Longitudinal associations of light-intensity physical activity with quality of life, functioning and fatigue after colorectal cancer

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Abstract

Purpose

Evidence from cross-sectional studies suggests that higher levels of light-intensity physical activity (LPA) are associated with better health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors. However, these associations have not been investigated in longitudinal studies that provide the opportunity to analyse how within-individual changes in LPA affect HRQoL. We investigated longitudinal associations of LPA with HRQoL outcomes in CRC survivors, from 6 weeks to 2 years post-treatment.

Methods

Data were used of a prospective cohort study among 325 stage I–III CRC survivors (67% men, mean age: 67 years), recruited between 2012 and 2016. Validated questionnaires were used to assess hours/week of LPA (SQUASH) and HRQoL outcomes (EORTC QLQ-C30, Checklist Individual Strength) at 6 weeks, and 6, 12 and 24 months post-treatment. We applied linear mixed regression to analyse longitudinal confounder-adjusted associations of LPA with HRQoL.

Results

We observed statistically significant longitudinal associations between more LPA and better global quality of life and physical, role and social functioning, and less fatigue over time. Intra-individual analysis showed that within-person increases in LPA (per 8 h/week) were related to improved HRQoL, including better global quality of life ( β = 1.67, 95% CI 0.71; 2.63; total range scale: 0–100) and less fatigue ( β = − 1.22, 95% CI − 2.37; − 0.07; scale: 20–140). Stratified analyses indicated stronger associations among participants below the median of moderate-to-vigorous physical activity (MVPA) at diagnosis.

Conclusion

Higher levels of LPA were longitudinally associated with better HRQoL and less fatigue in CRC survivors up to two years post-treatment. Further prospective studies using accelerometer data are necessary to inform development of interventions targeting LPA.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02566-7) contains supplementary material, which is available to authorized users.

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Most cited references 32

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Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.

Jacques Ferlay, Isabelle Soerjomataram, Rajesh Dikshit … (2015)

Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large "areas" of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths). © 2014 UICC.

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The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

N. Aaronson, S. Ahmedzai, B Bergman … (1993)

In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. We report here the results of an international field study of the practicality, reliability, and validity of the EORTC QLQ-C30, the current core questionnaire. The QLQ-C30 incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional, and social); three symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality-of-life scale. Several single-item symptom measures are also included. The questionnaire was administered before treatment and once during treatment to 305 patients with nonresectable lung cancer from centers in 13 countries. Clinical variables assessed included disease stage, weight loss, performance status, and treatment toxicity. The average time required to complete the questionnaire was approximately 11 minutes, and most patients required no assistance. The data supported the hypothesized scale structure of the questionnaire with the exception of role functioning (work and household activities), which was also the only multi-item scale that failed to meet the minimal standards for reliability (Cronbach's alpha coefficient > or = .70) either before or during treatment. Validity was shown by three findings. First, while all interscale correlations were statistically significant, the correlation was moderate, indicating that the scales were assessing distinct components of the quality-of-life construct. Second, most of the functional and symptom measures discriminated clearly between patients differing in clinical status as defined by the Eastern Cooperative Oncology Group performance status scale, weight loss, and treatment toxicity. Third, there were statistically significant changes, in the expected direction, in physical and role functioning, global quality of life, fatigue, and nausea and vomiting, for patients whose performance status had improved or worsened during treatment. The reliability and validity of the questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe. These results support the EORTC QLQ-C30 as a reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. Work is ongoing to examine the performance of the questionnaire among more heterogenous patient samples and in phase II and phase III clinical trials.

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Colorectal cancer.

Hermann Brenner, Matthias Kloor, Christian Peter Pox (2014)

More than 1·2 million patients are diagnosed with colorectal cancer every year, and more than 600,000 die from the disease. Incidence strongly varies globally and is closely linked to elements of a so-called western lifestyle. Incidence is higher in men than women and strongly increases with age; median age at diagnosis is about 70 years in developed countries. Despite strong hereditary components, most cases of colorectal cancer are sporadic and develop slowly over several years through the adenoma-carcinoma sequence. The cornerstones of therapy are surgery, neoadjuvant radiotherapy (for patients with rectal cancer), and adjuvant chemotherapy (for patients with stage III/IV and high-risk stage II colon cancer). 5-year relative survival ranges from greater than 90% in patients with stage I disease to slightly greater than 10% in patients with stage IV disease. Screening has been shown to reduce colorectal cancer incidence and mortality, but organised screening programmes are still to be implemented in most countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

E. H. van Roekel:

ORCID: http://orcid.org/0000-0002-9402-2029

eline.vanroekel@maastrichtuniversity.nl

Journal

Journal ID (nlm-ta): Qual Life Res

Journal ID (iso-abbrev): Qual Life Res

Title: Quality of Life Research

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0962-9343

ISSN (Electronic): 1573-2649

Publication date (Electronic): 2 July 2020

Publication date PMC-release: 2 July 2020

Publication date (Print): 2020

Volume: 29

Issue: 11

Pages: 2987-2998

Affiliations

[1 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Epidemiology, GROW School for Oncology and Developmental Biology, , Maastricht University, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands

[2 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, , Maastricht University, ; Maastricht, The Netherlands

[3 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, Department of Medical Oncology, GROW School for Oncology and Developmental Biology, , Maastricht University Medical Center, ; Maastricht, The Netherlands

[4 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Methodology and Statistics, , Maastricht University, ; Maastricht, The Netherlands

[5 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Human Movement Science, NUTRIM School for Nutrition and Translational Research in Metabolism, , Maastricht University, ; Maastricht, The Netherlands

[6 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, Department of Surgery, GROW School for Oncology and Developmental Biology, , Maastricht University Medical Center+, ; Maastricht, The Netherlands

[7 ]GRID grid.416856.8, ISNI 0000 0004 0477 5022, Department of Clinical Epidemiology, , VieCuri Medical Center, ; Venlo, The Netherlands

[8 ]Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands

Author information

E. H. van Roekel http://orcid.org/0000-0002-9402-2029

Article

Publisher ID: 2566

DOI: 10.1007/s11136-020-02566-7

PMC ID: 7591443

PubMed ID: 32617891

SO-VID: 12c5af67-46bf-457c-a02a-6dfad02d94b0

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date accepted : 19 June 2020

Funding

Funded by: Wereld Kanker Onderzoek Fonds (WKOF), as part of the World Cancer Research Fund International grant programme

Award ID: 2016/1620

Award ID: 2017/1619

Award Recipient : E. H. van Roekel M. Kenkhuis

Funded by: Kankeronderzoekfonds Limburg as part of Health Foundation Limburg

Award ID: 00005739

Award Recipient : J. L. Koole

Funded by: Stichting Alpe d'HuZes within the research program 'Leven met kanker' of the Dutch Cancer Society

Award ID: UM-2010-4867

Award ID: UM-2012-5653

Award Recipient : M. P. Weijenberg

Custom metadata

ScienceOpen disciplines: Public health

Keywords: colorectal cancer survivor,light-intensity physical activity,longitudinal,health-related quality of life,functioning,fatigue

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ScienceOpen disciplines: Public health

Keywords: colorectal cancer survivor, light-intensity physical activity, longitudinal, health-related quality of life, functioning, fatigue

Longitudinal associations of light-intensity physical activity with quality of life, functioning and fatigue after colorectal cancer

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Abstract

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Most cited references 32

Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.

The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

Colorectal cancer.

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