How Delayed Colorectal Cancer Screening Impacts Quality of Life

Announcer:
You’re listening to Clinician’s Roundtable on ReachMD. On this episode, we’ll hear from Dr. Christopher Cann, who’s an Assistant Professor in the Department of Hematology Oncology at Fox Chase Cancer Center in Philadelphia, where he's also the Director of the Young Adult Cancer Program. He’ll be discussing the quality-of-life implications from delayed colorectal cancer screening. Let’s hear from Dr. Cann now.

Dr. Cann:
So even just talking with stage three or resectable stage four where there is some areas that could be resected and potentially have curative intent, the surgery in and of itself becomes more extensive. So if we think about stage three cancers, it requires more lymph node dissections, and it potentially requires—depending on where this is—an ostomy, which can be permanent or will eventually be reversed after chemotherapy is used.

And that's the next component of this. For stage three and stage four colorectal cancer, chemotherapy is the general recommendation. For stage three cancers, you're looking at generally three to six months of chemotherapy. And so from a quality-of-life perspective, we're saying that you're coming in to get regular chemotherapy that has side effects: fatigue; GI side effects such as nausea, vomiting, and diarrhea; low white blood cell; red blood cell counts; and one big thing is peripheral neuropathy from the oxaliplatin-based chemo that is standard of care that has a cumulative effect over the course of time. But that could be a side effect that is potentially permanent, and that quality-of-life issue can last forever. From a stage four standpoint, if there is a potential for cure in the sense of there is limited disease spread potentially to the liver or to the lung, not only does that require resection of the primary tumor, but also resection of areas of the liver, resection of areas or radiation to areas in the lung if those are the areas of spread. So the extent of surgery and the recovery time becomes significantly longer, and complications obviously potentially increase as well the more that we are surgically involved.

And then if we're in a situation where we are not able to cure this cancer in the stage four setting, that's where lifelong chemotherapy is needed. And so from a quality-of-life perspective, we are obviously taking into account how we balance quantity of life by prolonging through chemotherapy with the quality of life that the chemotherapy can provide by improving symptoms but also the negative quality-of-life effects from the side effects of chemotherapy. And so this could be something that's patients are dealing with for years, and it limits their ability to potentially work or spend time with their family if they want to vacation, and in young patients, it can affect their fertility, which is one big issue we like to always address with our young adult patients—these chemotherapies can have permanent effects on your ability to have a child in the future.

So all that being said, it really focuses on the fact that screening is so important to catch these things early and to limit the potential quality-of-life issues that are associated with surgery and chemotherapy and the potentially life-limiting components of a stage four cancer diagnosis.

Announcer:
That was Dr. Christopher Cann talking about how delayed colorectal cancer screening can impact patients’ quality of life. To access this and other episodes in our series, visit Clinician's Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!