World Journal of Colorectal Surgery

Transcription

1 World Journal of Colorectal Surgery Volume 3, Issue Article 4 ISSUE 1 Assessment of quality of life of colorectal carcinoma patients after surgery Emad Hokkam MD. Sherif Farrag MD. Soliman El Kammash MD. Mohammed Faisal Msc. Suez Canal University, ehokkam@gmail.com Suez Canal University Suez Canal University Suez Canal University Copyright c 2013 The Berkeley Electronic Press. All rights reserved.

2 Assessment of quality of life of colorectal carcinoma patients after surgery Emad Hokkam MD., Sherif Farrag MD., Soliman El Kammash MD., and Mohammed Faisal Msc. Abstract Background: Colorectal carcinoma is the second leading cause of cancer-related deaths. Health related quality of life is now becoming one of the important outcome measures for cancer patients. The study aimed to assess the quality of life for patients with colorectal carcinoma in the post-operative period. Methods: A total number of 43 colorectal carcinoma patients, in the postoperative period before starting radio or chemotherapy were enrolled in the study. Medical history assessment, thoroughly clinical examination and reviewing of records for type of pathology, stage of the disease and type of performed operation were done for all patients. Quality of life was assessed using an arabic translated versions of European Organization for Research and Treatment of Cancer (EORTC QLQ C30) and colorectal cancer Module (EORTC QLQ CR29). Results: EORTC (QLQ-C30) questionnaire showed that the most preserved functional scale was the social function. Among symptom scales, the worst symptom was the financial difficulties followed by insomnia and fatigue. Patients without stoma showed significantly better scores than patients with stoma as regards to global health status (p-value < 0.05). EORTC (QLQ-CR29) questionnaire revealed that, the most annoying symptom affecting the quality of life was bloated feeling and it was significantly more with non-stoma patients (p-value < 0.05) Conclusion: colorectal carcinoma affect the quality of life of patients, and that of stoma patients are more affected than non-stoma patients. KEYWORDS: cancer, health well-being, colorectal, quality of life.

3 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 1 Introduction Colorectal cancer is a worldwide health problem. It is the second leading cause of cancer-related death and the fourth most prevalent malignant disease in many developed countries; it affects men and women almost equally. Almost 1 million new incident cases and 500,000 deaths occur worldwide each year. (1) Colorectal cancer is a disease of the elderly, and it also affects the younger population with an incidence of 2 to 6%. In Egypt, it shares the epidemiological characteristics of developing countries which are higher incidence in younger patients and predominance of carcinoma of the rectum. (2) Surgery is the primary form of therapy for most patients with colorectal cancer. (3,4) Their physical condition usually becomes drastically worse after surgery, and it has been reported that 18 25% of them experience emotional problems, such as anxiety, depression, and anger, during that time. (5) Besides disease-free and overall survival time, quality of life (QoL) has become an important outcome measure for cancer patients. The term quality of life refers to a multidimensional concept, which includes, at least, the dimensions of physical, emotional, and social functioning. Assessment of QoL in patients with cancer may improve our understanding of how cancer and its therapy influence the patients lives and how to adapt treatment strategies. (6) Colorectal cancer and its treatment can have an adverse effect on social functioning, including work and productive life; relationships with friends, relatives, and partners; and other social activities and interests. Patients with colorectal cancer, either with stoma or not, are troubled by Produced by The Berkeley Electronic Press, 2013

4 2 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 frequent or irregular bowel movements, diarrhea, flatulence, and fatigue, and often have to follow dietary restrictions. (7,8) Quality of life is generally measured by structured questionnaires that can be scored and quantified. (9) There are now two quality of life assessment tools available for colorectal cancer patients: the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) (10) and the European Organization for Research and Treatment of Cancer Quality of Life Module-Colorectal Cancer EORTC QLQ-CR 29. (11) Both of these tools could be used for colorectal cancer patients with a range of disease stages and different treatments. EORTC QLQ-CR29 is designed to be used together with EORTC QLQ-C30 which is reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. (12) The study aimed to assess the quality of life for patients with colorectal carcinoma in the postoperative period using the EORTC QLQ-CR29 and EORTC QLQ-C30 questionnaires and to compare this important measure -QoL- in patients with stoma with patients without stoma. Patients and methods This study was carried out as a descriptive quantitative cross-sectional study. After approval of our ethics committee, 43 operated patients for colorectal carcinoma have been enrolled in the study. It was accomplished at the outpatient clinics of surgery and oncology departments, Suez Canal University Hospital, Ismailia, Egypt. Patients above 18 years old, both sexes, with any type of operation, any pathological type and any stage of the disease have been included in the study. Exclusion criteria included the presence of other cancers, patients already on chemotherapy or radiotherapy and patients with organ failure (heart failure, renal failure, liver cell failure.etc).

5 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 3 After obtaining a written informed consent from all participants, all patients have been subjected to complete medical history assessment and thoroughly clinical examination. Their records were reviewed for the stage of the disease, pathological type and the type of performed operation. An Arabic translated versions of European Organization for Research and Treatment of Cancer Quality of Life Cancer (EORTC QLQ C30) and colorectal cancer Module (EORTC QLQ CR29) questionnaires have been used - after obtaining the agreement of the modules developers - to assess the quality of life of the studied patients. Quality of life of the studied patients was assessed after complete wound healing and before starting of chemo- or radiotherapy. The EORTC QLQ C30 was meant to assess quality of life among cancer patients in general though 30 questions assessing physical and psychological aspects of cancer patients. It includes five functional scales (physical, role, emotional, cognitive and social functioning), three symptom scales, a global health status / QoL scale, and six single items. Each of the multi-item scales includes a different set of items. No item occurs in more than one scale. The QLQ-CR29 was designed for use among a wide range of colorectal cancer patients varying in disease stage and treatment modality. The module comprises 29 questions assessing disease symptoms, side-effects of treatment, body image, sexuality and future perspective. For data analysis, the Statistical Package for Social Science (SPSS) version 15 was used. Quantitative data were expressed as means ± SD while qualitative data were expressed as numbers and percentages (%). Unpaired t test were used to test significance of difference for quantitative variables while Chi Square test were used to test significance of difference for qualitative variables. Multiple logistic regression analysis was performed to assess the Produced by The Berkeley Electronic Press, 2013

6 4 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 independent factors affecting the quality of life of colorectal carcinoma patients. A probability value (p-value) < 0.05 was considered statistically significant. Results Analysis of the sociodemograhic characteristics of the included patients have revealed that 53.5% of them were males, most of the patients were living in rural areas (67.4%), nearly three fourths of them were retired (72.1%). The mean age was 61.6 ± 8.2. No statistically significance differences have been reported between stoma and non-stoma patients as regarding their sociodemograhic characteristics Table 1. Twenty nine (67.4%) patients had cancer colon while fourteen patients (32.6%) had rectal carcinoma. Eleven patients (25.6%) were exposed to preoperative radio/chemotherapy. More than half of the patients (55.8%) were in late stages (T3/T4). In 30.2% of the studied patients there was positive lymphatic metastasis while in only 2.3% of the patients there was distant metastasis. Patients with abdominal stoma have longer duration of the disease than patients without abdominal stoma (P= 0.001) Table 2. Analysis of the data collected by EORTC (QLQ-C30) questionnaire showed that the most preserved of the functional scales was the social function. Among the symptom scales / items; the worst item was the financial difficulties followed by insomnia and fatigue. Patients without stoma showed significantly better scores than patients with stoma as regards to global health status, physical and role functioning (p-value < 0.05). Also, fatigue, dyspnea and appetite loss showed significantly higher scores (Worse) among stoma patients (p-value < 0.05) Table 3.

7 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 5 Data obtained from EORTC (QLQ-CR29) questionnaire showed that the most annoying symptom affecting the quality of life was bloated feeling in the abdomen and it was significantly more with non-stoma patients (p-value < 0.05). Non stoma patients were found to be significantly more embarrassed by bowel movements. Body image was significantly more preserved among non stoma patients. In general sexual function was well preserved and shows no statistically significant different between stoma and non stoma patients. Table 4 shows the results of EORTC (QLQ-CR29) among studied patients. Patients with cancer colon were having significantly better global health status than those with caner rectum (73.4 ± 11.8 Vs 56.9 ±18.6). The same was found when comparing patients in early stage with patients in late stages as the former has higher mean score of global health status (76.9 ± 20.6 Vs 43.8 ± 9.4). No statistically significant difference was found when comparing patients with preoperative radio/chemotherapy versus those without or comparing patients with positive lymphatic metastasis and those without Table 5. Assessment of independent factors affecting global mean score of QLQ-C30 and CR29 revealed that sex and marital status weren't significant risk factors for decreasing quality of life. Stoma, older age, lower educational level and longer duration of disease were found to have significant positive effect on EORTC (QLQ-C30 and CR29) questionnaires score Table 6. Discussion Worldwide, approximately 500,000 people die from colon and rectal cancer every year. A large number of patients suffering from colorectal cancer are elderly and these often have psychological and physical comorbidity. (13) Despite all progress in the development of conservative therapy (i.e., radiation and chemotherapy), radical surgical removal of the tumor is Produced by The Berkeley Electronic Press, 2013

8 6 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 the only chance of permanent cure of the disease. Besides cure of cancer, preservation of sphincter function is an important goal of surgery as permanent colostomy is a serious limitation of the quality of life. (14) Health-related quality of life (HRQL) is a global and multidimensional measure of the patients own perceptions of how the illness and its treatment have affected their daily activities, physical and mental health, social interactions, and general well-being. (15) HRQL is an important outcome after surgery for colorectal cancer, and accurate assessment is required to fully inform clinical decision making. (16) Quality of life measurement in a clinical setting may help to detect problems that could otherwise go unnoticed in the follow-up care. (17) In the present study; results of EORTC QLQ C30 showed impaired global health status of colorectal carcinoma patients with mean value 64.5 ± Our results were in accordance with other researchers (6, 18-20) which reported impaired health related quality of life among patients with colorectal carcinoma in terms of global health status, symptoms and functional aspects. Other studies showed different results, Nicolussi and Sawada (21) reported satisfactory mean global health status (79.13 ± 17.40) in colorectal carcinoma patients while Arndt V et al (22) showed that most patients reported high overall quality of life when compared with reference data from the general population. Regarding the functional scales of EORTC QLQ C30, the most affected function was emotional and physical functions while the most preserved function was social function. This partially matches with other studies (23, 24) which reported significant impairment of physical functions as well as social and emotional functions.

9 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 7 As regarding the symptom /item scales, financial difficulties, insomnia, fatigue and dyspnea were the worst symptoms / items affecting the health related quality of life among the studied patients. In accordance with our results, Arndt V et al (6) reported that fatigue and insomnia were the most severely affected symptoms followed by dyspnea, pain, diarrhea, constipation, and financial difficulties. When comparing the health related quality of life as assessed by EORTC QLQ C30 in patients with and without stoma, we found that stoma patients have significantly impaired global health status, physical and role functions. Also, stoma patients were found to have higher scores (worst) than non-stoma patients in symptoms including fatigue, dyspnea and appetite loss, while other bowel related symptoms as nausea, vomiting and constipation were not significantly different among stoma and non stoma patients. The EORTC QLQ-CR29 is still under development; however, analysis of its data revealed that non stoma patients are generally fare better than do stoma patients. However; they suffer from some physical problems in the form of impaired bowel function. These problems may become more prevalent when ultralow anastomosis is applied. (25) Rectal carcinoma patients were found to have significantly impaired global health status as compared to cancer colon. This may be explained by the frequent presence of stoma in patient with carcinoma of the rectum as resection of the rectum for cancer usually involves creation of permanent abdominal stoma which in turn worse quality of life scores (26). In the present study, stoma, older age, educational age and duration of the disease were found to be significant independent risk factors for health related quality of life as assessed by EORTC (QLQ-C30and CR29). Trentham-Dietz et al (27) reported that aging, body weight, and chronic Produced by The Berkeley Electronic Press, 2013

10 8 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 medical conditions are factors that may affect physical and mental health of the patients while Yost et al (28) reported gender, race/ethnicity and marital status are statistically significant predictors of follow-up of social/family well-being. This difference could be related to the nature of the population study and the different types the used assessment tools. An evaluation of the data in relation to the education level revealed that patients who had attended school for more than 12 years gave less importance to the question of a colostomy (p=0.061). These patients considered it very important to avoid adjuvant treatment (p=0.0087) and also gave more importance to the ability to resume work early (p=0.0061). Educational level was found to be significant determinant of health related quality of life among colorectal carcinoma patients by many other studies (21, 29). With limitations of our study, small sample size and all types of colorectal carcinoma patients, we concluded that colorectal carcinoma affects the quality of life of patients, and that quality of life of stoma patients are more affected than non-stoma patients. Acknowledgement The authors would like to thank the Quality of Life Department, European Organization for Research and Treatment of Cancer (EORTC) for its support and agreement for using EORTC modules. References 1. Ferlay J, Bray F, Pisani P, Parkin DM. Globocan 2002: cancer incidence, mortality and prevalence worldwide. IARC cancer base No.5. version 2.0, IARC Press, Lyon, France,

11 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 9 2. Abou-Zeid AA, Khafagy W, Marzouk DM, Alaa A, Mostafa I, Aboul Ela M. Colorectal cancer in Egypt. Dis. Colon Rectum. 2002;45: Colquhoun PH, Wexner SD. Surgical management of colon cancer. Curr Gastroenterol Rep. 2002;4: Beck DE. Surgical management of colon and rectal cancer. The Ochsner Journal. 2002;4: Yoo HJ, Kim JC, Eremenco S, Han OS. Quality of life in colorectal cancer patients with colectomy and the validation of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), Version 4. J Pain Symptom Manage. 2005;30: Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: a population-based study. J Clin Oncol. 2004;22: Sprangers MAG, de Velde A, Aaronson NK, Taal B. Quality of life following surgery for colorectal cancer. A literature review. Psycho-oncology. 1993;2: Turns D. Psychosocial issues: pelvic exenterative surgery. J Surg Oncol. 2001;76: DeCosse JJ, Cennerazzo WJ. Quality-of-life management of patients with colorectal cancer. CA Cancer J Clin. 1997;47: Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Qual Life Res. 1999;8: Produced by The Berkeley Electronic Press, 2013

12 10 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art Gujral S, Conroy T, Fleissner C, et al. Assessing quality of life in patients with colorectal cancer: an update of the EORTC quality of life questionnaire. Eur J Cancer. 2007;43: Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85: Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan. Int J Cancer. 2001;94: Renner K, Rosen HR, Novi G, Hölbling N, Schiessel R. Quality of life after surgery for rectal cancer: do we still need a permanent colostomy? Dis Colon Rectum. 1999;42: Kuzu MA, Topcu O, Ucar K, Ulukent S. Effect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in muslim patients. Dis Colon Rectum. 2001;45: Gujral S, Avery KN, Blazeby JM. Quality of life after surgery for colorectal cancer: clinical implications of results from randomized trials. Support Care Cancer. 2008;16: Di Fabio F, Koller M, Nascimbeni R, Talarico C, Salerni B. Long-term outcome after colorectal cancer resection. Patients self-reported quality of life, sexual dysfunction and surgeons awareness of patients needs. Tumori Jan-Feb;94(1): Efficace F, Innominato PF, Bjarnason G, et al. Validation of patient's self-reported social functioning as an independent prognostic factor for survival in metastatic colorectal

13 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 11 cancer patients: results of an international study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer. J Clin Oncol. 2008;26: Ross L, Abild-Nielsen AG, Thomsen BL, Karlsen RV, Boesen EH, Johansen C. Quality of life of Danish colorectal cancer patients with and without a stoma. Support Care Cancer. 2007;15: Alacacioglu A, Binicier O, Gungor O, Oztop I, Dirioz M, Yilmaz U. Quality of life, anxiety and depression in Turkish colorectal cancer patients. Support Care Cancer. 2010;18: Nicolussi AC, Sawada NO. Quality of life of patients with colorectal cancer who were receiving complementary therapy. Acta paul enferm. 2009;22: Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Restrictions in quality of life in colorectal cancer patients over three years after diagnosis: a population based study. Eur J Cancer. 2006;42: Schwenk W, Neudecker J, Haase O, Raue W, Strohm T, Müller JM. Comparison of EORTC quality of life core questionnaire (EORTC-QLQ-C30) and gastrointestinal quality of life index (GIQLI) in patients undergoing elective colorectal cancer resection. Int J Colorectal Dis. 2004;19: Guren M, Eriksen M, Wiig J, et al. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol.2005;31: Produced by The Berkeley Electronic Press, 2013

14 12 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art Sprangers MA, Taal BG, Aaronson NK, te Velde A. Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum. 1995;38: Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D. Quality of life in rectal cancer patients: A four year prospective study. Ann Surg. 2003;238: Trentham-Dietz A, Remington PL, Moinpour CM, Hampton JM, Sapp AL, Newcomb PA. Health-related quality of life in female long-term colorectal cancer survivors. Oncologist. 2003;8: Yost KJ, Hahn EA, Zaslavsky AM, Ayanian JZ, West DW. Predictors of health-related quality of life in patients with colorectal cancer. Health Qual Life Outcomes. 2008;25: Shokar NK, Carlson CA, Weller SC. Factors associated with racial/ethnic differences in colorectal cancer screening. J Am Board Fam Med. 2008;21:

15 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 13 Table 1: Sociodemograhic characteristics among the studied patients. Characteristic Total (n=43) With stoma (n=23) Without stoma (n=20) p-value Age Mean ± SD 61.6 ± ± ± (NS) Sex Residence Marital status Job Smoking Male N (%) 23 (53.5%) 12 (52.2%) 11 (55%) Female N (%) 20 (46.5%) 11 (47.8%) 9 (45%) Urban N (%) 14 (32.6%) 8 (34.8%) 6 (30%) Rural N (%) 29 (67.4%) 15 (65.2%) 14 (70%) Married N (%) 39 (90.7%) 20 (86.9%) 19 (95%) Divorced N (%) 1 (2.3%) 1 (4.4%) 0 (0%) Widow N (%) 3 (6.9%) 2 (8.7%) 1 (5%) Idle/Retired N (%) 31 (72.1%) 15 (65.2%) 16 (80%) Employee N (%) 3 (6.9%) 2 (8.7%) 1 (5%) Worker N (%) 9 (20.9%) 6 (26.1%) 3 (15%) Smokers N (%) 8 (18.6%) 4 (17.4%) 4 (20%) Ex-smokers N (%) 10 (23.3%) 6 (26.1%) 4 (20%) Nonsmokers N (%) 25 (58.1%) 13 (56.5%) 12 (60%) Illiterate N (%) 10 (23.3%) 6 (26.1%) 4 (20%) 0.9 (NS) 0.8 (NS) 0.6 (NS) 0.5 (NS) 0.8 (NS) Educational level Read write Middle level & N (%) 11 (25.6%) 8 (34.8%) 3 (15%) N (%) 13 (30.2%) 4 (17.4%) 9 (45%) 0.2 (NS) High level N (%) 9 (20.9%) 5 (21.7%) 4 (20%) NS: No statistically significant difference (p-value > 0.05) Produced by The Berkeley Electronic Press, 2013

16 14 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 Table 2: Disease characteristics among the studied patients. Characteristic Total (n=43) With stoma (n=23) Without stoma (n=20) p-value Duration of disease (months) Mean ± SD 7.3 ± ± ± * Site Colon N (%) 29 (67.4%) 14 (60.8%) 15 (75%) Rectal N (%) 14 (32.6%) 9 (39.1%) 5 (25%) 0.4 (NS) Preoperative radio/chemotherapy N (%) 11 (25.6%) 6 (26.1%) 5 (25%) 0.8 (NS) Stage Early stage (T1/T2) N (%) 19 (44.2%) 9 (39.1%) 10 (50%) 0.6 (NS) Late stage (T3/T4) N (%) 24 (55.8%) 14 (60.9%) 10 (50%) 0.7 (NS) Node positivity N (%) 13 (30.2%) 8 (34.8%) 5 (25%) 0.7 (NS) Distant metastasis N (%) 1 (2.3%) 1 (4.3%) 0 (0%) 0.9 (NS) *Statistically significant difference (p-value < 0.05) NS: No statistically significant difference (p-value > 0.05)

17 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 15 Table 3: Global mean score for the EORTC (QLQ-C30) questionnaire among studied patients. Item Total (n=43) With stoma (n=23) Without stoma (n=20) p-value Global health status 64.5 ± ± ± * Physical F ± ± ± * Functional scales Role F ± ± ± * Emotional F ± ± ± (NS) Cognitive F ± ± ± (NS) Social F ± ± ± (NS) QLO-C30 Symptom scales / items Fatigue 39.4 ± ± ± * Nausea/vomiting 17.5 ± ± ± (NS) Pain 21.6 ± ± ± (NS) Dyspnea 35.5 ± ± ± * Insomnia 39.8 ± ± ± (NS) Appetite loss 24.8 ± ± ± * Constipation 26.8 ± ± ± (NS) Diarrhea 17.8 ± ± ± (NS) Financial difficulties 47.6 ± ± ± (NS) *Statistically significant difference (p-value < 0.05) NS: No statistically significant difference (p-value > 0.05) Produced by The Berkeley Electronic Press, 2013

18 16 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 Table 4: Global mean score for the EORTC (CR29) questionnaire among studied patients. Item Total (n=43) With stoma (n=23) Without stoma (n=20) p-value Functional scales Anxiety scale Body image scale Sexual function (men) 21.3 ± ± ± ± ± * 53.1 ± ± * 66.3 ± ± (NS) Micturition problem Defecation problem 21.8 ± ± ± (NS) 29.6 ± ± QLO-CR29 Symptom scales Fecal incontinence scale Bloated feeling in the abdomen 23.9 ± ± ± ± ± Dry mouth 11.3 ± ± ± (NS) Hair loss 8.3 ± ± ± (NS) Trouble with taste 11.5 ± ± ± (NS) Sore skin 10.3 ± 10.2 ± ± (NS) Embarrassed by bowel movements 32.5 ± ± ± * Stoma related problems 49.6 ± ± Impotence 21.3 ± ± ± (NS) *Statistically significant difference (p-value < 0.05) NS: No statistically significant difference (p-value > 0.05)

19 Hokkam et al.: Assessment of quality of life of colorectal carcinoma patients af 17 Table 5: Comparison between the mean score of global health status among the studied patients. (Using EORTC QLQ-C30). N Global health status Mean ± SD p- value Site Preoperative radio/chemotherapy Stage Node status Colon ± 11.8 Rectum ± 18.6 Yes ± 13.6 No ± 15.1 Early ± 20.6 Late ± 9.4 +ve ± ve ± * 0.07 (NS) 0.001* 0.08 (NS) *Statistically significant difference (p-value < 0.05) NS: No statistically significant difference (p-value > 0.05) Produced by The Berkeley Electronic Press, 2013

20 18 World Journal of Colorectal Surgery Vol. 3, Iss. 1 [2013], Art. 4 Table 6: Assessment of factors affecting global mean score for the EORTC (QLQ-C30 and CR 29) questionnaires. Factor EORTC (QLQ-C30) EORTC (QLQ-CR29) Odds ratio P-value Odds ratio P-value Presence of stoma * * Age (> 60) * * sex (NS) (NS) Marital status (NS) (NS) Lower educational level Duration of disease (> 6 months) * * * * *Statistically significant difference (p-value < 0.05) NS: No statistically significant difference (p-value > 0.05)