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Complications Among Colorectal Cancer Survivors: SF-6D Preference-Weighted Quality of Life Scores

Hornbrook, Mark C. PhD*; Wendel, Christopher S. MA; Coons, Stephen Joel PhD‡§; Grant, Marcia PhD, RN; Herrinton, Lisa J. PhD; Mohler, M. Jane PhD†**††; Baldwin, Carol M. PhD, PN‡‡; McMullen, Carmit K. PhD*; Green, Sylvan B. MD**§§; Altschuler, Andrea PhD; Rawl, Susan M. PhD, RN¶¶; Krouse, Robert S. MD†††§§

doi: 10.1097/MLR.0b013e31820194c8
Brief Report

Background: Societal preference-weighted health-related quality of life (HRQOL) scores enable comparing multidimensional health states across diseases and treatments for research and policy.

Objective: To assess the effects of living with a permanent intestinal stoma, compared with a major bowel resection, among colorectal cancer (CRC) survivors.

Research Design: Cross-sectional multivariate linear regression analysis to explain preference-weighted HRQOL scores.

Subjects: In all, 640 CRC survivors (≥5 years) from 3 group model health maintenance organizations; ostomates and nonostomates with colorectal resections for CRC were matched on gender, age (±5 years), time since diagnosis, and tumor site (rectum vs. colon).

Measures: SF-6D scoring system was applied to Medical Outcomes Study Short Form-36 version 2 (SF-36v2); City of Hope Quality of Life-Ostomy; and Charlson-Deyo comorbidity index.

Methods: Survey of CRC survivors linked to respondents’ clinical data extracted from health maintenance organization files.

Results: Response rate was 52%. Ostomates and nonostomates had similar sociodemographic characteristics. Mean SF-6D score was 0.69 for ostomates, compared with 0.73 for nonostomates (P < 0.001), but other factors explained this difference. Complications of initial cancer surgery, and previous year comorbidity burden, and hospital use were negatively associated with SF-6D scores, whereas household income was positively associated.

Conclusions: CRC survivors’ SF-6D scores were not associated with living with a permanent ostomy after other factors were taken into account. Surgical complications, comorbidities, and metastatic disease lowered the preference-weighted HRQOL of CRC survivors with and without ostomies. Further research to understand and reduce late complications from CRC surgeries as well as associated depression is warranted.

From the *The Center for Health Research, Northwest/Hawaii/Southeast, Kaiser Permanente Northwest, Portland, OR; †Southern Arizona Veterans Affairs Health Care System, Tucson, AZ; ‡Department of Pharmacy Practice and Science, Critical Path Institute, Tucson, AZ; §University of Arizona, College of Pharmacy, Tucson, AZ; ¶Department of Nursing Research and Education, City of Hope Medical Center/Beckman Research Institute, Duarte, CA; ∥Division of Research, Kaiser Permanente Northern California, Oakland, CA; **University of Arizona, College of Public Health, Tucson, AZ; ††University of Arizona, College of Medicine, Tucson, AZ; ‡‡Arizona State University, College of Nursing and Health Innovation, Phoenix, AZ; §§Arizona Cancer Center, Tucson, AZ; and ¶¶Indiana University School of Nursing, Indianapolis, IN.

Deceased (Sylvan B. Green, University of Arizona, College of Public Health, Tucson, AZ; Arizona Cancer Center, Tucson, AZ).

Supported by NCI grants R01 CA106912 and P20 CA023074; Sun Capital Foundation; The Clayman Foundation.

The authors dedicate this article to Sylvan Green.

The views expressed in this article are those of the authors and do not necessarily represent the views of Kaiser Permanente or the Department of Veterans Affairs.

Reprints: Mark C. Hornbrook, PhD, The Center for Health Research, Northwest/Hawaii/Southeast, Kaiser Permanente Northwest, 3800 North Interstate Ave, Portland, OR 97227. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.