Colorectal cancer survivorship in a cohort of Sri Lankan patients; the time to widen focus from the care of acute patients to long-term survivors

Background: Survival of patients with colorectal cancer (CRC) has improved the world over and cancer survivorship has placed new demands on the provision of healthcare. Sri Lanka is a low to middle income country with good healthcare outcomes based on WHO regional data. Up to now, studies from Sri Lanka and South Asia focused on achieving a global standard of acute cancer care in the areas of curative and restorative resection for CRC. There is a lack of data from this region that focuses on CRC survivors and their needs. This study compared survival in two cohorts of Sri Lankan patients across two decades to evaluate perceived improvement in the outcome of treatment for CRC and assessed quality of life (QOL) in a subgroup of survivors to better define the needs of future healthcare requirements in the continued treatment of patients with CRC.
Materials and Methods: Two groups of patients with CRC were compared: Group A (425), 1996 to 2010 (rectal cancer-RC, 276 [65%] and colon cancer-CC, 149 [35%]) vs. Group B (289), 2010 to 2020 (RC, 165 [57%] and CC, 124 [43%]). Overall survival (OS) for the entire group, and RC and CC separately, was evaluated and compared. Histological characteristics of the resected specimens were compared for the two periods. In a subset of 100 (RC-65, CC-35) QOL in the physical component (PC) and emotional component (EC) domains were evaluated to compare RC with CC.
Results: Overall survival was better for patients post-2010 vs. pre-2010 (P<0·001); one, three and five-year survival for post-2010 were 89% (95%CI: 85.5% - 93.2%), 75% (95%CI: 69.9% - 82.2%) and 68% (95%CI: 61.5% - 76.0%) respectively versus 79% (95%CI: 75.8% - 83.5%), 67% (95%CI: 62.9% -72.1%) and 59% (95%CI: 54.3% 64.2%) for pre-2010 time period. This is because of a better OS and DFS for RC but not CC. QOL was similar for those with RC vs. CC in both physical and emotional domains, and for those who survived less than 5 years vs. greater than 5 years. Over two-thirds (69%) reported organ dysfunction, 30% experienced alteration in lifestyle and 7% reported depression.
Conclusion: Improvement in survival of patients with rectal cancer after 2010 contributed to overall improvement in survival for patients with CRC. The improvement in RC, OS and DFS correlates with the improvement in histological specimen quality. This may be attributed to the improvement in preoperative planning and technique post 2010. There is an emerging need for rehabilitation and multi-disciplinary services, outside the realm of acute care, for rectal cancer survivors, specifically, and for CRC patients in general.