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Published on: September 27, 2024
Functional and Participation Outcomes of Colorectal Cancer With Peritoneal Metastasis and Pseudomyxoma Peritonei
Mengzhe Yang1,2, Bhasker Amatya1,2,3,4,5, Alaeldin Elmalik1,2,4
1Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
Objective:
To assess the longer-term functional and participation outcomes in survivors with colorectal cancer with peritoneal metastasis (CRCPM) and pseudomyxoma peritonei (PMP) following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy intervention (CRS-HIPEC).
Method:
Adult CRCPM/PMP in the community following CRS-HIPEC completed validated questionnaires. Descriptive statistics summarized participant characteristics, while multivariate linear regression (p < 0.05) identified predictors of functional and psychosocial outcomes, and a binary logistic regression model identified factors associated with poorer quality of life (QoL).
Results:
Of 100 participants (59 CRCPM, 41 PMP), mean age: 59.1±12.2 years, 52% male, mean time since CRS-HIPEC: 2.4±2.5 years, overall, many reported persistent issues: fatigue (86%), fear of recurrence (79%), pain (58%), insomnia (52%) and bowel dysfunction (32%). Despite this, overall functional recovery was good (Clinical Functioning Information Tool median [IQR]: 28 [19.3-52.5]), with low perceived psychological impact (Depression Anxiety Stress Scale total: 6 [0-17.5]) and relatively preserved QoL (European Quality of Life VAS score: 78 [60-85]). The CRC-specific QoL was poorer (Functional Assessment of Cancer Therapy-Colorectal: 106 [91-115.6]) and community integration was modest (Community Integration Questionnaire: 20.3 [16-24]). The PMP cohort reported a lower persistent symptom burden and a more favourable QoL. Overall, older age and unemployment were strong predictors of poorer outcomes. Employment status and symptom burden independently predicted longer-term functional and participation outcomes in CRCPM survivorship, with female gender, stoma, and radiotherapy as additional influencing factors.
Conclusion:
Overall, despite participants being functionally well, many experience substantial longer-term symptom burden and participation-related challenges (especially in CRCPM) following CRS-HIPEC, reflecting significant unmet rehabilitation needs. Systematic integration of rehabilitation across the CRC care continuum is therefore essential to optimise longer-term functional and participation outcomes in this population.
