Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Assessment of Quality of Life (QoL) of Colorectal Cancer Patients using QLQ-30 and QLQ-CR 29 at King Abdulaziz Medical City, Jeddah, Saudi Arabia

Assessment of Quality of Life (QoL) of Colorectal Cancer Patients using QLQ-30 and QLQ-CR 29 at... Hindawi International Journal of Surgical Oncology Volume 2022, Article ID 4745631, 8 pages https://doi.org/10.1155/2022/4745631 Research Article Assessment of Quality of Life (QoL) of Colorectal Cancer Patients using QLQ-30 and QLQ-CR 29 at King Abdulaziz Medical City, Jeddah, Saudi Arabia 1,2 1,2 1,2 Jumanah T. Qedair , Abdullah A. Al Qurashi , Saeed Alamoudi, 1,2 1,2 Syed Sameer Aga , and Alqassem Y. Hakami Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, Jeddah, Saudi Arabia King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Aƒairs (NGHA), Jeddah, Saudi Arabia Correspondence should be addressed to Syed Sameer Aga; agas@ksau-hs.edu.sa Received 19 February 2022; Accepted 26 April 2022; Published 17 May 2022 Academic Editor: Gaetano Gallo Copyright © 2022 Jumanah T. Qedair et al. �is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. We aimed to assess the quality of life (QoL) and its predictors in colorectal cancer (CRC) patients at King Abdulaziz Medical City, Jeddah. Methods. A total of 118 CRC patients at King Abdulaziz Medical City, a tertiary hospital in Jeddah, participated in this study. �e participants were provided with the online questionnaire via WhatsApp by trained researchers and data collectors in February 2021. All participants were required to answer the three-section questionnaire comprising of (a) demographic data and a validated Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires, (b) a general version (QLQ-30), and (c) a CRC-speci“c version (QLQ-CR29). Results. Statistical analysis revealed that the most common comorbidity among the participants was diabetes mellitus (42.4%). In addition, the mean global health status was 63.91 ± 24.75. For the global health tool QLQ-C30, results exhibited that physical functioning [62.94 (30.04)] and social functioning [63.56 (31.95)] scored below the threshold, while the cognitive functioning scale scored the highest [74.86 (25.11)]. In addition, on the QLQ-C30 scales, fatigue and insomnia were distressing, with fatigue scoring the highest. For the disease-speci“c tool QLQ-CR29, it was found that for the symptom scale, urinary frequency and embarrassment scored the highest. Conclusion. �e participants reported high global quality of life on both the EORTC QLQ-30 and QLQ-CR29 scales. �is study identi“es the factors and predictors that aŸect the quality of life of CRC patients in Saudi Arabia. Recognizing these factors and predictors may empower those patients to maintain positive perception towards the impact of colorectal cancer and improve their survival. Cancer and its treatment carry a profound and long- 1. Introduction lasting eŸect on the quality of life (QoL) of cancer survivors Colorectal cancer (CRC) is the 3rd most common cancer even years after the end of the treatment, not to mention the th and the 4 leading cause of cancer-related deaths accounting emotional impact on patients and their families [1]. QoL is a for 1.4 million new cases and 700,000 deaths worldwide multidimensional concept that assesses multiple domains of [1, 2]. Saudi Arabia is a low-risk country for CRC, yet recent patients with cancer including physical, role, emotional, reports show an increase in the incidence rate [3, 4]. cognitive, and social functioning and is used as an outcome measure for cancer patients [1, 3, 6]. Moreover, assessment CRC is the most common cancer among Saudi males and the third most common among Saudi females [3, 5, 6]. �e of QoL in cancer patients provides insights on how the Saudi cancer registry (SCR) reported an age-standardized disease in¡uences patients’ lives and helps to fully evaluate incidence rate of 7.3 per 100,000 in 2011 [3, 7]. the impact of the cancer experience and its treatment 2 International Journal of Surgical Oncology [1, 3, 8]. Accumulating evidence suggests an impaired QoL considering that each question ranges from “not at all” to in CRC patients compared to the general population in the “very much.” *e last section of the questionnaire was the QLQ-CR29 aspects of physical, emotional, and social functioning [1, 9, 10]. Multiple tools have been developed to assess the version that included disease symptom scales and functional QoL in cancer patients, and importantly one such tool is the scales and consisted of 29 questions that assessed body European Organization for Research and Treatment of image, sexuality, and patients’ future perspective. It aims to Cancer (EORTC) quality of life questionnaires [3]. specifically evaluate the health-related quality of life among EORTC (QLQ C-30) is a structured multifaceted tool to colorectal cancer patients. *is questionnaire was provided assess QoL of patients with cancer and has been demon- in addition to the EORTC QLQ-C30 to investigate the strated to have adequate validity and reliability to evaluate treatment and its effects on patients’ daily functioning. outcomes of cancer patients across different countries *e researchers contacted the EORTC quality of life [3, 11]. Given the high prevalence of the disease, concerns group to obtain the Arabic version of the questionnaire and have been raised about how CRC affects QoL among patients the scoring manual. Each response scale was recorded and transformed through a description to give a score between 0 in Saudi Arabia. *ere is a drought in literature regarding QoL of CRC patients in Saudi Arabia. As such, very little is and 100. Higher scores in functional scales indicate better known about how patients in Saudi Arabia endure a chronic functioning, whereas higher scores in symptom scales in- and potentially life-threatening disease. dicate worse functioning. For functional scales, subjects *erefore, this study aims to assess the QoL of CRC scoring <33.3% have problems; those scoring ≥66.7% have patients at the tertiary care hospital at King Abdulaziz good functioning. For symptom scales/symptoms, subjects Medical City, Jeddah, using the EORTC (QLQ C-30) as- scoring <33.3% have good functioning; those scoring sessment tool to provide a glimpse of the effect this burden ≥66.7% have problems. has on life. 2.3. Inclusion and Exclusion Criteria. Following the IRB 2. Methods approval, patients’ data was extracted from the BESTCare system in KAMC. *e eligibility criteria included patients with 2.1. Subjects. Hundred and eighteen colorectal cancer a currently confirmed diagnosis of CRC from both genders (CRC) patients participated in this study with prior in- and all ages. Patients who refused to participate and did not formed consent. *e participation was through the invita- complete the questionnaire were excluded. Informed consent tion with full disclosure, and each participant was required was provided with the questionnaire and obtained from all to fill in the research questionnaire of this cross-sectional participants. Also, researchers checked patients’ medical study. *e study was conducted in King Abdulaziz Medical records to ensure the validity of the diagnosis, treatment City (KAMC), a tertiary hospital in Jeddah, and it was method, stage of the disease, and patients’ current status. specifically chosen because it provides a state-of-the-art practice of medical care services for the Saudi Arabian 2.4. Statistical Analysis. Sociodemographic characteristics population in the Western Region. Also, the hospital has a designated center for cancer patients. *e ethical approval were presented as frequencies and percentages. *e QLQ- C30 and C29 questionnaires were presented as the was obtained from the Institutional Review Board (IRB) committee of the King Abdullah International Medical mean± SD, 95% CI, percentage scoring <33.3, and per- centage scoring≥66.7. Scores were calculated as per EORTC Research Center (KAIMRC). QLQ-C30 scoring manual. Linear regression analysis was done to find out the factors predictive of global, functional, 2.2. Design Questionnaire. All eligible participants were and symptoms scales. *e analysis was performed in 95% contacted formally by the PI of the study through telephone confidence interval using the Statistical Package for Social and then provided with the online questionnaire via Science (SPSS), version 24.0 (IBM, Armonk, NY, USA), and WhatsApp by trained researchers and data collectors. *e p value of ≤0.05 was considered statistically significant. participants answered the questions of a validated Arabic version questionnaire of the EORTC quality of life (QOL) 3. Results questionnaires: a general version—QLQ-30 and a colorectal cancer specific version—QLQ-CR 29 (https://qol.eortc.org/ Among the 118 participants, the age group of above 60 years questionnaires/) [11–13]. old represented 47.5% of the total study sample. Among all *e online questionnaire comprised of three sections. cases, 64 (54.2%) were males, 58 (49.2%) were from Jeddah, *e first section was about the demographic data that in- 783 (70.3%) were married, only 24 (20.3%) were illiterate, 51 cluded participants’ age, nationality, city, gender, marital (43.2%) were retired, and 77 (65.3%) had colon tumor. status, level of education, employment status, monthly in- *e most common comorbidity among the participants come, presence of comorbidities, and tumor location. was diabetes mellitus (42.4%). *e detailed demographic *e second section of the questionnaire was the Arabic characteristic of the participants is presented in Table 1. translated form of QLQ-C30 (version 3) which included 30 *e mean global health status was 63.91± 24.75 (Table 2). questions that assessed patients’ overall health, functions, For the global health tool QLQ-C30, only two of five symptoms, and financial implications of the disease functional scales scored below the threshold of≥66.7% which International Journal of Surgical Oncology 3 Table 1: Demographic characteristics of the study population. scores as follows: anxiety 51.41 (36.37), weight 43.50 (34.73), and sexual interest (men) 38.54 (32.10). Characteristic No % For the symptom scale, two were identified as prob- Age lematic ones, i.e., urinary frequency 41.67 (31.63) and Below 40-year-old 10 8.5 embarrassment 40.93 (36.57); while five were found to From 41- to 50-year-old 20 16.9 have great functioning with scores less than 19 which are From 51- to 60-year-old 32 27.1 as follows: impotence 14.20 (22.06), urinary incontinence Above 60-year-old 56 47.5 14.69 (26.35), blood and mucus in stool 16.24 (23.41), Gender fecal incontinence 17.72 (29.15), and dysuria 18.36 (27.42) Male 64 54.2 (Table 2). Female 54 45.8 *ere was no significant difference between any of the City demographic characteristics of patients and the global health Jeddah 58 49.2 scales. However, age and income were found to be signifi- Riyadh 1 0.8 Others 59 50.0 cantly associated with the social functioning and cognitive functioning, respectively (p< 0.05) (Table 3). *e analysis Marital status Single 5 4.2 showed that old aged subjects had lesser functioning on Married 83 70.3 social scales while higher income subjects had better Divorced 9 7.6 functioning on the cognitive scales. Widow 21 17.8 Our study results also revealed significant differences Education level (p< 0.05) in the reported symptoms, i.e., nausea and Noneducated 24 20.3 vomiting and diarrhea across educational levels (Table 3), Primary 18 15.3 and income and financial difficulties across marital status, as Secondary School 13 11.0 well as tumor location. Married subjects with lower incomes High school 26 22.0 complained of financial difficulties (p< 0.05). University 37 31.4 *e predictors related to participants’ QoL as per QLQ- Employment status (CR29) are presented in Table 4. Significant associations No work 42 35.6 were found between symptoms and various demographic Government 20 16.9 characteristics of subjects: weight with marital status, uri- Private 5 4.2 nary frequency with education level and employment, blood Retired 51 43.2 and mucus in stool with education level and income, dysuria Income/month with tumor location, sore skin with income, impotence with Below 5000 SR 40 33.9 age, and dyspareunia with marital Status. Between 5 to 10 thousand SR 41 34.7 Between 10 to 20 thousand SR 27 22.9 Additionally, married participants complained of in- More than 20 thousand SR 10 8.5 tense symptoms of anxiety and dyspareunia (p< 0.05), while as those with higher education complained more of urinary Presence of comorbid disease Diabetes mellitus 50 42.4 frequency and blood and mucus in stool, and old aged Asthma 4 3.4 subjects of impotence. Heart disease 11 9.3 Hypertension 25 21.2 4. Discussion Tumor location Colon 77 65.3 Colorectal cancer (CRC) characterized by malignancy of Rectum 41 34.7 colon or rectal lumen cells is one of the major solid cancers affecting humans [14]. Even though CRC incidence rates vary widely geographically, there has been an increasing were as follows: physical functioning 62.94 (30.04) and social trend on a yearly basis since last decade [15]. In 2018, it has functioning 63.56 (31.95); while as the scores for other three become third most common and second most deadly cancer were as role functioning 67.51 (35.73), emotional functioning in the world, after lung and breast [16] in both genders. 69.00 (27.37), and cognitive functioning 74.86 (25.11). Furthermore, Western countries happen to have the highest For the symptom scale items, three out of nine symp- incidences of CRC in comparison to Asian and Middle toms had a good functioning which were as follows: nausea Eastern countries [7, 17–19]. and vomiting 24.44 (27.79), dyspnea 22.60 (29.20), and fi- In the Kingdom of Saudi Arabia (KSA), CRC ranks first nancial difficulties 30.79 (34.63); while two were distressing: among males (10.6%) and third in females (8.9%) [20]. In fatigue 46.14 (30.87) and insomnia 41.24 (36.38); and the rest 2014, there were 1,347 cases of CRC which accounted for of the four symptoms were mildly problematic as follows: 11.5% of all newly diagnosed cases, posing a significant pain 38.70 (31.42), appetite loss 35.59 (34.24), constipation health risk to Saudi nationals [20, 21]. It has been reported 35.59 (34.52), and diarrhea 34.46 (34.30). that the median age for the development of CRC in the Saudi For the disease-specific measuring tool QLQ-CR29, the population is 60 years (95% CI: 57–61 years) for men and 55 only item which had problems was identified as body image years (95% CI: 53–58 years) for women [22]. Additionally, in with a score of 33.71 (31.56); while other three had good Saudi Arabia, CRC tends to affect younger people more, and 4 International Journal of Surgical Oncology Table 2: Mean score of all items in QLQ-C30 and QLQ-C29 (n � 118). N (%) N (%) Variables N No. of items Mean (SD) 95% CI scoring < 33.3 scoring ≥ 66.7 Global health status/QoL Global health status/QoL 118 2 63.91 (24.75) 59.40–68.42 7 (5.93) 64 (54.24) Functional scales Physical functioning 118 5 62.94 (30.04) 57.46–68.41 15 (12.71) 64 (54.24) Role functioning 118 2 67.51 (35.73) 61.00–74.03 17 (14.41) 77 (65.25) Emotional functioning 118 4 69.00 (27.37) 64.01–73.99 12 (10.17) 59 (50.00) Cognitive functioning 118 2 74.86 (25.11) 70.28–79.44 7 (5.93) 91 (77.12) Social functioning 118 2 63.56 (31.95) 57.73–69.38 14 (11.86) 72 (61.02) QLQ-C30 Symptom scales/items Fatigue 118 3 46.14 (30.87) 40.51–51.77 34 (28.81) 39 (33.05) Nausea and vomiting 118 2 24.44 (27.79) 19.37–29.50 68 (57.63) 14 (11.86) Pain 118 2 38.70 (31.42) 32.97–44.43 46 (38.98) 34 (28.81) Dyspnea 118 1 22.60 (29.20) 17.28–27.92 64 (54.24) 20 (16.95) Insomnia 118 1 41.24 (36.38) 34.61–47.88 37 (31.36) 43 (36.44) Appetite loss 118 1 35.59 (34.24) 29.35–41.84 42 (35.59) 34 (28.81) Constipation 118 1 35.59 (34.52) 29.30–41.89 41 (34.75) 31 (26.27) Diarrhea 118 1 34.46 (34.30) 28.21–40.72 45 (38.14) 34 (28.81) Financial difficulties 118 1 30.79 (34.63) 24.48–37.11 53 (44.92) 29 (24.58) Functional scales Body image 118 3 33.71 (31.56) 23.70–77.89 61 (51.69) 25 (21.19) Anxiety 118 1 51.41 (36.37) 24.45–99.36 24 (20.34) 57 (48.31) Weight 118 1 43.50 (34.73) 14.60–99.69 30 (25.42) 45 (38.31) Sexual interest (men) 118 1 38.54 (32.10) 20.67–49.24 19 (16.10) 23 (19.49) Symptom scales/items Urinary frequency 118 2 41.67 (31.63) 13.15–58.28 32 (27.12) 35 (29.66) Blood and mucus in stool 118 2 16.24 (23.41) 7.95–27.00 85 (72.03) 8 (6.78) Stool frequency 118 2 27.92 (27.23) 2.19–30.76 34 (28.81) 8 (6.78) Urinary incontinence 118 1 14.69 (26.35) 4.39–61.53 83 (70.34) 12 (10.17) 18.36 (27.42) 4.39–61.53 73 (61.86) 15 (12.71) Dysuria 118 1 QLQ-CR29 Abdominal pain 118 1 39.83 (34.66) 14.60–99.69 38 (32.20) 45 (38.14) Buttock pain 118 1 25.42 (34.23) 5.14–71.05 67 (56.78) 27 (22.88) Dry mouth 118 1 35.03 (30.77) 15.53–51.13 37 (31.36) 33 (27.97) Hair loss 118 1 32.77 (35.67) 13.53–72.18 54 (45.76) 38 (32.20) Taste 118 1 22.88 (30.41) 2.19–30.76 65 (55.08) 20 (16.95) Flatulence 118 1 30.80 (34.50) 4.39–61.53 35 (29.66) 19 (16.10) Fecal incontinence 118 1 17.72 (29.15) 15.91–54.00 52 (44.07) 10 (8.47) Sore skin 118 1 25.64 (33.52) 15.91–54.00 41 (24.75) 14 (11.86) Embarrassment 118 1 40.93 (36.57) 2.57–35.53 24 (20.34) 26 (22.03) Stoma care problems 118 1 27.13 (29.33) 2.19–30.76 19 (16.10) 9 (7.63) 36 (30.51) 5 (4.24) Impotence 118 1 14.20 (22.06) 13.78–32.83 Dyspareunia 118 1 21.38 (35.26) 16.56–73.70 36 (30.51) 11 (9.32) For functional scales, subjects scoring<33.3% have problems; those scoring≥66.7% have good functioning. For symptom scales/symptoms, subjects scoring <33.3% have good functioning; those scoring ≥66.7% have problems. For functional scales, higher scores indicate better functioning. For symptom scales, higher scores indicate worse functioning. the 5-year survival rates have been reported to be lower In this study, we found that the CRC patients presented (about 44.6%) than those expected for matching stages in with a high level of functioning and quality of life, as evident other populations [7, 22]. from the high scores of the EORCT QLQ-C30 and QLQ- In the current study, we attempted to evaluate the quality CR29 scales (Table 2). *ese results were in concordance of life (QoL) among the CRC patients using the EORTC with the study published by Almutairi et al. [6] and Alshehri QLQ-C30 and QLQ-CR29 questionnaires. Additionally, we et al. [23] which included patients from the central region of attempted to evaluate the functionality of the participants in the country and reported higher functional scores on the dealing with the burden of progressive, chronic, and po- QLQ-C30 scales. Additionally, in comparison to other tentially fatal disease. *is study aimed to identify the factors similar studies in different geographical locations, the overall which affect the overall QoL and hence be of significance to global health status and all the functional scores of our study healthcare professionals in further improving the CRC were higher [24–26]. Since the study setting was in KAMC, it patients’ survival. does reflect on the fact that cancer patients who have access International Journal of Surgical Oncology 5 Table 3: Predictors of quality of life of colorectal cancer patients (CR30). Global health status/QoL Physical functioning Role functioning Emotional functioning Cognitive functioning Social functioning B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value Age −5.332 −11.22–55 0.075 −6.352 −13.33–0.63 0.074 −15.35–1.75 0.118 −2.631 −9.38 –4.12 0.441 −4.678 −10.56–1.21 0.118 −8.141 −15.88–0.40 0.039 −6.800 Marital status 2.014 −4.18–8.21 0.521 0.080 −7.27–7.43 0.983 −9.66–8.36 0.886 −114 −7.22 –6.99 0.975 −3.071 −9.27–3.13 0.328 −1.970 −10.12–6.18 0.633 −0.652 0.753 Education level 2.704 −2.02–7.43 0.259 2.926 −2.68–8.53 0.303 −4.29–9.44 0.460 −1.802 −7.22–3.62 0.511 −1.789 −6.51–2.94 0.455 .990 −5.22–7.20 2.569 Employment −2.039 −6.13–2.05 0.325 −2.599 −7.45–2.25 0.291 −10.43 –1.39 0.132 2.004 −2.68–6.69 0.399 −1.299 −5.39–2.79 0.530 −.176 −5.55–5.20 0.948 −4.549 2.53–14.96 0.006 −.351 −8.52–7.82 0.932 Income 2.830 −3.38–9.04 0.369 5.428 −1.94–12.80 0.147 −9.20–8.86 0.970 6.253 −.87–13.38 0.085 8.746 −8.326 Tumor location −1.553 −11.20–8.09 0.750 4.883 −6.56–16.33 0.400 −5.69–22.35 0.242 6.280 −4.78–17.35 0.263 5.307 −4.34–14.96 0.278 .751 −11.94–13.44 0.907 Fatigue Nausea and vomiting Pain Dyspnea Insomnia Appetite loss B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value Age 4.047 −3.49–11.59 0.290 1.853 −4.82–8.53 0.583 5.547 −2.04–13.13 0.150 1.982 −5.29–9.25 0.590 −2.879 −11.82–6.06 0.525 7.604 −0.79–15.99 0.075 Marital status .369 −7.57–8.31 0.927 3.291 −3.74–10.32 0.355 2.168 −5.82 –10.16 0.592 4.188 −3.47–11.84 0.281 4.243 −5.17–13.66 0.374 −1.202 −10.04–7.63 0.788 Education level −2.135 −8.19–3.92 0.486 5.460 .10–10.82 0.046 −1.168 −7.26–4.92 0.705 2.439 −3.40–8.27 0.409 1.330 −5.8–8.51 0.714 1.953 −4.78–8.69 0.67 Employment 2.650 −2.59–7.89 0.318 −2.611 −7.25–2.03 0.267 .789 −4.48–6.06 0.767 -2.787 −7.84–2.26 0.276 −353 −6.5–5.86 0.911 −3.261 −9.09–2.57 0.270 0.171 Income −3.816 −11.77–4.14 0.344 −10.672 −17.72–−3.63 0.003 −4.792 −12.80–3.22 0.238 -3.145 −10.82–4.53 0.418 −8.970 −18.41–0.47 0.062 −6.164 −15.02–2.69 Tumor location 1.255 −11.10–13.61 0.841 −5.796 −16.74–5.14 0.296 −748 −13.18–11.69 0.905 -3.017 −14.93–8.90 .617 −4.390 −19.05–10.27 0.554 −4.152 −17.91–9.60 0.551 Constipation Diarrhea Financial difficulties B 95% CI p-value B 95% CI p-value B 95% CI p-value Age 6.217 −2.15–14.58 0.144 −123 −8.63–8.39 0.977 1.596 –6.65–9.85 0.702 Marital status −4.394 −13.20–4.41 0.325 9.045 0.08–18.01 0.048 –10.322 –19.01–1.63 0.020 Education level 8.122 1.41–14.84 0.018 1.574 −5.26–8.40 0.649 –2.017 –8.64–4.61 0.547 Employment −5.593 −11.40–0.22 0.059 −1.677 −7.59–4.24 0.575 1.039 –4.69–6.77 0.720 Income −12.125 −20.95–-3.30 0.008 2.363 −6.62–11.35 0.603 –10.444 –19.15–1.73 0.019 Tumor location −3.136 −16.85–10.57 0.651 −2.072 −16.02–11.88 0.769 2.672 –10.85–16.20 0.696 6 International Journal of Surgical Oncology Table 4: Predictors of quality of life of colorectal cancer patients (CR29). Body image Anxiety Weight Sexual interest Urinary frequency Blood and mucus in stool B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value Age 5.503 −2.31–13.32 0.166 4.266 −4.53–13.07 0.339 1.640 −7.00–10.28 0.708 −8.051 −17.70–1.60 0.100 1.554 −6.10–9.21 0.688 1.884 −3.80–7.56 0.512 Marital status −2.919 −11.15–5.31 0.484 −11.682 −20.95–-2.41 0.014 −3.035 −12.13–6.06 0.510 −12.935 −28.21–2.34 0.095 0.771 −7.29–8.83 0.850 0.417 −5.56–6.40 0.890 Education level .025 −6.25–6.30 0.994 −0.685 −7.75–6.38 0.848 3.922 −3.01–10.86 0.265 −2.065 −10.39–6.26 0.621 −6.545 −12.69–-0.40 0.037 4.964 0.41–9.52 0.033 Employment 1.053 −4.38–6.48 0.702 −3.503 −9.62–2.61 0.259 −2.692 −8.70–3.31 0.376 3.309 −4.67–11.29 0.410 5.248 −0.07–10.56 0.053 −1.621 −5.57–2.32 0.417 Income −3.455 −11.71–4.80 0.409 −6.026 −15.32–3.26 0.201 −7.175 −16.30–1.95 0.122 1.322 −8.92–11.56 0.797 5.853 −2.22–13.93 0.154 −8.246 −14.24–-2.25 0.007 Tumor location −4.064 −16.88–8.75 0.531 −3.475 −17.90–10.95 0.634 −7.113 −21.28–7.05 0.322 7.929 −10.78–26.64 0.400 −1.109 −13.65–11.43 0.861 4.896 −4.41–14.21 0.300 Urinary incontinence Dysuria Abdominal pain Buttock pain Bloating Dry mouth B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value Age 6.161 −0.19–12.51 0.057 2.522 −4.10–9.15 0.452 7.708 −0.80–16.21 0.075 2.993 −5.62–11.61 0.493 6.974 −2.80–16.75 0.159 −1.623 −9.36–6.12 0.679 Marital status −5.700 −12.39–0.99 0.094 −3.069 −10.05–3.91 0.385 −5.719 −14.67–3.24 0.208 −3.078 −12.15–6.00 0.503 0.051 −10.94–11.04 0.993 4.137 −4.01–12.29 0.317 Education level −1.371 −6.47–3.73 0.595 −4.721 −10.04–0.60 0.081 0.305 −6.52–7.13 0.930 3.381 −3.54–10.30 0.335 0.749 −7.12–8.62 0.850 1.555 −4.66–7.77 0.621 Employment 1.663 −2.75–6.08 0.457 1.936 −2.67–6.54 0.407 −4.247 −10.15–1.66 0.157 −1.317 −7.30–4.67 0.664 −2.946 −10.36–4.47 0.431 0.335 −5.04–5.71 0.902 Income −3.203 −9.91–3.50 0.346 3.084 −3.91–10.08 0.384 −3.463 −12.44–5.51 0.446 −4.578 −13.68–4.52 0.321 −8.269 −19.19–2.65 0.136 −0.969 −9.14–7.20 0.815 Tumor location 7.985 −2.43–18.40 0.131 12.758 1.89–23.62 022 −1.202 −15.14–12.74 0.865 3.214 −10.91–17.34 0.653 −2.571 −19.52–14.37 0.763 −5.771 −18.46–6.92 0.369 Hair loss Taste Fecal incontinence Sore skin Impotence Dyspareunia B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value Age 4.338 −4.34–13.02 0.324 5.197 −2.24–12.64 0.169 2.616 −5.75–10.98 0.535 7.093 −2.58–16.77 0.148 −6.911 −13.47–−0.35 0.039 2.666 −9.74–15.07 0.667 Marital status 5.542 −3.60–14.68 0.232 2.869 −4.97–10.71 0.470 0.937 −8.46–10.34 0.843 −1.968 −12.76–8.82 0.717 −5.245 −11.69–1.20 0.108 −17.439 −29.68–−5.19 0.006 Education level 6.003 −0.96–12.97 0.090 4.558 −1.42–10.53 0.133 1.578 −5.15–8.31 0.642 7.115 −0.65–14.88 0.072 2.860 −3.21–8.93 0.348 5.530 −5.96–17.01 0.338 Employment −4.296 −10.33–1.73 0.161 −2.510 −7.68–2.66 0.338 2.865 −3.47–9.20 0.370 −4.386 −11.66–2.89 0.233 1.321 −3.23–5.87 0.562 0.695 −8.18–9.57 0.876 Income −8.297 −17.46–0.86 0.075 −4.255 −12.11–3.60 0.286 -8.715 −18.05–0.62 0.067 −12.137 −22.86–−1.42 0.027 2.137 −6.57–10.84 0.624 −7.530 −24.06–9.00 0.364 Tumor location −10.827 −25.05–3.40 0.134 −11.884 −24.08–0.32 0.056 4.682 −9.81–19.17 0.522 4.259 −12.38–20.90 0.611 −.527 −11.99–10.94 0.927 8.019 −13.67–29.71 0.461 International Journal of Surgical Oncology 7 *is study does have its own limitations. First, regarding to free and state-of-the- art healthcare services do tend to have a better QoL, as they feel less burdened by the disease the measuring tools, which lack the ability to measure the QoL before and after the treatment or intervention. Second, financially as well as emotionally [24, 25]. Furthermore, 52.5% of our study participants were of age the study sample size is small for the generalization of the less than 60 years old (Table 1), which was similar to the results for the whole population. previous studies but different from the report from Japan, where the majority of participants were above 70 years of age 5. Conclusion [24, 25, 27]. *e higher percentage of young patients confirms In conclusion, this study provides a glimpse into the QoL of the established fact that in Saudi Arabia CRC has a high CRC patients in our medical center and does sketch a good prevalence among the younger people [7]. *ere are numerous functioning of life among our participants as they reported a risk factors which are associated with CRC among young high global quality of life on both the EORTC QLQ-30 and individuals like smoking, high fat diet, low-fiber diet, sedentary QLQ-CR29 scales. Among the most distressing symptoms, lifestyle, less exercise, and higher consumption of fast food fatigue and insomnia topped the list, and among predictors [6, 14]. urinary frequency and blood and mucus in stool were found Globally, for any type of cancer, age is regarded as the to be the most common symptoms. Predictors for the chief factor which affects the QoL of a patient. However, in cognitive and social functioning were found to be age and our study we found that age was significantly associated with income. *is study reiterates the fact that the burden of the limitation of social functioning only. *ese results were carrying the cancer puts the patients at risk of poorer quality different than the ones reported by other studies [6, 28], of life which needs to be mitigated well within social and which reported that the oldest age group (≥60 years) private constraints to ease the suffering. exhibited a tendency to score lowest in functional domains especially in physical functioning scales. *is can be con- Data Availability sidered as the strength of our study in identifying that the healthcare facility provided at KAMC is at its best and *e pertaining data are available with the corresponding provides a necessary alleviation of the quality of life factors. author on demand. However, in our study we did find that age was related to impotence (p< 0.05). Ethical Approval In our study, we also found that cancer patients are concerned more about their body image, which scores *is study was approved by the Institutional Review Board the lowest in QLQ-CR29 scale (33.71). However, it was of King Abdullah International Medical Research Center not found to be associated with any of the demographic (KAIMRC), a research wing of KSAU-HS, Jeddah (Refer- characteristics of subjects. *is is understandable, as ence No: SPJ21J.179.05). most of our participants belonged to the younger age group (<60). It therefore presents a challenge for Conflicts of Interest healthcare providers to mitigate the awareness about cancers in general and about CRC in particular, so that *e authors declare that they have no conflicts of interest. the disease is caught well in the beginning for the treatment to be effective and for the disease to be less Authors’ Contributions crippling. Aga et al. have already reported that the JTQ, AAQ, and SA conceptualized the project and collected awareness among health and allied students regarding the data. SSA conceptualized the project, analyzed the colorectal cancer was low [29]. collected data, and wrote the entire manuscript. AH *erefore, there is a dire need of proactive, aggressive, reviewed, edited, and approved the final version of the and preventive medicine campaigns and educational pro- manuscript. grams to prepare the population for challenges posed by the increasing burden of cancer in the kingdom [20, 22, 29]. Acknowledgments Additionally, urinary frequency scores highest among the QLQ-CR29 symptoms scales which was found to be asso- *e authors would like to express their deep gratitude to- ciated with both education level and employment (p< 0.05) wards all participants who proactively took part in this (Table 4). *is highlights the dominant effect of education in study. *e authors also acknowledge the help of Mr. Abdul identifying the most irritating symptom which affects the Rehman in dispensing the survey to various leaders of daily functioning of cancer patients. KSAU-HS Students for the collection of data. We also found that marital status, education level, and income were the primary predictors of the quality of life References among the CRC patients, as each of them was significantly associated with at least two symptoms of CRC (Tables 3 and [1] S. Faury, E. Rullier, Q. Denost, and B. Quintard, “Quality of 4). Married subjects with lower income were in particularly life and fatigue among colorectal cancer survivors according worried about the financial difficulties because of the burden to stoma status—the national VICAN survey,” Journal of of carrying cancer. *ese results were similar to the results Psychosocial Oncology, vol. 38, no. 1, pp. 89–102, 2020. reported by Almutairi et al. [6]. [2] H. Brody, “Colorectal cancer,” Nature, vol. 521, 2015. 8 International Journal of Surgical Oncology [3] F. F. Alabbas, S. M. Al-Otaibi, M. H. C. Pasha et al., “Impact of riyadh,” Saudi Journal of Gastroenterology, vol. 21, no. 2, pp. 78–83, 2015. physiological symptoms and complications of colorectal cancer on the quality of life of patients at king Abdulaziz [21] “Cancer incidence report (Saudi Arabia),” https://nhic.gov.sa/ eServices/Documents/2014.pdf. university hospital,” Journal of Cancer Education, vol. 31, no. 2, pp. 221–227, 2016. [22] N. Alsanea, A. S. Abduljabbar, S. Alhomoud, L. H. Ashari, D. Hibbert, and S. Bazarbashi, “Colorectal cancer in Saudi [4] M. H. Mosli and M. S. Al-Ahwal, “Colorectal cancer in the Arabia: incidence, survival, demographics and implications Kingdom of Saudi Arabia: need for screening,” Asian Pacific for national policies,” Annals of Saudi Medicine, vol. 35, no. 3, Journal of Cancer Prevention, vol. 13, no. 8, pp. 3809–3813, pp. 196–202, 2015. [23] S. Alshehri, A. Alzamil, R. Alturki et al., “Quality of life of [5] “Saudi Cancer Registry,” 2016, https://nhic.gov.sa/en/ patients with cancer attending outpatient clinics at the king eServices/Documents/2016.pdf. Abdulaziz medical city, riyadh, Saudi Arabia,” Journal of [6] K. M. Almutairi, E. Alhelih, A. S. Al-Ajlan, and J. M. Vinluan, Nature and Science of Medicine, vol. 3, no. 1, pp. 53–58, 2020. “A cross-sectional assessment of quality of life of colorectal [24] D. P. Braun, D. Gupta, J. F. Grutsch, and E. D. Staren, “Can cancer patients in Saudi Arabia,” Clinical and Translational changes in health related quality of life scores predict survival Oncology, vol. 18, no. 2, pp. 144–152, 2016. in stages III and IV colorectal cancer?” Health and Quality of [7] M. S. Al-Ahwal, Y. H. Shafik, and H. M. Al-Ahwal, “First Life Outcomes, vol. 9, no. 1, p. 62, 2011. national survival data for colorectal cancer among Saudis [25] J. Engel, J. Kerr, A. Schlesinger-Raab, R. Eckel, H. Sauer, and between 1994 and 2004: what’s next?” BMC Public Health, D. Holzel, ¨ “Quality of life in rectal cancer patients,” Annals of vol. 13, no. 1, p. 73, 2013. Surgery, vol. 238, no. 2, pp. 203–213, 2003. [8] T. Conroy, H. Bleiberg, and B. Glimelius, “Quality of life in [26] S. E. Wan Puteh, N. M. Saad, S. M. Aljunid et al., “Quality of patients with advanced colorectal cancer: what has been life in Malaysian colorectal cancer patients,” Asia-Pacific learnt?” European Journal of Cancer (Oxford England: 1990), Psychiatry, vol. 5, pp. 110–117, 2013. vol. 39, no. 3, pp. 287–294, 2003. [27] A. Tsunoda, K. Nakao, K. Hiratsuka, N. Yasuda, [9] J. L. Rodriguez, N. A. Hawkins, Z. Berkowitz, and C. Li, M. Shibusawa, and M. Kusano, “Anxiety, depression and “Factors associated with health-related quality of life among quality of life in colorectal cancer patients,” International colorectal cancer survivors,” American Journal of Preventive Journal of Clinical Oncology, vol. 10, no. 6, pp. 411–417, 2005. Medicine, vol. 49, no. 6, pp. S518–S527, 2015. [28] A. E. Ahmed, A. S. Almuzaini, M. A. Alsadhan et al., “Health- [10] A. Caravati-Jouvenceaux, G. Launoy, D. Klein et al., “Health- related predictors of quality of life in cancer patients in Saudi related quality of life among long-term survivors of colorectal Arabia,” Journal of Cancer Education, vol. 33, no. 5, cancer: a population-based study,” 9e Oncologist, vol. 16, pp. 1011–1019, 2018. no. 11, pp. 1626–1636, 2011. [29] S. Aga, M. Khan, E. Alsulimani et al., “Knowledge & [11] N. K. Aaronson, S. Ahmedzai, B. Bergman et al., “*e Eu- awareness regarding colorectal cancer among health and al- ropean Organization for Research and Treatment of Cancer lied students of king saud bin Abdulaziz university for health QLQ-C30: a quality-of-life instrument for use in international sciences, Jeddah,” Journal of Family Medicine and Primary clinical trials in oncology,” JNCI Journal of the National Care, vol. 10, no. 6, pp. 2284–2292, 2021. Cancer Institute, vol. 85, no. 5, pp. 365–376, 1993. [12] European Organisation for Research and Treatment of Cancer Quality of Life Department, “Questionnaires. eortc QLQ-C30. brussels, belgium: European organisation for research and treatment of cancer,” , 2017. [13] M. A. Awad, S. Denic, and H. El Taji, “Validation of the European organization for research and treatment of cancer quality of life questionnaires for Arabic-speaking pop- ulations,” Annals of the New York Academy of Sciences, vol. 1138, no. 1, pp. 146–154, 2008. [14] A. S. Sameer, “Colorectal cancer: molecular mutations and polymorphisms,” Frontiers in Oncology, vol. 3, no. 5, p. 114, [15] B. A. Weinberg, J. L. Marshall, and M. E. Salem, “*e growing challenge of young adults with colorectal cancer,” Oncology, vol. 31, no. 5, pp. 381–389, 2017. [16] Globocan, http://gco.iarc.fr/today/data/factsheets/cancers/ 39-All-cancers-fact-sheet.pdf, 2018. [17] Globocan, http://gco.iarc.fr/today/data/factsheets/cancers/ 10_8_9-Colorectum-fact-sheet.pdf, 2018. [18] R. L. Siegel, K. D. Miller, S. A. Fedewa et al., “Colorectal cancer statistics, 2017,” CA: A Cancer Journal for Clinicians, vol. 67, no. 3, pp. 177–193, 2017. [19] E. J. Kuipers, W. M. Grady, D. Lieberman et al., “Colorectal cancer,” Nature Reviews Disease Primers, vol. 1, no. 1, Article ID 15065, 2015. [20] A. Zubaidi, A. AlHumaid, K. AlKhayal, O. AlObeed, N. AlSubaie, and S. Shaik, “Public awareness of colorectal cancer in Saudi Arabia: a survey of 1070 participants in http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Surgical Oncology Hindawi Publishing Corporation

Assessment of Quality of Life (QoL) of Colorectal Cancer Patients using QLQ-30 and QLQ-CR 29 at King Abdulaziz Medical City, Jeddah, Saudi Arabia

Loading next page...
 
/lp/hindawi-publishing-corporation/assessment-of-quality-of-life-qol-of-colorectal-cancer-patients-using-tOW2lauayS
Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2022 Jumanah T. Qedair et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2090-1402
eISSN
2090-1410
DOI
10.1155/2022/4745631
Publisher site
See Article on Publisher Site

Abstract

Hindawi International Journal of Surgical Oncology Volume 2022, Article ID 4745631, 8 pages https://doi.org/10.1155/2022/4745631 Research Article Assessment of Quality of Life (QoL) of Colorectal Cancer Patients using QLQ-30 and QLQ-CR 29 at King Abdulaziz Medical City, Jeddah, Saudi Arabia 1,2 1,2 1,2 Jumanah T. Qedair , Abdullah A. Al Qurashi , Saeed Alamoudi, 1,2 1,2 Syed Sameer Aga , and Alqassem Y. Hakami Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, Jeddah, Saudi Arabia King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Aƒairs (NGHA), Jeddah, Saudi Arabia Correspondence should be addressed to Syed Sameer Aga; agas@ksau-hs.edu.sa Received 19 February 2022; Accepted 26 April 2022; Published 17 May 2022 Academic Editor: Gaetano Gallo Copyright © 2022 Jumanah T. Qedair et al. �is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. We aimed to assess the quality of life (QoL) and its predictors in colorectal cancer (CRC) patients at King Abdulaziz Medical City, Jeddah. Methods. A total of 118 CRC patients at King Abdulaziz Medical City, a tertiary hospital in Jeddah, participated in this study. �e participants were provided with the online questionnaire via WhatsApp by trained researchers and data collectors in February 2021. All participants were required to answer the three-section questionnaire comprising of (a) demographic data and a validated Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires, (b) a general version (QLQ-30), and (c) a CRC-speci“c version (QLQ-CR29). Results. Statistical analysis revealed that the most common comorbidity among the participants was diabetes mellitus (42.4%). In addition, the mean global health status was 63.91 ± 24.75. For the global health tool QLQ-C30, results exhibited that physical functioning [62.94 (30.04)] and social functioning [63.56 (31.95)] scored below the threshold, while the cognitive functioning scale scored the highest [74.86 (25.11)]. In addition, on the QLQ-C30 scales, fatigue and insomnia were distressing, with fatigue scoring the highest. For the disease-speci“c tool QLQ-CR29, it was found that for the symptom scale, urinary frequency and embarrassment scored the highest. Conclusion. �e participants reported high global quality of life on both the EORTC QLQ-30 and QLQ-CR29 scales. �is study identi“es the factors and predictors that aŸect the quality of life of CRC patients in Saudi Arabia. Recognizing these factors and predictors may empower those patients to maintain positive perception towards the impact of colorectal cancer and improve their survival. Cancer and its treatment carry a profound and long- 1. Introduction lasting eŸect on the quality of life (QoL) of cancer survivors Colorectal cancer (CRC) is the 3rd most common cancer even years after the end of the treatment, not to mention the th and the 4 leading cause of cancer-related deaths accounting emotional impact on patients and their families [1]. QoL is a for 1.4 million new cases and 700,000 deaths worldwide multidimensional concept that assesses multiple domains of [1, 2]. Saudi Arabia is a low-risk country for CRC, yet recent patients with cancer including physical, role, emotional, reports show an increase in the incidence rate [3, 4]. cognitive, and social functioning and is used as an outcome measure for cancer patients [1, 3, 6]. Moreover, assessment CRC is the most common cancer among Saudi males and the third most common among Saudi females [3, 5, 6]. �e of QoL in cancer patients provides insights on how the Saudi cancer registry (SCR) reported an age-standardized disease in¡uences patients’ lives and helps to fully evaluate incidence rate of 7.3 per 100,000 in 2011 [3, 7]. the impact of the cancer experience and its treatment 2 International Journal of Surgical Oncology [1, 3, 8]. Accumulating evidence suggests an impaired QoL considering that each question ranges from “not at all” to in CRC patients compared to the general population in the “very much.” *e last section of the questionnaire was the QLQ-CR29 aspects of physical, emotional, and social functioning [1, 9, 10]. Multiple tools have been developed to assess the version that included disease symptom scales and functional QoL in cancer patients, and importantly one such tool is the scales and consisted of 29 questions that assessed body European Organization for Research and Treatment of image, sexuality, and patients’ future perspective. It aims to Cancer (EORTC) quality of life questionnaires [3]. specifically evaluate the health-related quality of life among EORTC (QLQ C-30) is a structured multifaceted tool to colorectal cancer patients. *is questionnaire was provided assess QoL of patients with cancer and has been demon- in addition to the EORTC QLQ-C30 to investigate the strated to have adequate validity and reliability to evaluate treatment and its effects on patients’ daily functioning. outcomes of cancer patients across different countries *e researchers contacted the EORTC quality of life [3, 11]. Given the high prevalence of the disease, concerns group to obtain the Arabic version of the questionnaire and have been raised about how CRC affects QoL among patients the scoring manual. Each response scale was recorded and transformed through a description to give a score between 0 in Saudi Arabia. *ere is a drought in literature regarding QoL of CRC patients in Saudi Arabia. As such, very little is and 100. Higher scores in functional scales indicate better known about how patients in Saudi Arabia endure a chronic functioning, whereas higher scores in symptom scales in- and potentially life-threatening disease. dicate worse functioning. For functional scales, subjects *erefore, this study aims to assess the QoL of CRC scoring <33.3% have problems; those scoring ≥66.7% have patients at the tertiary care hospital at King Abdulaziz good functioning. For symptom scales/symptoms, subjects Medical City, Jeddah, using the EORTC (QLQ C-30) as- scoring <33.3% have good functioning; those scoring sessment tool to provide a glimpse of the effect this burden ≥66.7% have problems. has on life. 2.3. Inclusion and Exclusion Criteria. Following the IRB 2. Methods approval, patients’ data was extracted from the BESTCare system in KAMC. *e eligibility criteria included patients with 2.1. Subjects. Hundred and eighteen colorectal cancer a currently confirmed diagnosis of CRC from both genders (CRC) patients participated in this study with prior in- and all ages. Patients who refused to participate and did not formed consent. *e participation was through the invita- complete the questionnaire were excluded. Informed consent tion with full disclosure, and each participant was required was provided with the questionnaire and obtained from all to fill in the research questionnaire of this cross-sectional participants. Also, researchers checked patients’ medical study. *e study was conducted in King Abdulaziz Medical records to ensure the validity of the diagnosis, treatment City (KAMC), a tertiary hospital in Jeddah, and it was method, stage of the disease, and patients’ current status. specifically chosen because it provides a state-of-the-art practice of medical care services for the Saudi Arabian 2.4. Statistical Analysis. Sociodemographic characteristics population in the Western Region. Also, the hospital has a designated center for cancer patients. *e ethical approval were presented as frequencies and percentages. *e QLQ- C30 and C29 questionnaires were presented as the was obtained from the Institutional Review Board (IRB) committee of the King Abdullah International Medical mean± SD, 95% CI, percentage scoring <33.3, and per- centage scoring≥66.7. Scores were calculated as per EORTC Research Center (KAIMRC). QLQ-C30 scoring manual. Linear regression analysis was done to find out the factors predictive of global, functional, 2.2. Design Questionnaire. All eligible participants were and symptoms scales. *e analysis was performed in 95% contacted formally by the PI of the study through telephone confidence interval using the Statistical Package for Social and then provided with the online questionnaire via Science (SPSS), version 24.0 (IBM, Armonk, NY, USA), and WhatsApp by trained researchers and data collectors. *e p value of ≤0.05 was considered statistically significant. participants answered the questions of a validated Arabic version questionnaire of the EORTC quality of life (QOL) 3. Results questionnaires: a general version—QLQ-30 and a colorectal cancer specific version—QLQ-CR 29 (https://qol.eortc.org/ Among the 118 participants, the age group of above 60 years questionnaires/) [11–13]. old represented 47.5% of the total study sample. Among all *e online questionnaire comprised of three sections. cases, 64 (54.2%) were males, 58 (49.2%) were from Jeddah, *e first section was about the demographic data that in- 783 (70.3%) were married, only 24 (20.3%) were illiterate, 51 cluded participants’ age, nationality, city, gender, marital (43.2%) were retired, and 77 (65.3%) had colon tumor. status, level of education, employment status, monthly in- *e most common comorbidity among the participants come, presence of comorbidities, and tumor location. was diabetes mellitus (42.4%). *e detailed demographic *e second section of the questionnaire was the Arabic characteristic of the participants is presented in Table 1. translated form of QLQ-C30 (version 3) which included 30 *e mean global health status was 63.91± 24.75 (Table 2). questions that assessed patients’ overall health, functions, For the global health tool QLQ-C30, only two of five symptoms, and financial implications of the disease functional scales scored below the threshold of≥66.7% which International Journal of Surgical Oncology 3 Table 1: Demographic characteristics of the study population. scores as follows: anxiety 51.41 (36.37), weight 43.50 (34.73), and sexual interest (men) 38.54 (32.10). Characteristic No % For the symptom scale, two were identified as prob- Age lematic ones, i.e., urinary frequency 41.67 (31.63) and Below 40-year-old 10 8.5 embarrassment 40.93 (36.57); while five were found to From 41- to 50-year-old 20 16.9 have great functioning with scores less than 19 which are From 51- to 60-year-old 32 27.1 as follows: impotence 14.20 (22.06), urinary incontinence Above 60-year-old 56 47.5 14.69 (26.35), blood and mucus in stool 16.24 (23.41), Gender fecal incontinence 17.72 (29.15), and dysuria 18.36 (27.42) Male 64 54.2 (Table 2). Female 54 45.8 *ere was no significant difference between any of the City demographic characteristics of patients and the global health Jeddah 58 49.2 scales. However, age and income were found to be signifi- Riyadh 1 0.8 Others 59 50.0 cantly associated with the social functioning and cognitive functioning, respectively (p< 0.05) (Table 3). *e analysis Marital status Single 5 4.2 showed that old aged subjects had lesser functioning on Married 83 70.3 social scales while higher income subjects had better Divorced 9 7.6 functioning on the cognitive scales. Widow 21 17.8 Our study results also revealed significant differences Education level (p< 0.05) in the reported symptoms, i.e., nausea and Noneducated 24 20.3 vomiting and diarrhea across educational levels (Table 3), Primary 18 15.3 and income and financial difficulties across marital status, as Secondary School 13 11.0 well as tumor location. Married subjects with lower incomes High school 26 22.0 complained of financial difficulties (p< 0.05). University 37 31.4 *e predictors related to participants’ QoL as per QLQ- Employment status (CR29) are presented in Table 4. Significant associations No work 42 35.6 were found between symptoms and various demographic Government 20 16.9 characteristics of subjects: weight with marital status, uri- Private 5 4.2 nary frequency with education level and employment, blood Retired 51 43.2 and mucus in stool with education level and income, dysuria Income/month with tumor location, sore skin with income, impotence with Below 5000 SR 40 33.9 age, and dyspareunia with marital Status. Between 5 to 10 thousand SR 41 34.7 Between 10 to 20 thousand SR 27 22.9 Additionally, married participants complained of in- More than 20 thousand SR 10 8.5 tense symptoms of anxiety and dyspareunia (p< 0.05), while as those with higher education complained more of urinary Presence of comorbid disease Diabetes mellitus 50 42.4 frequency and blood and mucus in stool, and old aged Asthma 4 3.4 subjects of impotence. Heart disease 11 9.3 Hypertension 25 21.2 4. Discussion Tumor location Colon 77 65.3 Colorectal cancer (CRC) characterized by malignancy of Rectum 41 34.7 colon or rectal lumen cells is one of the major solid cancers affecting humans [14]. Even though CRC incidence rates vary widely geographically, there has been an increasing were as follows: physical functioning 62.94 (30.04) and social trend on a yearly basis since last decade [15]. In 2018, it has functioning 63.56 (31.95); while as the scores for other three become third most common and second most deadly cancer were as role functioning 67.51 (35.73), emotional functioning in the world, after lung and breast [16] in both genders. 69.00 (27.37), and cognitive functioning 74.86 (25.11). Furthermore, Western countries happen to have the highest For the symptom scale items, three out of nine symp- incidences of CRC in comparison to Asian and Middle toms had a good functioning which were as follows: nausea Eastern countries [7, 17–19]. and vomiting 24.44 (27.79), dyspnea 22.60 (29.20), and fi- In the Kingdom of Saudi Arabia (KSA), CRC ranks first nancial difficulties 30.79 (34.63); while two were distressing: among males (10.6%) and third in females (8.9%) [20]. In fatigue 46.14 (30.87) and insomnia 41.24 (36.38); and the rest 2014, there were 1,347 cases of CRC which accounted for of the four symptoms were mildly problematic as follows: 11.5% of all newly diagnosed cases, posing a significant pain 38.70 (31.42), appetite loss 35.59 (34.24), constipation health risk to Saudi nationals [20, 21]. It has been reported 35.59 (34.52), and diarrhea 34.46 (34.30). that the median age for the development of CRC in the Saudi For the disease-specific measuring tool QLQ-CR29, the population is 60 years (95% CI: 57–61 years) for men and 55 only item which had problems was identified as body image years (95% CI: 53–58 years) for women [22]. Additionally, in with a score of 33.71 (31.56); while other three had good Saudi Arabia, CRC tends to affect younger people more, and 4 International Journal of Surgical Oncology Table 2: Mean score of all items in QLQ-C30 and QLQ-C29 (n � 118). N (%) N (%) Variables N No. of items Mean (SD) 95% CI scoring < 33.3 scoring ≥ 66.7 Global health status/QoL Global health status/QoL 118 2 63.91 (24.75) 59.40–68.42 7 (5.93) 64 (54.24) Functional scales Physical functioning 118 5 62.94 (30.04) 57.46–68.41 15 (12.71) 64 (54.24) Role functioning 118 2 67.51 (35.73) 61.00–74.03 17 (14.41) 77 (65.25) Emotional functioning 118 4 69.00 (27.37) 64.01–73.99 12 (10.17) 59 (50.00) Cognitive functioning 118 2 74.86 (25.11) 70.28–79.44 7 (5.93) 91 (77.12) Social functioning 118 2 63.56 (31.95) 57.73–69.38 14 (11.86) 72 (61.02) QLQ-C30 Symptom scales/items Fatigue 118 3 46.14 (30.87) 40.51–51.77 34 (28.81) 39 (33.05) Nausea and vomiting 118 2 24.44 (27.79) 19.37–29.50 68 (57.63) 14 (11.86) Pain 118 2 38.70 (31.42) 32.97–44.43 46 (38.98) 34 (28.81) Dyspnea 118 1 22.60 (29.20) 17.28–27.92 64 (54.24) 20 (16.95) Insomnia 118 1 41.24 (36.38) 34.61–47.88 37 (31.36) 43 (36.44) Appetite loss 118 1 35.59 (34.24) 29.35–41.84 42 (35.59) 34 (28.81) Constipation 118 1 35.59 (34.52) 29.30–41.89 41 (34.75) 31 (26.27) Diarrhea 118 1 34.46 (34.30) 28.21–40.72 45 (38.14) 34 (28.81) Financial difficulties 118 1 30.79 (34.63) 24.48–37.11 53 (44.92) 29 (24.58) Functional scales Body image 118 3 33.71 (31.56) 23.70–77.89 61 (51.69) 25 (21.19) Anxiety 118 1 51.41 (36.37) 24.45–99.36 24 (20.34) 57 (48.31) Weight 118 1 43.50 (34.73) 14.60–99.69 30 (25.42) 45 (38.31) Sexual interest (men) 118 1 38.54 (32.10) 20.67–49.24 19 (16.10) 23 (19.49) Symptom scales/items Urinary frequency 118 2 41.67 (31.63) 13.15–58.28 32 (27.12) 35 (29.66) Blood and mucus in stool 118 2 16.24 (23.41) 7.95–27.00 85 (72.03) 8 (6.78) Stool frequency 118 2 27.92 (27.23) 2.19–30.76 34 (28.81) 8 (6.78) Urinary incontinence 118 1 14.69 (26.35) 4.39–61.53 83 (70.34) 12 (10.17) 18.36 (27.42) 4.39–61.53 73 (61.86) 15 (12.71) Dysuria 118 1 QLQ-CR29 Abdominal pain 118 1 39.83 (34.66) 14.60–99.69 38 (32.20) 45 (38.14) Buttock pain 118 1 25.42 (34.23) 5.14–71.05 67 (56.78) 27 (22.88) Dry mouth 118 1 35.03 (30.77) 15.53–51.13 37 (31.36) 33 (27.97) Hair loss 118 1 32.77 (35.67) 13.53–72.18 54 (45.76) 38 (32.20) Taste 118 1 22.88 (30.41) 2.19–30.76 65 (55.08) 20 (16.95) Flatulence 118 1 30.80 (34.50) 4.39–61.53 35 (29.66) 19 (16.10) Fecal incontinence 118 1 17.72 (29.15) 15.91–54.00 52 (44.07) 10 (8.47) Sore skin 118 1 25.64 (33.52) 15.91–54.00 41 (24.75) 14 (11.86) Embarrassment 118 1 40.93 (36.57) 2.57–35.53 24 (20.34) 26 (22.03) Stoma care problems 118 1 27.13 (29.33) 2.19–30.76 19 (16.10) 9 (7.63) 36 (30.51) 5 (4.24) Impotence 118 1 14.20 (22.06) 13.78–32.83 Dyspareunia 118 1 21.38 (35.26) 16.56–73.70 36 (30.51) 11 (9.32) For functional scales, subjects scoring<33.3% have problems; those scoring≥66.7% have good functioning. For symptom scales/symptoms, subjects scoring <33.3% have good functioning; those scoring ≥66.7% have problems. For functional scales, higher scores indicate better functioning. For symptom scales, higher scores indicate worse functioning. the 5-year survival rates have been reported to be lower In this study, we found that the CRC patients presented (about 44.6%) than those expected for matching stages in with a high level of functioning and quality of life, as evident other populations [7, 22]. from the high scores of the EORCT QLQ-C30 and QLQ- In the current study, we attempted to evaluate the quality CR29 scales (Table 2). *ese results were in concordance of life (QoL) among the CRC patients using the EORTC with the study published by Almutairi et al. [6] and Alshehri QLQ-C30 and QLQ-CR29 questionnaires. Additionally, we et al. [23] which included patients from the central region of attempted to evaluate the functionality of the participants in the country and reported higher functional scores on the dealing with the burden of progressive, chronic, and po- QLQ-C30 scales. Additionally, in comparison to other tentially fatal disease. *is study aimed to identify the factors similar studies in different geographical locations, the overall which affect the overall QoL and hence be of significance to global health status and all the functional scores of our study healthcare professionals in further improving the CRC were higher [24–26]. Since the study setting was in KAMC, it patients’ survival. does reflect on the fact that cancer patients who have access International Journal of Surgical Oncology 5 Table 3: Predictors of quality of life of colorectal cancer patients (CR30). Global health status/QoL Physical functioning Role functioning Emotional functioning Cognitive functioning Social functioning B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value Age −5.332 −11.22–55 0.075 −6.352 −13.33–0.63 0.074 −15.35–1.75 0.118 −2.631 −9.38 –4.12 0.441 −4.678 −10.56–1.21 0.118 −8.141 −15.88–0.40 0.039 −6.800 Marital status 2.014 −4.18–8.21 0.521 0.080 −7.27–7.43 0.983 −9.66–8.36 0.886 −114 −7.22 –6.99 0.975 −3.071 −9.27–3.13 0.328 −1.970 −10.12–6.18 0.633 −0.652 0.753 Education level 2.704 −2.02–7.43 0.259 2.926 −2.68–8.53 0.303 −4.29–9.44 0.460 −1.802 −7.22–3.62 0.511 −1.789 −6.51–2.94 0.455 .990 −5.22–7.20 2.569 Employment −2.039 −6.13–2.05 0.325 −2.599 −7.45–2.25 0.291 −10.43 –1.39 0.132 2.004 −2.68–6.69 0.399 −1.299 −5.39–2.79 0.530 −.176 −5.55–5.20 0.948 −4.549 2.53–14.96 0.006 −.351 −8.52–7.82 0.932 Income 2.830 −3.38–9.04 0.369 5.428 −1.94–12.80 0.147 −9.20–8.86 0.970 6.253 −.87–13.38 0.085 8.746 −8.326 Tumor location −1.553 −11.20–8.09 0.750 4.883 −6.56–16.33 0.400 −5.69–22.35 0.242 6.280 −4.78–17.35 0.263 5.307 −4.34–14.96 0.278 .751 −11.94–13.44 0.907 Fatigue Nausea and vomiting Pain Dyspnea Insomnia Appetite loss B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value B 95% CI p-value Age 4.047 −3.49–11.59 0.290 1.853 −4.82–8.53 0.583 5.547 −2.04–13.13 0.150 1.982 −5.29–9.25 0.590 −2.879 −11.82–6.06 0.525 7.604 −0.79–15.99 0.075 Marital status .369 −7.57–8.31 0.927 3.291 −3.74–10.32 0.355 2.168 −5.82 –10.16 0.592 4.188 −3.47–11.84 0.281 4.243 −5.17–13.66 0.374 −1.202 −10.04–7.63 0.788 Education level −2.135 −8.19–3.92 0.486 5.460 .10–10.82 0.046 −1.168 −7.26–4.92 0.705 2.439 −3.40–8.27 0.409 1.330 −5.8–8.51 0.714 1.953 −4.78–8.69 0.67 Employment 2.650 −2.59–7.89 0.318 −2.611 −7.25–2.03 0.267 .789 −4.48–6.06 0.767 -2.787 −7.84–2.26 0.276 −353 −6.5–5.86 0.911 −3.261 −9.09–2.57 0.270 0.171 Income −3.816 −11.77–4.14 0.344 −10.672 −17.72–−3.63 0.003 −4.792 −12.80–3.22 0.238 -3.145 −10.82–4.53 0.418 −8.970 −18.41–0.47 0.062 −6.164 −15.02–2.69 Tumor location 1.255 −11.10–13.61 0.841 −5.796 −16.74–5.14 0.296 −748 −13.18–11.69 0.905 -3.017 −14.93–8.90 .617 −4.390 −19.05–10.27 0.554 −4.152 −17.91–9.60 0.551 Constipation Diarrhea Financial difficulties B 95% CI p-value B 95% CI p-value B 95% CI p-value Age 6.217 −2.15–14.58 0.144 −123 −8.63–8.39 0.977 1.596 –6.65–9.85 0.702 Marital status −4.394 −13.20–4.41 0.325 9.045 0.08–18.01 0.048 –10.322 –19.01–1.63 0.020 Education level 8.122 1.41–14.84 0.018 1.574 −5.26–8.40 0.649 –2.017 –8.64–4.61 0.547 Employment −5.593 −11.40–0.22 0.059 −1.677 −7.59–4.24 0.575 1.039 –4.69–6.77 0.720 Income −12.125 −20.95–-3.30 0.008 2.363 −6.62–11.35 0.603 –10.444 –19.15–1.73 0.019 Tumor location −3.136 −16.85–10.57 0.651 −2.072 −16.02–11.88 0.769 2.672 –10.85–16.20 0.696 6 International Journal of Surgical Oncology Table 4: Predictors of quality of life of colorectal cancer patients (CR29). Body image Anxiety Weight Sexual interest Urinary frequency Blood and mucus in stool B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value Age 5.503 −2.31–13.32 0.166 4.266 −4.53–13.07 0.339 1.640 −7.00–10.28 0.708 −8.051 −17.70–1.60 0.100 1.554 −6.10–9.21 0.688 1.884 −3.80–7.56 0.512 Marital status −2.919 −11.15–5.31 0.484 −11.682 −20.95–-2.41 0.014 −3.035 −12.13–6.06 0.510 −12.935 −28.21–2.34 0.095 0.771 −7.29–8.83 0.850 0.417 −5.56–6.40 0.890 Education level .025 −6.25–6.30 0.994 −0.685 −7.75–6.38 0.848 3.922 −3.01–10.86 0.265 −2.065 −10.39–6.26 0.621 −6.545 −12.69–-0.40 0.037 4.964 0.41–9.52 0.033 Employment 1.053 −4.38–6.48 0.702 −3.503 −9.62–2.61 0.259 −2.692 −8.70–3.31 0.376 3.309 −4.67–11.29 0.410 5.248 −0.07–10.56 0.053 −1.621 −5.57–2.32 0.417 Income −3.455 −11.71–4.80 0.409 −6.026 −15.32–3.26 0.201 −7.175 −16.30–1.95 0.122 1.322 −8.92–11.56 0.797 5.853 −2.22–13.93 0.154 −8.246 −14.24–-2.25 0.007 Tumor location −4.064 −16.88–8.75 0.531 −3.475 −17.90–10.95 0.634 −7.113 −21.28–7.05 0.322 7.929 −10.78–26.64 0.400 −1.109 −13.65–11.43 0.861 4.896 −4.41–14.21 0.300 Urinary incontinence Dysuria Abdominal pain Buttock pain Bloating Dry mouth B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value Age 6.161 −0.19–12.51 0.057 2.522 −4.10–9.15 0.452 7.708 −0.80–16.21 0.075 2.993 −5.62–11.61 0.493 6.974 −2.80–16.75 0.159 −1.623 −9.36–6.12 0.679 Marital status −5.700 −12.39–0.99 0.094 −3.069 −10.05–3.91 0.385 −5.719 −14.67–3.24 0.208 −3.078 −12.15–6.00 0.503 0.051 −10.94–11.04 0.993 4.137 −4.01–12.29 0.317 Education level −1.371 −6.47–3.73 0.595 −4.721 −10.04–0.60 0.081 0.305 −6.52–7.13 0.930 3.381 −3.54–10.30 0.335 0.749 −7.12–8.62 0.850 1.555 −4.66–7.77 0.621 Employment 1.663 −2.75–6.08 0.457 1.936 −2.67–6.54 0.407 −4.247 −10.15–1.66 0.157 −1.317 −7.30–4.67 0.664 −2.946 −10.36–4.47 0.431 0.335 −5.04–5.71 0.902 Income −3.203 −9.91–3.50 0.346 3.084 −3.91–10.08 0.384 −3.463 −12.44–5.51 0.446 −4.578 −13.68–4.52 0.321 −8.269 −19.19–2.65 0.136 −0.969 −9.14–7.20 0.815 Tumor location 7.985 −2.43–18.40 0.131 12.758 1.89–23.62 022 −1.202 −15.14–12.74 0.865 3.214 −10.91–17.34 0.653 −2.571 −19.52–14.37 0.763 −5.771 −18.46–6.92 0.369 Hair loss Taste Fecal incontinence Sore skin Impotence Dyspareunia B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value B 95% CI p value Age 4.338 −4.34–13.02 0.324 5.197 −2.24–12.64 0.169 2.616 −5.75–10.98 0.535 7.093 −2.58–16.77 0.148 −6.911 −13.47–−0.35 0.039 2.666 −9.74–15.07 0.667 Marital status 5.542 −3.60–14.68 0.232 2.869 −4.97–10.71 0.470 0.937 −8.46–10.34 0.843 −1.968 −12.76–8.82 0.717 −5.245 −11.69–1.20 0.108 −17.439 −29.68–−5.19 0.006 Education level 6.003 −0.96–12.97 0.090 4.558 −1.42–10.53 0.133 1.578 −5.15–8.31 0.642 7.115 −0.65–14.88 0.072 2.860 −3.21–8.93 0.348 5.530 −5.96–17.01 0.338 Employment −4.296 −10.33–1.73 0.161 −2.510 −7.68–2.66 0.338 2.865 −3.47–9.20 0.370 −4.386 −11.66–2.89 0.233 1.321 −3.23–5.87 0.562 0.695 −8.18–9.57 0.876 Income −8.297 −17.46–0.86 0.075 −4.255 −12.11–3.60 0.286 -8.715 −18.05–0.62 0.067 −12.137 −22.86–−1.42 0.027 2.137 −6.57–10.84 0.624 −7.530 −24.06–9.00 0.364 Tumor location −10.827 −25.05–3.40 0.134 −11.884 −24.08–0.32 0.056 4.682 −9.81–19.17 0.522 4.259 −12.38–20.90 0.611 −.527 −11.99–10.94 0.927 8.019 −13.67–29.71 0.461 International Journal of Surgical Oncology 7 *is study does have its own limitations. First, regarding to free and state-of-the- art healthcare services do tend to have a better QoL, as they feel less burdened by the disease the measuring tools, which lack the ability to measure the QoL before and after the treatment or intervention. Second, financially as well as emotionally [24, 25]. Furthermore, 52.5% of our study participants were of age the study sample size is small for the generalization of the less than 60 years old (Table 1), which was similar to the results for the whole population. previous studies but different from the report from Japan, where the majority of participants were above 70 years of age 5. Conclusion [24, 25, 27]. *e higher percentage of young patients confirms In conclusion, this study provides a glimpse into the QoL of the established fact that in Saudi Arabia CRC has a high CRC patients in our medical center and does sketch a good prevalence among the younger people [7]. *ere are numerous functioning of life among our participants as they reported a risk factors which are associated with CRC among young high global quality of life on both the EORTC QLQ-30 and individuals like smoking, high fat diet, low-fiber diet, sedentary QLQ-CR29 scales. Among the most distressing symptoms, lifestyle, less exercise, and higher consumption of fast food fatigue and insomnia topped the list, and among predictors [6, 14]. urinary frequency and blood and mucus in stool were found Globally, for any type of cancer, age is regarded as the to be the most common symptoms. Predictors for the chief factor which affects the QoL of a patient. However, in cognitive and social functioning were found to be age and our study we found that age was significantly associated with income. *is study reiterates the fact that the burden of the limitation of social functioning only. *ese results were carrying the cancer puts the patients at risk of poorer quality different than the ones reported by other studies [6, 28], of life which needs to be mitigated well within social and which reported that the oldest age group (≥60 years) private constraints to ease the suffering. exhibited a tendency to score lowest in functional domains especially in physical functioning scales. *is can be con- Data Availability sidered as the strength of our study in identifying that the healthcare facility provided at KAMC is at its best and *e pertaining data are available with the corresponding provides a necessary alleviation of the quality of life factors. author on demand. However, in our study we did find that age was related to impotence (p< 0.05). Ethical Approval In our study, we also found that cancer patients are concerned more about their body image, which scores *is study was approved by the Institutional Review Board the lowest in QLQ-CR29 scale (33.71). However, it was of King Abdullah International Medical Research Center not found to be associated with any of the demographic (KAIMRC), a research wing of KSAU-HS, Jeddah (Refer- characteristics of subjects. *is is understandable, as ence No: SPJ21J.179.05). most of our participants belonged to the younger age group (<60). It therefore presents a challenge for Conflicts of Interest healthcare providers to mitigate the awareness about cancers in general and about CRC in particular, so that *e authors declare that they have no conflicts of interest. the disease is caught well in the beginning for the treatment to be effective and for the disease to be less Authors’ Contributions crippling. Aga et al. have already reported that the JTQ, AAQ, and SA conceptualized the project and collected awareness among health and allied students regarding the data. SSA conceptualized the project, analyzed the colorectal cancer was low [29]. collected data, and wrote the entire manuscript. AH *erefore, there is a dire need of proactive, aggressive, reviewed, edited, and approved the final version of the and preventive medicine campaigns and educational pro- manuscript. grams to prepare the population for challenges posed by the increasing burden of cancer in the kingdom [20, 22, 29]. Acknowledgments Additionally, urinary frequency scores highest among the QLQ-CR29 symptoms scales which was found to be asso- *e authors would like to express their deep gratitude to- ciated with both education level and employment (p< 0.05) wards all participants who proactively took part in this (Table 4). *is highlights the dominant effect of education in study. *e authors also acknowledge the help of Mr. Abdul identifying the most irritating symptom which affects the Rehman in dispensing the survey to various leaders of daily functioning of cancer patients. KSAU-HS Students for the collection of data. We also found that marital status, education level, and income were the primary predictors of the quality of life References among the CRC patients, as each of them was significantly associated with at least two symptoms of CRC (Tables 3 and [1] S. Faury, E. Rullier, Q. Denost, and B. Quintard, “Quality of 4). Married subjects with lower income were in particularly life and fatigue among colorectal cancer survivors according worried about the financial difficulties because of the burden to stoma status—the national VICAN survey,” Journal of of carrying cancer. *ese results were similar to the results Psychosocial Oncology, vol. 38, no. 1, pp. 89–102, 2020. reported by Almutairi et al. [6]. [2] H. Brody, “Colorectal cancer,” Nature, vol. 521, 2015. 8 International Journal of Surgical Oncology [3] F. F. Alabbas, S. M. Al-Otaibi, M. H. C. Pasha et al., “Impact of riyadh,” Saudi Journal of Gastroenterology, vol. 21, no. 2, pp. 78–83, 2015. physiological symptoms and complications of colorectal cancer on the quality of life of patients at king Abdulaziz [21] “Cancer incidence report (Saudi Arabia),” https://nhic.gov.sa/ eServices/Documents/2014.pdf. university hospital,” Journal of Cancer Education, vol. 31, no. 2, pp. 221–227, 2016. [22] N. Alsanea, A. S. Abduljabbar, S. Alhomoud, L. H. Ashari, D. Hibbert, and S. Bazarbashi, “Colorectal cancer in Saudi [4] M. H. Mosli and M. S. Al-Ahwal, “Colorectal cancer in the Arabia: incidence, survival, demographics and implications Kingdom of Saudi Arabia: need for screening,” Asian Pacific for national policies,” Annals of Saudi Medicine, vol. 35, no. 3, Journal of Cancer Prevention, vol. 13, no. 8, pp. 3809–3813, pp. 196–202, 2015. [23] S. Alshehri, A. Alzamil, R. Alturki et al., “Quality of life of [5] “Saudi Cancer Registry,” 2016, https://nhic.gov.sa/en/ patients with cancer attending outpatient clinics at the king eServices/Documents/2016.pdf. Abdulaziz medical city, riyadh, Saudi Arabia,” Journal of [6] K. M. Almutairi, E. Alhelih, A. S. Al-Ajlan, and J. M. Vinluan, Nature and Science of Medicine, vol. 3, no. 1, pp. 53–58, 2020. “A cross-sectional assessment of quality of life of colorectal [24] D. P. Braun, D. Gupta, J. F. Grutsch, and E. D. Staren, “Can cancer patients in Saudi Arabia,” Clinical and Translational changes in health related quality of life scores predict survival Oncology, vol. 18, no. 2, pp. 144–152, 2016. in stages III and IV colorectal cancer?” Health and Quality of [7] M. S. Al-Ahwal, Y. H. Shafik, and H. M. Al-Ahwal, “First Life Outcomes, vol. 9, no. 1, p. 62, 2011. national survival data for colorectal cancer among Saudis [25] J. Engel, J. Kerr, A. Schlesinger-Raab, R. Eckel, H. Sauer, and between 1994 and 2004: what’s next?” BMC Public Health, D. Holzel, ¨ “Quality of life in rectal cancer patients,” Annals of vol. 13, no. 1, p. 73, 2013. Surgery, vol. 238, no. 2, pp. 203–213, 2003. [8] T. Conroy, H. Bleiberg, and B. Glimelius, “Quality of life in [26] S. E. Wan Puteh, N. M. Saad, S. M. Aljunid et al., “Quality of patients with advanced colorectal cancer: what has been life in Malaysian colorectal cancer patients,” Asia-Pacific learnt?” European Journal of Cancer (Oxford England: 1990), Psychiatry, vol. 5, pp. 110–117, 2013. vol. 39, no. 3, pp. 287–294, 2003. [27] A. Tsunoda, K. Nakao, K. Hiratsuka, N. Yasuda, [9] J. L. Rodriguez, N. A. Hawkins, Z. Berkowitz, and C. Li, M. Shibusawa, and M. Kusano, “Anxiety, depression and “Factors associated with health-related quality of life among quality of life in colorectal cancer patients,” International colorectal cancer survivors,” American Journal of Preventive Journal of Clinical Oncology, vol. 10, no. 6, pp. 411–417, 2005. Medicine, vol. 49, no. 6, pp. S518–S527, 2015. [28] A. E. Ahmed, A. S. Almuzaini, M. A. Alsadhan et al., “Health- [10] A. Caravati-Jouvenceaux, G. Launoy, D. Klein et al., “Health- related predictors of quality of life in cancer patients in Saudi related quality of life among long-term survivors of colorectal Arabia,” Journal of Cancer Education, vol. 33, no. 5, cancer: a population-based study,” 9e Oncologist, vol. 16, pp. 1011–1019, 2018. no. 11, pp. 1626–1636, 2011. [29] S. Aga, M. Khan, E. Alsulimani et al., “Knowledge & [11] N. K. Aaronson, S. Ahmedzai, B. Bergman et al., “*e Eu- awareness regarding colorectal cancer among health and al- ropean Organization for Research and Treatment of Cancer lied students of king saud bin Abdulaziz university for health QLQ-C30: a quality-of-life instrument for use in international sciences, Jeddah,” Journal of Family Medicine and Primary clinical trials in oncology,” JNCI Journal of the National Care, vol. 10, no. 6, pp. 2284–2292, 2021. Cancer Institute, vol. 85, no. 5, pp. 365–376, 1993. [12] European Organisation for Research and Treatment of Cancer Quality of Life Department, “Questionnaires. eortc QLQ-C30. brussels, belgium: European organisation for research and treatment of cancer,” , 2017. [13] M. A. Awad, S. Denic, and H. El Taji, “Validation of the European organization for research and treatment of cancer quality of life questionnaires for Arabic-speaking pop- ulations,” Annals of the New York Academy of Sciences, vol. 1138, no. 1, pp. 146–154, 2008. [14] A. S. Sameer, “Colorectal cancer: molecular mutations and polymorphisms,” Frontiers in Oncology, vol. 3, no. 5, p. 114, [15] B. A. Weinberg, J. L. Marshall, and M. E. Salem, “*e growing challenge of young adults with colorectal cancer,” Oncology, vol. 31, no. 5, pp. 381–389, 2017. [16] Globocan, http://gco.iarc.fr/today/data/factsheets/cancers/ 39-All-cancers-fact-sheet.pdf, 2018. [17] Globocan, http://gco.iarc.fr/today/data/factsheets/cancers/ 10_8_9-Colorectum-fact-sheet.pdf, 2018. [18] R. L. Siegel, K. D. Miller, S. A. Fedewa et al., “Colorectal cancer statistics, 2017,” CA: A Cancer Journal for Clinicians, vol. 67, no. 3, pp. 177–193, 2017. [19] E. J. Kuipers, W. M. Grady, D. Lieberman et al., “Colorectal cancer,” Nature Reviews Disease Primers, vol. 1, no. 1, Article ID 15065, 2015. [20] A. Zubaidi, A. AlHumaid, K. AlKhayal, O. AlObeed, N. AlSubaie, and S. Shaik, “Public awareness of colorectal cancer in Saudi Arabia: a survey of 1070 participants in

Journal

International Journal of Surgical OncologyHindawi Publishing Corporation

Published: May 17, 2022

References