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BMC Gastroenterology

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Quality of life of early stage colorectal cancer patients in Morocco

  • Hind Mrabti1Email author,
  • Mounia Amziren1,
  • Ibrahim ElGhissassi1,
  • Youssef Bensouda1,
  • Narjiss Berrada1,
  • Halima Abahssain1,
  • Saber Boutayeb1,
  • Samira El Fakir2,
  • Chakib Nejjari2,
  • Abdellatif Benider3,
  • Nawfel Mellas4,
  • Omar El Mesbahi4,
  • Maria Bennani5,
  • Rachid Bekkali5,
  • Ahmed Zidouh5 and
  • Hassan Errihani1
BMC GastroenterologyBMC series – open, inclusive and trusted201616:131

https://doi.org/10.1186/s12876-016-0538-9

Received: 25 July 2015

Accepted: 18 June 2016

Published: 12 October 2016

Abstract

Background

A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life.

Methods

We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up.

Results

Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21–88). The male–female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year.

Conclusion

Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.

Keywords

Quality of lifeEORTC QLQ C30EarlyColorectal cancer

Background

Colorectal cancer is frequent in western countries, it represents the third most common cancer in France, with approximately 40 000 new cases per year [1]. According to Moroccan registries, it represents the first gastro-intestinal cancer before gastric cancer, and the fourth most common cancer, with an incidence of 8,4/100 000 habitants in 2007 [2]. This incidence have increased these last years (it was 6.9/100 000 habitants in 2005) [2]. This could be explained by the fact that Morocco has experienced, over the past 5 years, considerable progress in the detection, diagnosis and treatment of cancer. Many anticancer centers, equipped with the latest technologies have been constructed, most of anti-cancer drugs are available, and a national cancer plan (2010–2019) has been established.

When improving treatment of cancer, quality of life (QOL) becomes an important parameter to assess. It permits the evaluation of the impact of cancer and its treatment on the overall life of patients.

A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of Moroccan cancer patients, including colorectal, cervical, breast and lung cancer [3, 4]. It is a prospective multicentre cohort study, performed in the ten existing oncological centers in Morocco.

The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after specific cancer treatment (chemotherapy and/or radiotherapy), to identify other factors which are related to this quality of life (age, sex, localization: colon or rectum, performance status, disease stage), to describe Moroccan cancer patients characteristics.

Methods

Study design and study population

This is a Moroccan multicentre prospective cohort study. Patients were included, between December 2009 and December 2011, in the ten existing cancer centers in Morocco: seven public institutions (National Institute of oncology and Mohammed V military hospital in Rabat, Ibn rochd University hospital in Casablanca, Oujda, Agadir, Marrakech, Fez) and 3 private cancer clinics (Al Kindy and le Littoral in Casablanca, Nakhil in Rabat).

All patients were adults of 18 years or older, newly diagnosed with a histologically proven colorectal cancer. The diagnosis had to be made in less than three months before inclusion. Patients operated for their cancers within 3 months before inclusion were eligible to enter the study. A written informed consent was required for enrolment in the study, after the patient has received all the informations regarding the conditions of the study. Ethical approval was obtained from the ethics committees of the University Hospital Center Hassan II in Fez. Patients who received a specific treatment, chemotherapy or radiotherapy, and those with major neuropsychological defect were excluded.

In this paper we report quality of life assessment of early stage colorectal cancer patients which was defined by localized, stage I-II and III, colorectal cancer. Metastatic colorectal cancer (stage IV) was excluded, and will be separately analyzed, because patients are treated in a palliative setting, with systemic therapy and all patients remain under treatment at one year.

Collection data procedure

Questionnaires and data collection

We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC). It is a validated tool for the assessment of QoL in cancer patients. It contains 14 items: 5 of them are related to activity (Physical, professional and leisure, cognitive, emotional and social functioning), 3 of them to symptoms (Asthenia, pain, nauseas and vomiting) and the remaining six are independent items evaluating other symptoms (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). The QLQ-C30 was used after a transcultural validation [3]. It was developed according to Beaton and al recommendations [5].

The QLQ-C30 is a self-reporting questionnaire; however it was administered to illiterate patients by trained interviewers. The Data collection was done at inclusion and then every three months to each patient, until one year of follow-up.

All socio-demographic, economic and therapeutic data were extracted for colorectal cancer : age, gender, geographic origin, marital status, profession, income, level of education, medical insurance, localization, histological subtype, Tumor-Node-Metastasis (TNM) staging, evaluation of performance status according to Eastern Cooperative Oncology Group (ECOG) criteria, treatment (surgery, pre-operative radiotherapy or concurrent chemo-radiation for rectal cancer, adjuvant chemotherapy).

Statistical methods

  • Calculation of EORTC QLQ-C30 scores [6]:

Scores of the items were linearly transformed to a scale from 0 to 100. A high score for a functional scale represents a healthy level of functioning, a high score for the global health status represents a high quality of life, but a high score for a symptom item represents a high level of symptomatology.
  • Descriptive analysis

Descriptive analysis was performed for sociodemographic and clinical features, with a confidence interval defined at 95 %. To describe the quality of life scores, we calculated the means and standard deviations, minimum and maximum.
  • Univariate analysis:

At inclusion, a global analysis was conducted in the whole population of early colorectal patients. Subgroup analyses were performed according to some variables: age, gender, tumor location (colon versus rectum), performance status (PS ≤ 1 versus >1) and stage. The comparison between subgroups was performed by t-tests and one-way ANOVA. A p-value of less than 0.05 was considered as statistically significant. To assess the scores variability of quality of life between inclusion (before treatment: chemotherapy or radiotherapy) and at 1 year (after treatment), we used the paired Student’s t-test. The statistical analysis was performed by SPSS, version 17.0, software.

Results

Overall 2903 cancer patients were recruited, among whom 461 patients presented with colorectal cancer, 294 (63.7 %) were diagnosed at an early stage (I, II or III).

Socio-demographic and clinical characteristics of early colorectal cancer patients

Two hundred ninety-four patients with an early stage colorectal cancer were included in the study, of which there were 161 colon cancers (54.7 %) and 133 rectal cancers (45.3 %). The median age at diagnosis was 56 years (range: 21–88). The male–female sex ratio was 1.17. Majority of patients came from urban areas (78.2 %), a significant number were illiterate (49 %), and only 7.5 % had a high level of education. 32.7 % of patients were professionally active, but the majority of them had a low-intermediate socio-economic status. About 60 % of patients had no medical insurance. Eighty percent were married (see Table 1).
Table 1

Sociodemographic characteristics of colorectal cancer patients at inclusion, Morocco, 2009–2011

 

No (total 294)

%

Age (median)

56 years (range : 21–88)

Sex

 • Male

159

54.1

 • Female

135

45.9

Living environment

 • Urban

204

78.2

 • Rural

57

21.8

Residency

 • Casablanca

29

10.2

 • Rabat

33

11.6

 • Agadir

9

3.2

 • Meknes

9

3.2

 • Kenitra

9

3.2

 • Marrakech

35

12.3

 • Others

170

57.9

Education

 • Illiterate

144

49.0

 • Primary school

55

18.7

 • College

73

24.8

 • High school

22

7.5

Marital status

 • Single

32

10.9

 • Married

235

80

 • Divorced

10

3.4

 • Widower

17

5.8

Professional Status

 • Working

96

32.7

 • Retired

41

13.9

 • Without profession

49

16.7

 • Housewife

106

36.1

 • Student

2

0.7

Socioeconomic Status

 • Low

142

48.3

 • Intermediate

141

48.0

 • High

11

3.7

Medical insurance

 • Public health-insurance

108

36.7

 • Private insurance

10

3.4

 • No medical insurance

176

59.9

Tumor-node-metastasis staging system was as follows: Stage I = 19 (6.5 %), stage II = 80 (27.2 %), stage III = 195 (66.3 %). One hundred and ninety eight patients (67.3 %) patients received adjuvant chemotherapy based on the combination of capecitabin and Oxaliplatin every three weeks, during 6 months (eight cycles). Among rectal cancer patients (133), 50 (37.5 %) received pre-operative radiotherapy, which was concomitant to chemotherapy in 40 patients. (See Table 2).
Table 2

Clinical features of early colorectal cancer patients, Morocco, 2009–2011

 

No (total 294)

%

Localization

 • Colon

161

54.7

 • Rectum

133

45.3

TNM Staging

 • Stage I

19

6.5

 • Stage II

80

27.2

 • Stage III

195

66.3

Surgery

 • Radical surgery

113

38.4

 • Conservative surgery

67

22.8

 • Palliative surgery

5

1.7

 • Unknown

109

37.1

Radiotherapy

(rectal cancer)

133

 

 • Performed

50

37.5

 • Not performed

83

62.5

Adjuvant chemotherapy

 • Performed

198

67.3

 • Not performed

77

26.2

 • Unknown

19

6.5

This study have some limitations: mainly data concerning surgery are missed. The surgery have been performed, in majority of patients (223) (except those treated by pre-operative radiotherapy) before inclusion in the study. At inclusion, 50 patients presenting with rectal cancer have not been operated because they were candidate for pre-operative radiotherapy. The surgical procedure was unknown in 37 % of patients (Table 2). Therefore, the QOL have not been assessed before surgical treatment.

QOL assessment

At inclusion, all patients were assessed before receiving any specific treatment: radiotherapy or chemotherapy.

At inclusion, the global health status was the most affected functional dimension (score 62.84). For symptoms: financial difficulties and fatigue scores were the highest ones (61.72 and 38.21 respectively). The scores at inclusion are summarized in Tables 3 and 4.
Table 3

Inclusion mean scores of functional dimensions according to sex, age, localization, stage and Performance status, among colorectal cancer patients, Morocco, 2009–2011

Subgroup

Global health status

Physical function

Role function

Emotional function

Cognitive function

Social function

All

62.8499

71.6667

67.5641

65.6595

86.0051

81.9338

Localization

 Colon

63.4199

70.6494

67.9825

68.7049*

86.5801

85.6061*

 Rectum

62.0370

73.1308

66.9753

61.3169

85.1852

76.6975

    

p = 0.022

 

p = 0.005

Stage

 I

66.6667

69.8148

74.0741

68.5185

91.6667

88.8889

 II

68.3824

72.9657

67.1642

69.2402

89.9510

81.3725

 III

60.3220*

71.3524

67.0476

63.9836

83.9015

81.4394

 

p = 0.003

     

Sex

 Male

64,0443

71,4085

69,4836

67.4825

85.5478

83.3333

 Female

61,4146

71,9748

65,2542

63.4687

86.5546

80.2521

Age

  < 50

63.5294

74.5490*

71.7647

65.3595

85.2941

83.9216

 50–60

63.5294

72.2603

65.9722

65.0304

89.2694

84.2466

 60–69

62.9944

73.6782

70.3390

67.0904

85.3107

77.1186

  ≥ 70

58.8889

62.6667

58.3333

65.3704

82.9630

80.7407

  

p = 0.033

    

PS

  < 1

70.2236*

80.8333*

79.2683*

69.9864

90.8537*

92.6829*

  ≥ 1

59.4907

67.4674

62.1723

63.6883

83.7963

77.0370

 

p < 0 .001

p < 0 .001

p < 0 .001

 

p < 0 .001

p < 0 .001

*: statistically significant

Table 4

Inclusion mean scores of symptoms according to sex, age, localization, stage and Performance status, among colorectal cancer patients, Morocco, 2009–2011

Subgroup

Fatigue

Nausea

Pain

Dyspnea

Insomnia

Anorexia

Constipation

Diarrhea

Financial difficulties

All

38.2103

11.3868

30.1527

15.2672

32.3116

32.3116

20.4835

18.3206

61.7188

Localization

 Colon

35.7504

8.9827*

25.3247*

13.4199

21.8615*

28.5714*

14.9351*

14.5022

62.6398

 Rectum

41.7181

14.8148

37.0370

17.9012

35.1852

37.6947

28.3951

23.7654

60.4361

  

p =0.028

p =0.001

 

p =0.001

p = 0.024

p < 0.001

p = 0.006

 

Stage

 I

37.0370

15.7407*

23.1481

11.1111

25.9259

29.6296

18.5185

18.5185

61.1111*

 II

35.8660

4.4118

26.7157

12.2549

22.5490

28.9216

13.7255

18.1373

52.0202

 III

39.2361

13.6364

32.1970

16.8561

29.3561

33.9048

23.2955

18.3712

65.5039

  

p = 0.006

      

p = 0.033

Sex

 Male

36.2082

11.6550

27.3893

14.6853

26.3403

28.4038*

18.1818

19.8135

61.2293

 Female

40.6162

11.0644

33.4734

15.9664

36.9748

36.9748

23.2493

16.5266

62.3188

      

p = 0.032

   

Age

  < 50

36.4052

13.1373

30.3922

16.4706

30.5882

35.3175

23.1373

18.0392

65.4618

 50–60

36.5297

8.9041

27.3973

11.8721

27.3973

27.3973

17.3516

20.5479

60.0939

 60–69

38.4181

11.2994

31.6384

13.5593

23.1638

34.4633

16.3842

16.9492

57.4713

  ≥ 70

44.0741

12.2222

32.2222

20.7407

26.6667

31.8519

25.9259

17.0370

62.8788

PS

  < 1

26,8970*

6,5041*

20,5285*

11,3821*

17.0732

24.7967*

11.7886*

15.4472

65.0407

  ≥ 1

43,3642

13,6111

34,5370

17,0370

32.0370

35.7542

24.4444

19.6296

60.1533

 

p < 0.001

p = 0.012

p < 0.001

p < 0.001

 

p = 0.01

p = 0.001

  

*: statistically significant

Localization specific scores

The global health status had the lowest score at inclusion for both colon and rectal cancer patients. The less affected dimension was the cognitive function (scores 86 and 85 for colon and rectal cancers respectively). Differences were statistically significant between the two localizations for emotional and social functions. They were worse in rectal cancer (61 vs 68 and 76 vs 85 respectively) (see Table 3).

Most symptoms were more present in rectal cancer. The difference was statistically significant for Nauseas, pain, insomnia, anorexia, constipation and diarrhea (See Table 4).

Stage specific scores

At inclusion, global health status score was significantly worse in stage III (p = 0.003). Moreover, Role, emotional and cognitive functions were more altered in stage III colorectal cancer but the difference was not statistically significant (see Table 3). In addition to financial difficulties, the prominent symptom in all stages was the fatigue. The scores were 37, 39 and 36 for stages I, II and III respectively. Curiously, nausea was significantly higher in stage I (See Table 4).

Sex specific scores

Overall, women had more altered functional functions and more permanent symptoms (see stables 3 and 4). Anorexia was significantly more prevalent among colorectal female patients (28 versus 37) (see Table 4).

Age specific scores

Patients over 70 years-old had lower scores, for global health status, physical role and cognitive functions. The difference was statistically significant for the physical function item (see Table 3). Major symptoms in all age subgroups were financial difficulties (scores ranges between 57 and 65) and fatigue (scores 36 to 44). There was no significant difference between symptoms according to the age range. Nevertheless, descriptive data suggested that patients of more than 70 years-old had higher scores of pain, dyspnea and constipation. Patients between 60 and 69 years-old had more diarrheas while patients less than 50 years-old had higher scores of nauseas and insomnia (see Table 4).

Performance status (PS) specific scores

Majority of patients had PS >1 (67.9 %) at inclusion (see Table 2). Except for the emotional function, all of the functional dimensions were significantly more altered in patients with PS > 1 (see Table 3). In the same way, most symptoms scores were higher in “PS > 1” patients. The difference was statistically significant apart from dyspnea, diarrhea and financial difficulties (see Table 4).

Evolution according to treatment

Overall, Functional dimensions scores were improved after the end of chemotherapy. However, this improvement was significant only for global health status and role functioning (66.93 vs 73.4 and 70 vs 79.8 respectively) (Fig. 1). A trend to an improvement was also seen for symptoms. The scores of fatigue, pain, appetite loss, constipation and diarrhea significantly decreased after completion of chemotherapy (Fig. 2).
Fig. 1

QLQ C30 functional scores before and after treatment by chemotherapy, among colorectal cancer patients, Morocco, 2009–2011

Fig. 2

QLQ C30 symptoms scores before and after treatment by chemotherapy, among colorectal cancer patients, Morocco, 2009–2011

Curiously, the cognitive function was the only dimension which had a statistically significant variation. The cognitive capacities were altered after treatment by radiotherapy (91 vs 80 p = 0.04) (Fig. 3). Likewise, except for constipation, the symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year (Fig. 4). The constipation score fell from 38 to 13.33 (p = 0.005). Moreover, there was a borderline trend to an improvement in pain scores (40 vs 24.16 p = 0.054) (Fig. 4).
Fig. 3

QLQ C30 functional scores before and after treatment by radiotherapy, among colorectal cancer patients, Morocco, 2009–2011

Fig. 4

QLQ C30 symptoms scores before and after treatment by radiotherapy, among colorectal cancer patients, Morocco, 2009–2011

When we look to the evolution of QOL scores every three months: overall, functional dimensions were stable at 12 weeks and have started to improve thereafter. The global health status began to improve after inclusion, whereas social function has slightly worsened at 12 weeks and increased thereafter (Fig. 5). Majority of symptoms were also stable at 12 weeks and decreased with time. Some symptoms have started to improve at 12 weeks like pain and constipation. Nausea was the only symptom that worsened at 12 weeks and improved thereafter (Fig. 6).
Fig. 5

Evolution of functional dimensions every three months

Fig. 6

Evolution of symptoms every three months

Discussion

This is the first large prospective study assessing the quality of life of early colorectal cancer patients, in Morocco, and also in North Africa. The objective of this study was also to compare quality of life, before and after specific cancer treatment (chemotherapy and/or radiotherapy), at one year, when acute treatment effects are expected to have declined, to identify other factors which are related to this quality of life (age, sex, localization: colon or rectum, performance status, disease stage), to describe Moroccan cancer patients characteristics. In our study, the global health status was the most affected functional dimension at inclusion. For symptoms: financial difficulties and fatigue scores were the main factors affecting colorectal cancer patient’s Qol. The most important factors affecting Qol were: rectal location, advanced disease (stage III). The impact of age and gender on Qol was less important, mainly the impact of advanced age was equivocal.

The data on socio-demographic characteristics of the Moroccan population are important to describe, they may explain some Qol aspects. About one third of patients were less than 50 years old, the median age at diagnosis was comparable to the one found in a study assessing quality of life of Malaysian colorectal cancer patients [7] but it was lower than the European average [8]. There was also a slight male predominance, which is in agreement with other studies [79]. This study reports the socio-economic characteristics of Moroccan colorectal cancer patients; they are consistent with the results of previous studies examining psychosocial characteristics of Moroccan cancer patients [10, 11]. Most of patients are illiterate, have low income. However the rate of medical insurance is higher in this study (40 %) while it was not exceeding 15 % in previous Moroccan cohorts [10, 11], this could be explained by a new health policy of the Moroccan government. Moreover, majority of patients came from urban areas (78 %), in contradiction with previous studies where this rate was between 30 and 40 % [8, 9], and this could be explained, by the availability of new structures treating cancers in most of Moroccan regions.

It was interesting to assess the quality of life of Moroccan cancer patients in this particular context of poverty and illiteracy, while the health system, and in particular management of cancer is improving. Another proof of better fight against cancer is the diagnosis of colorectal cancer at a non-metastatic stage in more than 60 % of cases, while this percentage was previously found for metastatic disease. However most of patients had a stage III disease (66.3 %), which is comparable to the results of Malaysian and Chinese studies [7, 12]. In developed countries, earlier stages, I and II, are the most frequent [13]. This could be explained by the absence of a screening program in Morocco, in addition to the other socioeconomic characteristics of Moroccan patients. The proportion of rectal cancers (45 %) is high in this study, as it was reported in Moroccan registries, in comparison with European studies. In a French cohort, examining colorectal cancer quality of life, rectal cancer represented 36 % [1].

At inclusion, the global health status was comparable to an American population [9] and the EORTC reference values [8]. However, it was lower than a Malaysian population. (See Table 5).
Table 5

Comparison of QLQ-C30 scores at inclusion between Moroccan colorectal cancer patients and patients of three others populations

Item

Moroccan population

Malaysian population

American population

EORTC reference values

Global health status

62.8

79

62.6

60.7

Physical function

71

83

78.6

79.2

Role function

67

79

70.3

70.4

Emotional function

65.65

86.4

70.6

68.9

Cognitive function

86

92.2

79.7

85.2

Social function

81

88.2

68.4

76

Fatigue

38.2

16.6

38.8

34.7

Nauseas

11.3

4

13.4

7.3

Pain

30.15

17.2

29.3

24

Dyspnea

15.26

8.7

19.5

17.4

Insomnia

32.3

20.7

33.7

30.5

Appetite loss

32.6

18

25.2

19.1

Constipation

20.4

8.67

17.5

15.8

Diarrhea

18.3

10.3

15.4

16.6

Financial difficulties

61.7

26

32.5

13.6

Physical, role and emotional functions scores are lower than those of other populations but they remain close to the EORTC reference values [8]. All these parameters may be related, to the socioeconomic status of Moroccan patients.

The social function score is well above American and European ones [1, 8, 9]. This could be due to the Moroccan culture that promotes social and family relationships [10, 11].

The financial difficulties are, by far, more present in the Moroccan population. This is because of the low socioeconomic status and the lack of medical insurance. The lowest score are found in the European’s, whose health system is very well designed [1, 8].

The other symptoms scores are higher than those of the Malaysian population, in spite of the fact that the Malaysian study included stage IV colorectal cancer [7]. Moroccan scores are close to EORTC reference values except for nauseas, pain and appetite losses, suggesting a need for better supportive care for our patients.

Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. The difference was statistically significant for Nauseas, pain, insomnia, anorexia, constipation and diarrhea. At inclusion, global health status score was significantly worse in stage III. Anorexia was the only parameter which was significantly more important among colorectal female patients. A german study, didn’t find significant differences, between patients with colon and rectal cancer, neither differences between male nor female [13]. An Austrian study focused on the Qol impact of gender and found no gender-specific reaction to disease [14].

For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. The influence of age on the impact of the disease is equivocal. Older people certainly have a higher morbidity associated with the disease. However, studies have shown that they better accept the deterioration of their health. Younger patients may be more impaired quality of life especially in relation to the psychological impact of the disease and some symptoms that are seen more significantly [13]. In our study, patients less than 50 years-old had higher scores of nauseas and insomnia.

Overall, Functional dimensions scores were improved after the end of chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. When we look to the evolution of QOL scores every three months: overall, functional dimensions and symptoms were stable at 12 weeks and have started to improve thereafter, so even during treatments, as chemotherapy or radiotherapy, the QOL was maintained. Nausea was the only symptom that worsened at 12 weeks and improved thereafter, since it is the main symptom of which patients undergoing chemotherapy complain. This finding is consistent with a german study, where adjuvant chemotherapy didn’t alter long term’s quality of life of early colorectal cancer patients, at one year [13]. In the subgroup treated by adjuvant chemotherapy, a significant improvement was seen in the global health status, role function, fatigue, pain, anorexia, constipation and diarrhea [13]. Several studies showed that with actual management of adjuvant chemotherapy, the Qol can decrease during treatement, but in a non statistiscally significant manner. However patients quickly recover their quality of life scores before treatment within a few months after completion of therapy [15, 16].

In the radiotherapy subgroup, the only significant change for functional dimensions was observed in the cognitive function. Unfortunately, we could not find any reasonable explanation. Moreover, constipation was significantly and largely improved, according to EORTC criteria [1719]. Pre-operative radiotherapy or chemoradiation didn’t impact quality of life of early colorectal cancer patients. The main limitation of this study is the lack of Qol assessment before surgery, mainly for colon cancer. QOL effects seen could be due to the surgery or the subsequent treatments. The strengths of the reported study are in related with its multicentre characteristic, including all Moroccan oncology centers and using a reliable tool of quality of life assessment.

Conclusion

This study shows that Moroccan colorectal cancer patients are a young population. A screening program and more generalized medical insurance may help diagnosing colorectal cancer at an earlier stage. QLQ C30 scores are overall comparable to the EORTC QLQ C30 reference values except for some symptoms, which could be improved by more supportive care. Neither chemotherapy, nor radiotherapy worsened the long term quality of life of early colorectal cancer patients. The management of colorectal cancer, in addition to specific treatments, must take into account the patients quality of life, to overcome some insufficiencies.

Abbreviations

EORTC: 

European organization for Research and treatment of Cancer

PS: 

Performance status

QOL: 

Quality of life

Declarations

Acknowledgments

To The Foundation Lalla Salma-Prevention and treatment of cancer and “Roche Laboratories” for their support.

Availability of data and materials

All questionnaires and consents forms are available in various oncology centers where the study was conducted. The data were pooled and analyzed at the department of Epidemiology and Public health, Faculty of Medicine, in Fez- Morocco.

Authors’ contributions

HM has contributed to conception and design, acquisition of data, analysis and interpretation of data, wrote the manuscript; MA have been involved in drafting the manuscript; IE has contributed to acquisition of data; YB has contributed to acquisition of data; NB has contributed to acquisition of data; HA has contributed to acquisition of data; SB has contributed to acquisition of data; SF has contributed to conception and design, acquisition of data, analysis and interpretation of data, CN has contributed to conception and design, analysis and interpretation of data, has been involved in revising critically the manuscript for important intellectual content and has given final approval of the version to be published; AB has made substantial contributions to conception and design of data; NM has contributed to acquisition of data, OM has contributed to acquisition of data; MB has contributed to conception and design of data; RB has contributed to conception and design of data; AZ has contributed to conception and design; HE has contributed to conception and design of data, acquisition of data, has been involved in revising critically the manuscript for important intellectual content and has given final approval of the version to be published. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study has been approved by the ethics committee of the University Hospital Center Hassan II in Fez- Morocco.

A written informed consent was required for enrolment in the study.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Medical Oncology, National Institute of Oncology, University Hospital
(2)
Department of Epidemiology and Public health, Faculty of Medicine
(3)
Department of Radiotherapy, Ibn Rochd University Hospital
(4)
Department of Medical Oncology, Hassan II University Hospital
(5)
Lalla Salma Foundation-Prevention and Treatment of Cancers

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Copyright

© The Author(s). 2016

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