The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review
Authors: Cabilan C.J. , Hines Sonia 
Published: November 2019

EXECUTIVE SUMMARY

Background
Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients.

Objectives
To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis.

Inclusion criteria Types of participants
Colorectal cancer survivors aged 18 years and over.

Types of interventions
Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy.

Types of studies
Pre- and post-observational and experimental studies.

Outcomes
Physical activity, ability to perform activities of daily living (functional status) and QoL.

Search strategy
CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015.

Methodological quality
All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.

Data extraction
Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software.

Data synthesis
The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form.

Results
A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies.

Conclusion
In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment.

Implications for practice
The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors.

Implications for research
The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.