Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer

Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer Toshifumi Watanabe, Ryo Ohno, Ryuji Kajitani, Kurumi Sahara, Taro Munechika, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2732261/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 May, 2023 Read the published version in International Journal of Colorectal Disease → Version 1 posted 8 You are reading this latest preprint version Abstract Purpose Elderly people are thought to be more likely than their non-elderly counterparts to experience a decline in activities of daily living (ADL) and quality of life (QOL) due to the onset and treatment of disease. In this study, we investigated whether there was an age-related difference in changes in health-related QOL indices after surgical resection of colorectal cancer. Methods Patients who underwent elective surgery for primary colorectal cancer at our hospital between September 2017 and November 2021 were enrolled. Changes in QOL after surgery were evaluated after dividing the study population into a non-elderly (NE) group (younger than 75 years) and an elderly (E) group. A self-administered Short-Form 36-Item Health Survey was used as an index of QOL. The subscale and component summary scores before and 6 months after surgery were compared. Results There was no significant difference in clinical or demographic characteristics between the NE group (n=166) and the E group (n=47). There was also no significant difference in worsening of indices of physical function after surgery in either group. In the NE group, there were significant decreases in role physical and role component summary scores and significant increases in general health, mental health, and mental component summary scores. In the E group, there were no significant changes in the subscale or component summary scores after surgery. Conclusion There was no significant difference in QOL after surgery for colorectal cancer between elderly patients and non-elderly patients. Surgical resection for colorectal cancer should be considered even for elderly patients, while considering possible risk factors for worsening ADL and QOL. Quality of life colorectal cancer elderly patients surgery Figures Figure 1 Figure 2 Introduction Elderly people may have less physical and functional capacity than non-elderly people and be at greater risk of decline in activities of daily living (ADL) and failure to recover from illness [1, 2]. It has been reported that illness and injury leading to hospitalization in elderly patients precipitate and worsen disability despite intervention [2, 3]. Many of the diseases that occur in the elderly are long-term disorders that are considered difficult to cure [4]. Therefore, the important goals of treatment in this age group are not only prolongation of life but also preservation of ADL [1, 2]. While radical curative resection is performed for early-stage colorectal cancer, palliative surgery is often required in advanced cases to relieve symptoms and maintain performance of ADL and quality of life (QOL) [5], even when there is little possibility of a cure because of distant metastasis or infiltration into other organs. In recent years, there has been a rapid increase in the number of elderly patients with cancer [6-8], with more opportunities to consider surgery for patients in this age group in Japan [9]. However, there is concern that ADL and health-related QOL (HRQOL) may decline after invasive surgical intervention in the same way as with treatment for chronic disease, but there is relatively little information on changes in HRQOL following digestive surgery in elderly patients. The purpose of this study was to investigate whether there is a difference in the HRQOL score between elderly and non-elderly patients after surgical resection of colorectal cancer (CRC). Methods Study design This single-center prospective observational study recruited patients who planned to undergo surgical resection of primary CRC between September 2017 and November 2021 at our hospital. The inclusion criteria were histologically proven colorectal adenocarcinoma, an age of 40 years or older and no emergency surgery. The exclusion criteria were cognitive and functional ability insufficient to answer questionnaires. The study was approved by the Fukuoka University Hospital Ethics Committee (2017M030). Written informed consent was obtained from all participants after they were provided with an explanation of the purpose of the study and its methodology. Patients who completed the questionnaire before and 6 months after surgery were ultimately included in the analysis of the study. Clinical and demographic characteristics and HRQOL scores were compared between non-elderly patients (aged younger than 75 years; the NE group) and elderly patients (aged 75 years or older; the E group). The primary outcome of the study was the change in HRQOL score after surgery. Applied questionnaires Participants were asked to self-assess their HRQOL before and 6 months after surgery using the Short-Form 36-Item Health Survey (SF-36) version 2.0 questionnaire. The SF-36 has been translated into Japanese and validated for the general Japanese population [10, 11]. We used the three-component model as this has been reported to be better than the two-component model in Japan [12]. Eight subscale scores (physical functioning [PF], role physical [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role emotional [RE], mental health [MH]) and three component summary scores (physical component summary [PCS], mental component summary [MCS], Role-social component summary [RCS]) calculated from the responses to the SF-36 were used as the HRQOL score. Statistics Continuous variables are shown as the mean ± standard deviation or median (range) and ordinal and categorical variables as the number (percent). Categorical variables were compared using the chi-squared test and continuous variables using the Mann-Whitney U test. HRQOL scores were compared using the paired t-test. All analyses were performed using JMP® (version.17.0, SAS Institute Japan Ltd., Tokyo, Japan). A p-value of <0.05 was considered statistically significant. Results Fig. 1 shows the flow diagram of this study. Of 250 patients who were registered in the study, 37 patients did not complete the SF-36 questionnaire both before and 6 months after surgery because of unanswered or unadministered questionnaires (n=14), follow-up at another hospital (n=7), priority to treatment for comorbidities (n=5), incorrect follow-up timing (n=5), death due to other diseases within 6 months after surgery (n=3), missing date at baseline (n=2) and lost to follow-up (n=1). 213 patients were eligible for the analysis of this study (NE group, n = 166; E group, n = 47). The questionnaire completion rate was 85.2% (NE group, 88.3%; E group, 75.8%). The characteristics of the NE and E groups are shown in Table 1. There were no significant differences in clinicopathological characteristics or surgical outcomes. The indicators of physical function are shown for each group in Table 2. Comparison of the NE and E groups revealed significant differences in preoperative gait speed (1.27 ± 0.24 m/s vs 1.08 ± 0.26 m/s, p < 0.01) and handgrip strength (27.9 ± 9.1 kg vs22.8 ± 7.6 kg, p = 0.010). Gait speed improved from 1.27 ± 0.24 m/s before surgery to 1.33 ± 0.25 m/s after surgery in the NE group and from 1.08 ± 0.26 m/s to 1.18 ± 0.23 m/s in the E group. There was no significant change in the Barthel index or grip strength after surgery in either group. Fig. 2 shows the changes in HRQOL scores after surgery in each group. In the NE group, GH, MH, and MCS were significantly increased after surgery. Conversely, there was a significant decrease in RP from 82.2 ± 24.2 to 78.0 ± 25.7 (p = 0.029) and in RCS from 47.4 ± 12.7 to 44.8 ± 13.9 (p = 0.021). There were no significant changes in PF, BP, VT, or PCS. No significant changes in any of the HRQOL scores were found in the E group. Discussion The findings of this observational study demonstrate that there may be little difference in HRQOL after CRC surgery between elderly and non-elderly patients. We found no significant age-related difference in factors thought to be involved in postoperative HRQOL, such as preoperative Eastern Cooperative Oncology Group performance status, tumor location, surgical approach, permanent stoma formation, and postoperative complications. In the non-elderly group, GH and MH were improved at 6 months after surgery. Immediately after surgery (e.g., at 1 month postoperatively), patients are likely to be interested in whether their cancer has been cured [13]. It is assumed that patients become more aware of their well-being about 6 months after surgery when adjuvant therapy is completed and surveillance becomes less frequent. In the NE group, RP and RCS were significantly reduced at 6 months after surgery, whereas there was no significant decrease in BP, VT, or PCS. This indicates that non-elderly patients may face few physical problems when performing ADL 6 months after surgery but may still find it difficult to do housework and return to work. There was also a slight decrease in RE after surgery, albeit not statistically significant, which also suggests that non-elderly patients feel some degree of apprehension about undertaking a task with responsibility. Cabilan et al. [14] reported a decline in QOL for up to 6 months after curative treatment for CRC but that the scores almost returned to baseline levels at 1 year. In our elderly patients, there was no significant change in HRQOL scores after CRC surgery. Unlike patients in the NE group, those in the E group seemed not to experience a decline in postoperative HRQOL in terms of roles, probably because they have retired from work and are exempt from social roles with heavy responsibility. HRQOL associated with psychological status, which improved after surgery in non-elderly patients, remained unchanged in elderly patients. A possible explanation for this finding is that elderly people are more likely to have symptoms associated with comorbidities and their perception of improvement in their health condition after surgery may be less than that in their non-elderly counterparts. It has been reported that elderly people are more likely than non-elderly people to experience a decline in ADL in response to onset of disease and its treatment [1, 2]. In our study, preoperative indices of physical function (i.e., gait speed and handgrip strength) were lower in elderly patients, indicating that they were more fragile than non-elderly patients. However, these indices were similar in both groups and did not worsen after CRC surgery. Amemiya et al. [15] reported that 24% of patients aged 75 years or older who had undergone elective surgery for gastric cancer or CRC showed a transient decline in ADL that recovered in most cases by 6 months after surgery, with only a small percentage of patients showing a protracted decline. It has recently been reported that age alone does not correlate with surgical outcomes and that fitness is more important than age per se in an older patient with cancer and should be considered [6, 16]. Several reports suggest that frailty, postoperative complications, sex, cancer stage, tumor location, stoma formation, and comorbidities are risk factors for declining ADL and QOL after cancer surgery [6, 15-18]. In our study, the rate of postoperative complications with a Clavien–Dindo classification of 3b or over was low in both groups. Almost all patients who were eligible for this trial underwent minimally invasive surgery, which is expected to reduce the incidence of complications after CRC surgery even in elderly patients [19-21]. These factors probably explain why our elderly group did not show a significant decline in ADL or HRQOL after surgery for CRC. Further research is needed to identify factors that may have a significant interaction with age. A limitation of this study is the potential influence of selection bias. Considering that the study included only patients with cognitive and functional ability sufficient to answer the questionnaire, it is possible that the results here may differ from those of all patients undergoing CRC surgery. Conclusion This single-center observational study did not find a significant difference in the decrease in HRQOL after CRC surgery between elderly and non-elderly patients. Surgical resection for CRC should be considered whenever needed, even for elderly patients, while considering the possible risk factors for declining ADL or QOL. Reduction of postoperative complications can prevent the decline of QOL in elderly patients. Declarations Author contribution All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Ryo Ohno, Ryuji Kajitani, Taro Munechika, Yoshiko Matsumoto. The first draft of the manuscript was written by Toshifumi Watanabe, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding No funding was received for conducting this study. Data and Material availability The data and materials are available on reasonable request from the corresponding author. Ethics approval The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the Fukuoka University Hospital Ethics Committee. Consent to participate Informed consent was obtained from all individual participants included in the study. Competing interest The authors have no competing interests to declare that are relevant to the content of this article. Consent to publish Not applicable. References Gill TM, Allore HG, Holford TR, Guo ZH (2004) Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons. JAMA 292:2115-2124. http// doi:10.1001/jama.292.17.2115. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS (2003) Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age. J Am Geriatr Soc 51:451-458. http//doi: 10.1046/j.1532-5415.2003.51152.x. Gill TM, Allore HG, Gahbauer EA, Murphy TE (2010) Change in disability after hospitalization or restricted activity in older persons. JAMA 304:1919–1928. http//doi: 10.1001/jama.2010.1568. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37-43. http// doi: 10.1016/S0140-6736(12)60240-2. Tan WJ, Chew MH, Tan IBH, Law JH, Zhao R, Acharyya S, Mao YL, Fernandez LG, Loi CT, Tang CL (2016) Palliative surgical intervention in metastatic colorectal carcinoma: a prospective analysis of quality of life. Colorectal Dis 18:357-363. http// doi: 10.1111/codi.13142. Montroni I, Ugolini G, Saur NM, Rostoft S, Spinelli A, Van Leeuwen BL, De Liguori Carino N, Ghignone F, Jaklitsch MT, Somasundar P, Garutti A, Zingaretti C, Foca F, Vertogen B, Nanni O, Wexner SD, Audisio RA (2022) Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study. JNCI J Natl Cancer Inst 114:969-978. http// doi: 10.1093/jnci/djac071. Outlaw D, Williams GR (2020) Is the Lack of Evidence in Older Adults with Cancer Compromising Safety? Expert Opin Drug Saf 19:1059-1061. http// doi: 10.1080/14740338.2020.1805429. Nagashima F, Furuse J (2022) Treatments for elderly cancer patients and reforms to social security systems in Japan. Int J Clin Oncol 27:310-315. http// doi: 10.1007/s10147-021-02099-0. Fukata S, Ando M, Amemiya T, Kuroiwa K, Oda K (2012) Postoperative function following radical surgery in gastric and colorectal cancer patients over 80 years of age--an objection to "ageism". Nagoya J. Med. Sci 74:241-251. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K (1998) Translation, Adaptation, and Validation of the SF-36 Health Survey for Use in Japan. J Clin Epidemiol 51:1037-1044. http// doi: 10.1016/s0895-4356(98)00095-x. Fukuhara S, Ware JE Jr, Kosinski M, Wada S, Gandek B (1998) Psychometric and Clinical Tests of Validity of the Japanese SF-36 Health Survey. J Clin Epidemiol 51:1045-1053. http// doi: 10.1016/s0895-4356(98)00096-1. Suzukamo Y, Fukuhara S, Green J, Kosinski M, Gandek B, Ware JE (2011) Validation testing of a three-component model of Short Form-36 scores. J Clin Epidemiol 64:301-308. http// doi: 10.1016/j.jclinepi.2010.04.017. Ohya H, Watanabe J, Suwa Y, Suwa H, Ozawa M, Ishibe A, Fujii S, Kubota K, Kunisaki C, Endo I (2020) The comparison of health-related quality of life and patient satisfaction between single-incision and multiport laparoscopic colectomy for cancer: A sub-study of a randomized, prospective clinical trial. Ann Gastroenterol Surg 4:684-692. http// doi: 10.1002/ags3.12378. Cabilan CJ, Hines S (2017) The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life a systematic review. JBI Database System Rev Implement Rep 15:517-566. http// doi: 10.11124/JBISRIR-2016003282. Amemiya T, Oda K, Ando M, Kawamura T, Kitagawa Y, Okawa Y, Yasui A, Ike H, Shimada H, Kuroiwa K, Nimura Y, Fukata S (2007) Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers. Ann Surg 246:222-228. http// doi: 10.1097/SLA.0b013e3180caa3fb. Shahrokni A, Alexander K (2019) The Age of Talking About Age Alone is Over. Ann Surg Oncol 26:12-14. http// doi: 10.1245/s10434-018-6983-7. Valeikaite-Tauginiene G, Kraujelyte A, Poskus E, Jotautas V, Saladzinskas Z, Tamelis A, Lizdenis P, Dulskas A, Samalavicius NE, Strupas K, Poškus T (2022) Predictors of Quality of Life Six Years after Curative Colorectal Cancer Surgery: Results of the Prospective Multicenter Study. Medicina (Kaunas) 58:482. http//doi: 10.3390/medicina58040482. Wheelwright S, Permyakova NV, Calman L, Din A, Fenlon D, Richardson A, Sodergren S, Smith PWF, Winter J, Foster C (2020) Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study. PLOS ONE 15:e0231332. http//doi: 10.1371/journal.pone.0231332. Kazama K, Aoyama T, Hayashi T, Yamada T, Numata M, Amano S, Kamiya M, Sato T, Yoshikawa T, Shiozawa M, Oshima T, Yukawa N, Rino Y, Masuda M (2017) Evaluation of short-term outcomes of laparoscopic-assisted surgery for colorectal cancer in elderly patients aged over 75 years old: a multi-institutional study (YSURG1401). BMC Surgery 17:29. http//doi: 10.1186/s12893-017-0229-7. Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O (2013) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27:19-30. http// doi: 10.1007/s00464-012-2414-1. Sujatha-Bhaskar S, Alizadeh RF, Inaba CS, Koh CY, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2018) Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc 32:1280-1285. http// doi: 10.1007/s00464-017-5805-5. Tables Table 1 to 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables12.docx Cite Share Download PDF Status: Published Journal Publication published 31 May, 2023 Read the published version in International Journal of Colorectal Disease → Version 1 posted Editorial decision: Major revision 09 Apr, 2023 Reviews received at journal 30 Mar, 2023 Reviewers agreed at journal 30 Mar, 2023 Reviewers agreed at journal 30 Mar, 2023 Reviewers invited by journal 29 Mar, 2023 Submission checks completed at journal 26 Mar, 2023 Editor assigned by journal 26 Mar, 2023 First submitted to journal 24 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2732261","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":186632891,"identity":"d0ff2cfa-89bb-45d0-b3d0-097fbb508131","order_by":0,"name":"Toshifumi Watanabe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABRElEQVRIie2RMUvDQBTH33FwWRK6XqilXyEh0FqI7VcxBDo7ScGAB8K5BGcF6TcQUoSTbicH6aLOEYS2S6cOglDSQbGpInK0QzeR/IY3PO7H/717ACUlfxkHgAD0ADFAk1UpGl9g7aVZFPmjPBQKdnZQEN+g6HTAdN9eo5d602Bkuuy3azcME/uK+16FmQ7kERhNPcX0qExn7jCWhmeJ0BNypQx4t0Gl6aA4BdximmIlVBKFkuyQVJHAgZCV1J5y5cN47oBVzCl15TaXH6qTjCfEXl6fBuuUQqkXKe8bFUHvuQqSDAi1mAq+B1MNZ6XgTSmqsth/vFDhMA541UxHnlAYty6fup4ryZHaS6m+i3HOw6y3UAd3hkrtPDqpidEZeo6Pfbcv8WA6j/xQ+7Ffh0JM76wvRsOtF9pKe3elpKSk5H/xCXZ3dBV+ovDpAAAAAElFTkSuQmCC","orcid":"","institution":"Fukuoka University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Toshifumi","middleName":"","lastName":"Watanabe","suffix":""},{"id":186632892,"identity":"227667f1-3c7b-425f-acaf-fc9fa31fb774","order_by":1,"name":"Ryo Ohno","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ryo","middleName":"","lastName":"Ohno","suffix":""},{"id":186632893,"identity":"db4d767c-5ef5-4144-9870-88d480a5c773","order_by":2,"name":"Ryuji Kajitani","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ryuji","middleName":"","lastName":"Kajitani","suffix":""},{"id":186632894,"identity":"5ff8bc15-0752-4d7e-a232-714aa8d108f0","order_by":3,"name":"Kurumi Sahara","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kurumi","middleName":"","lastName":"Sahara","suffix":""},{"id":186632895,"identity":"d72e53ec-9c4e-405e-b795-38a3e68c65ca","order_by":4,"name":"Taro Munechika","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Taro","middleName":"","lastName":"Munechika","suffix":""},{"id":186632896,"identity":"1988653f-ea5f-4331-931e-1fdf87043a1d","order_by":5,"name":"Yoshiko Matsumoto","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yoshiko","middleName":"","lastName":"Matsumoto","suffix":""},{"id":186632897,"identity":"48d9cbd0-4370-4cf1-a89c-2feec740b6fa","order_by":6,"name":"Naoya Aisu","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Naoya","middleName":"","lastName":"Aisu","suffix":""},{"id":186632898,"identity":"f1fb6dd6-17e8-43c5-82cd-517d610b9060","order_by":7,"name":"Daibo Kojima","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Daibo","middleName":"","lastName":"Kojima","suffix":""},{"id":186632900,"identity":"b6a46c9e-a651-4c73-be16-0ee5ed21d087","order_by":8,"name":"Gumpei Yoshimatsu","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gumpei","middleName":"","lastName":"Yoshimatsu","suffix":""},{"id":186632901,"identity":"35d49a3e-f856-41d0-a045-acff87244e6c","order_by":9,"name":"Suguru Hasegawa","email":"","orcid":"","institution":"Fukuoka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Suguru","middleName":"","lastName":"Hasegawa","suffix":""}],"badges":[],"createdAt":"2023-03-24 13:29:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2732261/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2732261/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00384-023-04440-7","type":"published","date":"2023-05-31T21:02:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":34944786,"identity":"cc740195-4508-414b-9f5a-85e0d690942f","added_by":"auto","created_at":"2023-03-28 22:26:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50869,"visible":true,"origin":"","legend":"\u003cp\u003eStudy profile\u003c/p\u003e\n\u003cp\u003eAbbreviations: E, elderly; n, number of patients; NE, non-elderly\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2732261/v1/fbaef9067fa8bae641ab125b.jpg"},{"id":34945295,"identity":"a57a2d95-31ff-4e7f-a8a7-a34787ee0868","added_by":"auto","created_at":"2023-03-28 22:34:33","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79767,"visible":true,"origin":"","legend":"\u003cp\u003eSF-36 subscale and component summary scores\u003c/p\u003e\n\u003cp\u003eAbbreviations: AS, after surgery; BP, bodily pain; BS, before surgery; E, elderly; GH, general health; MCS, mental component summary; MH, mental health; NE, non-elderly; PCS, physical component summary; PF, physical functioning; RCS, role/social component summary; RE, role emotional; RP, role physical; SF, social functioning; VT, vitality\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2732261/v1/30161aa427766394ae2fcd99.jpg"},{"id":44734560,"identity":"5613b831-392e-4fd8-9708-90ffe6c73c68","added_by":"auto","created_at":"2023-10-16 22:19:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":369186,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2732261/v1/11f05a10-3947-4674-81cc-541499d182c9.pdf"},{"id":34944787,"identity":"dd526a87-6cb3-47ff-bd64-d6293408ed65","added_by":"auto","created_at":"2023-03-28 22:26:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":135677,"visible":true,"origin":"","legend":"","description":"","filename":"Tables12.docx","url":"https://assets-eu.researchsquare.com/files/rs-2732261/v1/fd2e88f114e4c40738c8369b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eElderly people may have less physical and functional capacity than non-elderly people and be at greater risk of decline in activities of daily living (ADL) and failure to recover from illness [1, 2]. It has been reported that illness and injury leading to hospitalization in elderly patients precipitate and worsen disability despite intervention [2, 3].\u0026nbsp;Many of the diseases that occur in the elderly are long-term disorders that are considered difficult to cure\u0026nbsp;[4]. Therefore, the important goals of treatment in this age group are not only prolongation of life but also preservation of ADL [1, 2].\u003c/p\u003e\n\u003cp\u003eWhile radical curative resection is performed for early-stage colorectal cancer, palliative surgery is often required in advanced cases to relieve symptoms and maintain performance of ADL and quality of life (QOL) [5], even when there is little possibility of a cure because of distant metastasis or infiltration into other organs. In recent years, there has been a rapid increase in the number of elderly patients with cancer [6-8], with more opportunities to consider surgery for patients in this age group in Japan [9]. However, there is concern that ADL and health-related QOL (HRQOL) may decline after invasive surgical intervention in the same way as with treatment for chronic disease, but there is relatively little information on changes in HRQOL following digestive surgery in elderly patients. The purpose of this study was to investigate whether there is a difference in the HRQOL score between elderly and non-elderly patients after surgical resection of colorectal cancer (CRC).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center prospective observational study recruited patients who planned to undergo surgical resection of primary CRC between September 2017 and November 2021 at our hospital. The inclusion criteria were histologically proven colorectal adenocarcinoma, an age of 40 years or older\u0026nbsp;and no emergency surgery.\u0026nbsp;The exclusion criteria were cognitive and functional ability insufficient to answer questionnaires. The study was approved by the Fukuoka University Hospital Ethics Committee (2017M030). Written informed consent was obtained from all participants after they were provided with an explanation of the purpose of the study and its methodology. Patients who completed the questionnaire before and 6 months after surgery were ultimately included in the analysis of the study. Clinical and demographic characteristics and HRQOL scores were compared between non-elderly patients (aged younger than 75 years; the NE group) and elderly patients (aged 75 years or older; the E group). The primary outcome of the study was the change in HRQOL score after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApplied questionnaires\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were asked to self-assess their HRQOL before and 6 months after surgery using the Short-Form 36-Item Health Survey (SF-36) version 2.0 questionnaire. The SF-36 has been translated into Japanese and validated for the general Japanese population [10, 11]. We used the three-component model as this has been reported to be better than the two-component model in Japan [12]. Eight subscale scores (physical functioning [PF], role physical [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role emotional [RE], mental health [MH]) and three component summary scores (physical component summary [PCS], mental component summary [MCS], Role-social component summary [RCS]) calculated from the responses to the SF-36 were used as the HRQOL score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables are shown as the mean \u0026plusmn; standard deviation or median (range) and ordinal and categorical variables as the number (percent). Categorical variables were compared using the chi-squared test and continuous variables using the Mann-Whitney U test. HRQOL scores were compared using the paired t-test. All analyses were performed using JMP\u0026reg; (version.17.0, SAS Institute Japan Ltd., Tokyo, Japan). A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFig. 1 shows the flow diagram of this study. Of 250 patients who were registered in the study, 37 patients did not complete the SF-36 questionnaire both before and 6 months after surgery because\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eof unanswered or unadministered questionnaires (n=14), follow-up at another hospital (n=7), priority to treatment for comorbidities (n=5), incorrect follow-up timing (n=5), death due to other diseases within 6 months after surgery (n=3), missing date at baseline (n=2) and lost to follow-up (n=1). 213 patients were eligible for the analysis of this study (NE group, n = 166; E group, n = 47). The questionnaire completion rate was 85.2% (NE group, 88.3%; E group, 75.8%).\u003c/p\u003e\n\u003cp\u003eThe characteristics\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eof the NE and E groups are shown in Table 1. There were no significant differences in clinicopathological characteristics or surgical outcomes.\u003c/p\u003e\n\u003cp\u003eThe indicators of physical function are shown for each group in Table 2. Comparison of the NE and E groups revealed significant differences in preoperative gait speed (1.27 \u0026plusmn; 0.24 m/s vs 1.08 \u0026plusmn; 0.26 m/s, p \u0026lt; 0.01) and handgrip strength (27.9 \u0026plusmn; 9.1 kg vs22.8 \u0026plusmn; 7.6 kg, p = 0.010). Gait speed improved from 1.27 \u0026plusmn; 0.24 m/s before surgery to 1.33 \u0026plusmn; 0.25 m/s after surgery in the NE group and from 1.08 \u0026plusmn; 0.26 m/s to 1.18 \u0026plusmn; 0.23 m/s in the E group. There was no significant change in the Barthel index or grip strength after surgery in either group.\u003c/p\u003e\n\u003cp\u003eFig. 2 shows the changes in HRQOL scores after surgery in each group. In the NE group, GH, MH, and MCS were significantly increased after surgery. Conversely, there was a significant decrease in RP from 82.2 \u0026plusmn; 24.2 to 78.0 \u0026plusmn; 25.7 (p = 0.029) and in RCS from 47.4 \u0026plusmn; 12.7 to 44.8 \u0026plusmn; 13.9 (p = 0.021). There were no significant changes in PF, BP, VT, or PCS. No significant changes in any of the HRQOL scores were found in the E group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this observational study demonstrate that there may be little difference in HRQOL after CRC surgery between elderly and non-elderly patients. We found no significant age-related difference in factors thought to be involved in postoperative HRQOL, such as preoperative Eastern Cooperative Oncology Group performance status, tumor location, surgical approach, permanent stoma formation, and postoperative complications.\u003c/p\u003e\n\u003cp\u003eIn the non-elderly group, GH and MH were improved at 6 months after surgery. Immediately after surgery (e.g., at 1 month postoperatively), patients are likely to be interested in whether their cancer has been cured\u0026nbsp;[13]. It is assumed that patients become more aware of their well-being about 6 months after surgery when adjuvant therapy is completed and surveillance becomes less frequent. In the NE group, RP and RCS were significantly reduced at 6 months after surgery, whereas there was no significant decrease in BP, VT, or PCS. This indicates that non-elderly patients may face few physical problems when performing ADL 6 months after surgery but may still find it difficult to do housework and return to work. There was also a slight decrease in RE after surgery, albeit not statistically significant, which also suggests that non-elderly patients feel some degree of apprehension about undertaking a task with responsibility. Cabilan et al. [14]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ereported a decline in QOL for up to 6 months after curative treatment for CRC but that the scores almost returned to baseline levels at 1 year.\u003c/p\u003e\n\u003cp\u003eIn our elderly patients, there was no significant change in HRQOL scores after CRC surgery. Unlike patients in the NE group, those in the E group seemed not to experience a decline in postoperative HRQOL in terms of roles, probably because they have retired from work and are exempt from social roles with heavy responsibility. HRQOL associated with psychological status, which improved after surgery in non-elderly patients, remained unchanged in elderly patients. A possible explanation for this finding is that elderly people are more likely to have symptoms associated with comorbidities and their perception of improvement in their health condition after surgery may be less than that in their non-elderly counterparts.\u003c/p\u003e\n\u003cp\u003eIt has been reported that elderly people are more likely than non-elderly people to experience a decline in ADL in response to onset of disease and its treatment [1, 2]. In our study, preoperative indices of physical function (i.e., gait speed and handgrip strength) were lower in elderly patients, indicating that they were more fragile than non-elderly patients. However, these indices were similar in both groups and did not worsen after CRC surgery. Amemiya et al. [15]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ereported that 24% of patients aged 75 years or older who had undergone elective surgery for gastric cancer or CRC showed a transient decline in ADL that recovered in most cases by 6 months after surgery, with only a small percentage of patients showing a protracted decline. It has recently been reported that age alone does not correlate with surgical outcomes and that fitness is more important than age per se in an older patient with cancer and should be considered [6, 16]. Several reports suggest that frailty, postoperative complications, sex, cancer stage, tumor location, stoma formation, and comorbidities are risk factors for declining ADL and QOL after cancer surgery [6, 15-18]. In our study, the rate of postoperative complications with a Clavien\u0026ndash;Dindo classification of 3b or over was low in both groups. Almost all patients who were eligible for this trial underwent minimally invasive surgery, which is expected to reduce the incidence of complications after CRC surgery even in elderly patients\u0026nbsp;[19-21]. These factors probably explain why our elderly group did not show a significant decline in ADL or HRQOL after surgery for CRC. Further research is needed to identify factors that may have a significant interaction with age.\u003c/p\u003e\n\u003cp\u003eA limitation of this study is the potential influence of selection bias. Considering that the study included only patients with cognitive and functional ability sufficient to answer the questionnaire, it is possible that the results here may differ from those of all patients undergoing CRC surgery.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis single-center observational study did not find a significant difference in the decrease in HRQOL after CRC surgery between elderly and non-elderly patients. Surgical resection for CRC should be considered whenever needed, even for elderly patients, while considering the possible risk factors for declining ADL or QOL. Reduction of postoperative complications can prevent the decline of QOL in elderly patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e All authors contributed to the study\u0026rsquo;s conception and design. Material preparation, data collection, and analysis were performed by Ryo Ohno, Ryuji Kajitani, Taro Munechika, Yoshiko Matsumoto. The first draft of the manuscript was written by Toshifumi Watanabe, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e No funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and Material availability\u0026nbsp;\u003c/strong\u003eThe data and materials are available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the Fukuoka University Hospital Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e The authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGill TM, Allore HG, Holford TR, Guo ZH (2004) Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons. JAMA 292:2115-2124. http// doi:10.1001/jama.292.17.2115.\u003c/li\u003e\n \u003cli\u003eCovinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D,\u0026nbsp;Burant CJ, Landefeld CS (2003)\u0026nbsp;Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age. J Am Geriatr Soc 51:451-458. http//doi: 10.1046/j.1532-5415.2003.51152.x.\u003c/li\u003e\n \u003cli\u003eGill TM, Allore HG, Gahbauer EA, Murphy TE (2010) Change in disability after hospitalization or restricted activity in older persons. JAMA 304:1919\u0026ndash;1928. http//doi: 10.1001/jama.2010.1568.\u003c/li\u003e\n \u003cli\u003eBarnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37-43. http// doi: 10.1016/S0140-6736(12)60240-2.\u003c/li\u003e\n \u003cli\u003eTan WJ, Chew MH, Tan IBH, Law JH, Zhao R, Acharyya S, Mao YL, Fernandez LG, Loi CT, Tang CL (2016) Palliative surgical intervention in metastatic colorectal carcinoma: a prospective analysis of quality of life. Colorectal Dis 18:357-363. http// doi: 10.1111/codi.13142.\u003c/li\u003e\n \u003cli\u003eMontroni I, Ugolini G, Saur NM, Rostoft S, Spinelli A, Van Leeuwen BL, De Liguori Carino N, Ghignone F, Jaklitsch MT, Somasundar P, Garutti A, Zingaretti C, Foca F, Vertogen B, Nanni O, Wexner SD, Audisio RA (2022)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eQuality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study. JNCI J Natl Cancer Inst 114:969-978. http// doi: 10.1093/jnci/djac071.\u003c/li\u003e\n \u003cli\u003eOutlaw D, Williams GR (2020) Is the Lack of Evidence in Older Adults with Cancer Compromising Safety? Expert Opin Drug Saf 19:1059-1061. http// doi: 10.1080/14740338.2020.1805429.\u003c/li\u003e\n \u003cli\u003eNagashima F, Furuse J (2022) Treatments for elderly cancer patients and reforms to social security systems in Japan. Int J Clin Oncol 27:310-315. http// doi: 10.1007/s10147-021-02099-0.\u003c/li\u003e\n \u003cli\u003eFukata S, Ando M, Amemiya T, Kuroiwa K, Oda K (2012) Postoperative function following radical surgery in gastric and colorectal cancer patients over 80 years of age--an objection to \u0026quot;ageism\u0026quot;. Nagoya J. Med. Sci 74:241-251.\u003c/li\u003e\n \u003cli\u003eFukuhara S, Bito S, Green J, Hsiao A, Kurokawa K (1998) Translation, Adaptation, and Validation of the SF-36 Health Survey for Use in Japan. J Clin Epidemiol 51:1037-1044. http// doi: 10.1016/s0895-4356(98)00095-x.\u003c/li\u003e\n \u003cli\u003eFukuhara S, Ware JE Jr, Kosinski M, Wada S, Gandek B (1998) Psychometric and Clinical Tests of Validity of the Japanese SF-36 Health Survey. J Clin Epidemiol 51:1045-1053. http// doi: 10.1016/s0895-4356(98)00096-1.\u003c/li\u003e\n \u003cli\u003eSuzukamo Y, Fukuhara S, Green J, Kosinski M, Gandek B, Ware JE (2011) Validation testing of a three-component model of Short Form-36 scores.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eJ Clin Epidemiol\u0026nbsp;64:301-308. http// doi: 10.1016/j.jclinepi.2010.04.017.\u003c/li\u003e\n \u003cli\u003eOhya H, Watanabe J, Suwa Y, Suwa H, Ozawa M, Ishibe A, Fujii S, Kubota K, Kunisaki C, Endo I (2020) The comparison of health-related quality of life and patient satisfaction between single-incision and multiport laparoscopic colectomy for cancer: A sub-study of a randomized, prospective clinical trial. Ann Gastroenterol Surg 4:684-692. http// doi: 10.1002/ags3.12378.\u003c/li\u003e\n \u003cli\u003eCabilan CJ, Hines S (2017) The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life a systematic review. JBI Database System Rev Implement Rep 15:517-566. http// doi: 10.11124/JBISRIR-2016003282.\u003c/li\u003e\n \u003cli\u003eAmemiya T, Oda K, Ando M, Kawamura T, Kitagawa Y, Okawa Y, Yasui A, Ike H, Shimada H, Kuroiwa K, Nimura Y, Fukata S (2007) Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers. Ann Surg 246:222-228. http// doi: 10.1097/SLA.0b013e3180caa3fb.\u003c/li\u003e\n \u003cli\u003eShahrokni A, Alexander K (2019) The Age of Talking About Age Alone is Over. Ann Surg Oncol 26:12-14. http// doi: 10.1245/s10434-018-6983-7.\u003c/li\u003e\n \u003cli\u003eValeikaite-Tauginiene G, Kraujelyte A, Poskus E, Jotautas V, Saladzinskas Z, Tamelis A, Lizdenis P, Dulskas A, Samalavicius NE, Strupas K, Po\u0026scaron;kus T (2022) Predictors of Quality of Life Six Years after Curative Colorectal Cancer Surgery: Results of the Prospective Multicenter Study. Medicina (Kaunas) 58:482. http//doi: 10.3390/medicina58040482.\u003c/li\u003e\n \u003cli\u003eWheelwright S, Permyakova NV, Calman L, Din A, Fenlon D, Richardson A, Sodergren S, Smith PWF, Winter J, Foster C (2020) Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study. PLOS ONE 15:e0231332. http//doi: 10.1371/journal.pone.0231332.\u003c/li\u003e\n \u003cli\u003eKazama K, Aoyama T, Hayashi T, Yamada T, Numata M, Amano S, Kamiya M, Sato T, Yoshikawa T, Shiozawa M, Oshima T, Yukawa N, Rino Y, Masuda M (2017)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eEvaluation of short-term outcomes of laparoscopic-assisted surgery for colorectal cancer in elderly patients aged over 75 years old: a multi-institutional study (YSURG1401). BMC Surgery 17:29. http//doi: 10.1186/s12893-017-0229-7.\u003c/li\u003e\n \u003cli\u003eGrailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O (2013) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27:19-30. http// doi: 10.1007/s00464-012-2414-1.\u003c/li\u003e\n \u003cli\u003eSujatha-Bhaskar S, Alizadeh RF, Inaba CS, Koh CY, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2018) Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc 32:1280-1285. http// doi: 10.1007/s00464-017-5805-5.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-colorectal-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcd","sideBox":"Learn more about [International Journal of Colorectal Disease](http://link.springer.com/journal/384)","snPcode":"384","submissionUrl":"https://submission.nature.com/new-submission/384/3","title":"International Journal of Colorectal Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Quality of life, colorectal cancer, elderly patients, surgery","lastPublishedDoi":"10.21203/rs.3.rs-2732261/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2732261/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose \u003c/strong\u003eElderly people are thought to be more likely than their non-elderly counterparts to experience a decline in activities of daily living (ADL) and quality of life (QOL) due to the onset and treatment of disease. In this study, we investigated whether there was an age-related difference in changes in health-related QOL indices after surgical resection of colorectal cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003ePatients who underwent elective surgery for primary colorectal cancer at our hospital between September 2017 and November 2021 were enrolled. Changes in QOL after surgery were evaluated after dividing the study population into a non-elderly (NE) group (younger than 75 years) and an elderly (E) group. A self-administered Short-Form 36-Item Health Survey was used as an index of QOL. The subscale and component summary scores before and 6 months after surgery were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThere was no significant difference in clinical or demographic characteristics between the NE group (n=166) and the E group (n=47). There was also no significant difference in worsening of indices of physical function after surgery in either group. In the NE group, there were significant decreases in role physical and role component summary scores and significant increases in general health, mental health, and mental component summary scores. In the E group, there were no significant changes in the subscale or component summary scores after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThere was no significant difference in QOL after surgery for colorectal cancer between elderly patients and non-elderly patients. Surgical resection for colorectal cancer should be considered even for elderly patients, while considering possible risk factors for worsening ADL and QOL.\u003c/p\u003e","manuscriptTitle":"Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-28 22:26:28","doi":"10.21203/rs.3.rs-2732261/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-04-09T17:25:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-31T03:18:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"a520d21d-dfb6-4e81-aeb2-2192f20e02ed","date":"2023-03-30T08:20:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299b8f78-dc07-4568-a60f-19dd3678d27c","date":"2023-03-30T06:21:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-29T17:56:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-26T23:08:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-03-26T23:08:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Colorectal Disease","date":"2023-03-24T13:24:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-colorectal-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcd","sideBox":"Learn more about [International Journal of Colorectal Disease](http://link.springer.com/journal/384)","snPcode":"384","submissionUrl":"https://submission.nature.com/new-submission/384/3","title":"International Journal of Colorectal Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"150d6ec2-b583-407a-9c2c-15430a57a955","owner":[],"postedDate":"March 28th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T22:01:19+00:00","versionOfRecord":{"articleIdentity":"rs-2732261","link":"https://doi.org/10.1007/s00384-023-04440-7","journal":{"identity":"international-journal-of-colorectal-disease","isVorOnly":false,"title":"International Journal of Colorectal Disease"},"publishedOn":"2023-05-31 21:02:30","publishedOnDateReadable":"May 31st, 2023"},"versionCreatedAt":"2023-03-28 22:26:28","video":"","vorDoi":"10.1007/s00384-023-04440-7","vorDoiUrl":"https://doi.org/10.1007/s00384-023-04440-7","workflowStages":[]},"version":"v1","identity":"rs-2732261","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2732261","identity":"rs-2732261","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}