Which Factors Most Affect Quality of Life in Colorectal Cancer?

Advanced tumor stage and the presence of a stoma were identified as the strongest predictors of reduced quality of life (QOL) in patients with colorectal cancer (CRC), according to new research.¹ Using validated Arabic QOL instruments, researchers highlighted how these factors significantly impact functional status and symptom burden, emphasizing the importance of targeted supportive care interventions.

This cross-sectional study is published in the Journal of Patient-Reported Outcomes.

“The aim of this study was to investigate the effects of patient factors, such as age, sex, comorbidities, tumor site and stage, surgery type, postoperative leak complications, stoma presence, and chemoradiotherapy, on the QOL of patients with CRC using the Cancer Quality of Life Questionnaire-30 (QLQ-30) and Colorectal Cancer Quality of Life Questionnaire-29 (QLQ-CR29),” wrote the researchers of the study.

QOL is an essential consideration for CRC survivors, who may face lasting physical, emotional, and social challenges after treatment. While many report overall high QoL, factors such as tumor location, treatment type, stoma presence, and gender can lead to significant disparities.² Understanding these influences is critical for developing personalized survivorship care and supportive interventions that address both functional outcomes and symptom burden over the long term.

The study was conducted at Dr Suliman Fakeeh Hospital, a private tertiary care center in Jeddah, Saudi Arabia.¹ Adult patients diagnosed with CRC were invited to participate and completed validated Arabic versions of the European Organisation for Research and QLQ-30 and the QLQ-CR29. Patient demographic and clinical data—including age, sex, tumor site and stage, comorbidities, surgical type and approach, presence of leaks or stoma, and use of neoadjuvant or adjuvant therapy—were collected from medical records. Data analysis was performed to examine associations between patient factors and QOL scores. Additionally, linear correlations between functional and symptom domains and 11 preselected patient and treatment factors were assessed to identify predictors of poor QOL.

Among 104 patients surveyed, the mean global health score was 72.43 (95% CI, 68.18-76.52). Cognitive function scored highest at 76.92 (95% CI, 71.47-81.73), while physical function was lowest at 24.92 (95% CI, 65.57-74.61). The most severe symptom reported on the QLQ-30 was insomnia, with a mean score of 42.30 (95% CI, 36.21-48.71). On the QLQ-CR29, stoma embarrassment and bloating were the most distressing symptoms, with a mean of 41.34 (95% CI, 24.67-58.01).

Advanced tumor stage and the presence of a stoma emerged as the strongest predictors of poor QOL, with each unit increase in tumor stage associated with a 4.88-point decrease in global health status, and stoma presence linked to a 22-fold reduction in social function scores. Additional factors affecting male sexual function included age, tumor stage, comorbidities, and receipt of chemoradiotherapy.

However, the researchers acknowledged several limitations, including a small sample size and reliance on self-reported data, which may have limited generalizability and introduced bias.

Nonetheless, the researchers believe this study provides important insights into factors affecting QOL in patients with CRC.

“The identification of such predictors can allow for close monitoring of patients, helping to minimize complications and enhance outcomes,” wrote the researchers. “We propose the establishment of lifestyle offices and two support programs for those with stomas and those with advanced tumors to improve patients’ QOL. This study may help identify additional predictors, optimize resource allocation for patients with critical needs, and foster innovation in management.”

References

1. Alotaibi A, Kim SH, Alzahrani A, et al. Predictors of impaired quality of life among colorectal cancer survivors: a cross-sectional study. J Patient Rep Outcomes. 25;9(1):136. doi:10.1186/s41687-025-00971-5

2. Marchewczyk P, Costeira B, da Silva FB, et al. Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center. Qual Life Res. 2025;34(5):1501-1514. doi:10.1007/s11136-025-03918-x