Adjuvant chemo does not alter QOL trajectory for CRC patients, but functional recovery a challenge

The health-related quality of life (QOL) trajectories for colorectal cancer (CRC) patients are largely similar, regardless of whether they received adjuvant chemotherapy, according to a study from Singapore. However, CRC patients who undergo adjuvant treatments commonly experience difficulties with functional recovery.

In a prospective cohort of patients who received a CRC diagnosis between 2018 and 2021 across three Singapore public hospitals, those who received adjuvant chemotherapy and those who did not both experienced similar patterns of initially deteriorating EORTC QLQ-C30* outcome scores before a generally consistent recovery until the end of the study period, researchers reported.

EORTC QLQ-C30 scores for the global health status and the five functioning subscales, namely physical, role, emotional, cognitive, and social worsened over 1–2 days after surgery before hospital discharge (predischarge). The scores returned to baseline levels around the 12-month time point, which suggests that adjuvant chemotherapy may not exert longer term effects on CRC patients, the researchers pointed out. [Health Qual Life Outcomes 2025;23:30]

Adjuvant chemotherapy was significantly associated with poorer physical (p<0.05) and role functioning (p<0.05) scores over the study period. Elderly patients exhibited a more pronounced worsening of physical functioning scores over time (p<0.05). Yet, nonelderly patients who received adjuvant chemotherapy tended to experience poorer health-related QOL in general compared with elderly patients.

Overall, the prospective QOL trajectories in patients who received adjuvant chemotherapy in this study provide novel insights into the CRC population, especially within the context of an Asian health system, according to the researchers.

“Singapore is an urbanized society with a highly developed healthcare infrastructure. In the context of CRC patients requiring adjuvant chemotherapy, this includes an extensive suite of supportive care encompassing palliative, psychosocial, rehabilitation, and other domains,” they said. “It is possible that the ease of access to such adjunct services could have helped ‘close the gap’ in QOL between the adjuvant chemotherapy and no-adjuvant chemotherapy groups.”

Notably, among patients who do require adjuvant chemotherapy, it seems that elderly patients fare better than their younger counterparts, the researchers said. “This makes sense in the Singaporean context, where families tend to be small and nuclear with both spouses employed, and with the retirement age set at 63 years.”

The researchers explained that nonelderly CRC patients requiring adjuvant chemotherapy are more likely to experience financial toxicity from the indirect cost of work stoppages and/or changes in job scope due to cancer care. In addition, challenges related to sexual wellbeing, such as erectile dysfunction, possibly hold greater significance for younger patients, particularly concerning family planning, they noted.

“Conversely, elderly CRC patients are more likely to be retired, with adult children who often function as informal caregivers providing functional, financial, and social support,” they added.

Going forward, allied health services and other support agencies should focus on facilitating the recovery of CRC patients, especially younger individuals undergoing adjuvant treatments, according to the researchers. This effort must extend beyond healthcare settings and include employers, who should acknowledge the unique challenges faced by cancer survivors, they added.

The analysis included 251 CRC patients, of which 102 (40.64 percent) received adjuvant chemotherapy. Compared with the no-adjuvant chemotherapy group, those who received adjuvant chemotherapy were younger (64.50 vs 70.21 years) and were more likely to have stage III CRC (52.94 percent vs 18.80 percent). All patients completed the EORTC QLQ-C30 questionnaire over seven time points (diagnosis, predischarge, 1-, 3-, 6-, 9-, 12-months after surgery).

*EORTC Core Quality of Life Questionnaire