Clinicopathological patterns and quality of life of colorectal cancer patients at Komfo Anokye Teaching Hospital, Kumasi Ghana

Colorectal cancer is a major cause of morbidity and mortality throughout the world and the incidence of colorectal cancer is increasing in developing countries including Sub Sahara Africa. The aim of this study was to elucidate the incidence, five years survival rate and the quality of life of colorectal cancer patients, as well as to identify the prognostic factors among diagnosed and treated patients at Komfo Anokye Teaching Hospital (KATH). A retrospective cross sectional study where all colorectal cancer cases from 2009 to 2015 presented to the Surgical and Oncological Department of KATH were reviewed. The records of subjects were analysed for information on their demographics, clinical and pathological parameters. Survival analysis was done, and the survival time was defined as the time between the date of first diagnosis and the date of last follow-up or death. Quality of life of patients was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) standard questionnaire for cancer patients and the colorectal cancer specific model EORTC CR 29. The EORTC questionnaire was filled through telephone interviews with the study subjects. In all, 221 cases of colorectal cancer were identified. The mean age of the study participants was 54 ± 16.8 and ranged from 16 to 90 years. Fifty (50) of the participants (22.6%) were less than 40 years. Majority were females 127 (57.5%), 16 (7.24%) showed records of family history of cancer and the prevalence of comorbidities was (24.89%). The major clinical symptoms presented; were weight loss (44.80%), bleeding per rectum (39.82%), abdominal pain (38.91%) constipation (31.67%) Hematochezia (28.96%) change in bowel habit (20.81%), anorexia (20.36%), and anaemia (15.84%). Majority of the patients presented with rectal cancer cases 108(48.87%). The rectum 96(43.40%) was the most common anatomical site for colorectal cancer, followed by the caecum 35 (15.80%) and sigmoid colon 22 (10.00%) among the study participants. Adenocarcinoma was the commonest histopathological tumour in 151 (68.33%) of the studied subjects. Majority of the tumours showed moderately differentiation 104 (47.10%). According to the Tumour Node Metastasis (TNM) staging of cancer, majority of the patients 89(40.27%) were in late stage (TNM Stage III) of the cancer and only 13 (5.98%) were in stage 1. The overall crude annual incidence of colorectal cancer at KATH was 4.62 per 100,000 population. The age specific standardized incidence rate using WHO world population as standard was 7.93 per 100,000 population. The five years survival rate was recorded at 16%. Family history, Chemotherapy, BMI and both chemotherapy and radiotherapy were significant (p< 0.05) clinical prognostic factors. TNM tumour stage, depth of tumour invasion, lymph node metastasis, and distance metastasis had worse significant association with overall survival. The global health status had a mean score of 64.15±24.58, signifying moderate quality of life among the patients. Colon cancer patients (72.8±21.7) had a significantly (p=0.039) better quality of life compared to rectal cancer patients (56.9±20.7) Overall, the function scales assessment was good among the patients with physical function having the highest scores of 84.61±24.58 and emotional function having the least score 66.36±26.32. With the exception of financial difficulty 33.0 (0.0-100), pain 17.0 (0.0-33.0) and fatigue 22.0 (0.0-33.0), the symptom scale assessment was good among the patients. With the CRC specific questionnaire, body image had the highest score (85.25± 22.35) on the functional scale and a comparison between colon and rectal cancer patients showed a significant difference (p=0.0261). In the symptom scale, flatulence was the most common symptom with the highest score 33(0.0-67.0). Overall, patients had good symptom score. Our study has established that, there is a progressive but steady increase in the incidence of colorectal cancer in our setting and that the observed trend is similar to that of most African countries. Late staged presentations, high mortality and hence low survival rate are the hallmarks of the disease in this region and pose a great challenge in the management and clinical outcome of these patients.

Source: KNUST