Quality-of-life management of patients with colorectal cancer

We have reviewed management of the patient with colorectal cancer both after primary treatment and in the palliative setting. Although we have addressed quantitative measures of quality of life as applied to patients with colorectal cancer, the limitations of combining disparate variables that encompass morbidity, an idealized lifestyle, and personal variation in interpretation of that lifestyle into a single number or point on a graph are self-evident. The caring family physician has a better intuitive integration of patient complexity than does the outcomes analyst. When the apparently cured patient returns to the family physician after initial operative treatment, recovery is just beginning. We have addressed the morbidity of surgery, the role of adjuvant treatments, the short-term and long-term effects of adjuvant treatments on quality of life, and the management of these effects. Restoration of quality of life extends beyond cure or survival and embraces repair of the patient's confidence and psychosocial well-being. The patient with persistent or recurrent colorectal cancer merits the entire range of medical skills of the family physician. Not all patient findings arise from cancer; other treatable medical and surgical diseases occur. If findings are from recurrent colorectal cancer, the patient may still be curable by treatment or may enjoy prolonged quality of life with or without anticancer treatment. Do not rush to judgment about remaining life span. Although pain control is the benchmark of palliative care, psychological elements that affect severity of pain and the invariably associated depression of the patient require the emotional support and compassion of the family physician.