition to surgery, as well as more intensive follow-up with frequent blood tests, scans and endoscopic examinations. This process would be expected to take a physical and emotional toll on colorectal cancer survivors,” said Associate Professor Emile Tan, Head and Senior Consultant, Department of Colorectal Surgery, SGH, who is the senior and corresponding author of the study.
The results were based on 400 colorectal cancer survivor responses to detailed questionnaires assessing bowel function, sexual health, and overall QOL. Respondents averaged 64 years of age and over 6 years from time of their cancer surgery. Patients who had stage 4 cancer, which had already spread to other organs, were not included in the study.
One explanation for the better scores is the increased frequency of healthcare worker interaction with patients who had more advanced disease, which provided opportunities for reassurance or management of expectations. In other words, a regular and purposeful patient-doctor relationship may play an important role in building and maintaining positive perspectives of cancer survivors.
The topic of sexual health is often avoided in Asian societies, particularly among older adults. The study also revealed that almost 60 per cent of male and 40 per cent of female patients in the cohort remained sexually active following colorectal cancer treatment. However, issues with sexual function were common. Rectal cancer patients were more likely to experience problems such as erectile dysfunction or ejaculation issues in men, and vaginal dryness or painful sexual intercourse among women.
Dr Isaac Seow-En, a consultant from the same department and first author of the study said, “As cancer therapy improves, longer-term survivorship outcomes are becoming as important as cancer-related outcomes. Colorectal cancer is the most common cancer in Singapore, with over 60 per cent of patients expected to survive more than five years from the time of diagnosis. The findings of our study are useful to inform healthcare providers of the day-to-day functioning of cancer survivors and the possible resources required to help patients live healthy and productive lives long after surgery.”
Despite an increasing emphasis on long-term QOL and function, survivorship data from Asian populations remains scarce. The study, published in scientific journal Colorectal Disease in September 2021, is one of the largest to date examining colorectal cancer survivorship in Asia.
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