Quality of life of colorectal cancer patients at Moi Teaching and Referral Hospital and validation of fact - C Questionnaire in the Kenyan context

Abstract

Introduction: Globally colorectal cancer (CRC) is the third commonest cancer and it accounts for approximately 7.6% of all cancers in Kenya. Advancements in CRC management have increased survival rates with Quality of Life (QoL) becoming critical in survivorship care strategies. QoL is affected by loss of health due to both CRC symptomatology and consequences of treatment; resulting in psychophysical and social impairment which influences treatment outcomes. Studies amongst longterm CRC survivors suggest that those who survive for >5 years, experience good QoL with moderately lower physical functioning. Locally, there is paucity of data on QoL of CRC patients and a Kiswahili translation of FACT-C questionnaire which is designed to specifically estimate QoL in CRC, had not yet been validated in Kenya as at the time of this study. Objectives: To assess the QoL of colorectal cancer patients at Moi Teaching and Referral Hospital (MTRH) and to validate a Kiswahili working translation of the FACT-C questionnaire. Methods: This was a cross-sectional study conducted at MTRH between April 2019 and January 2020. The study population included 90 patients aged >18 years with histologically confirmed CRC, enrolled by census sampling. Structured interviewer administered questionnaires were utilized to collect sociodemographic and clinical data. QoL was assessed using the validated Kiswahili Functional Assessment of Cancer Therapy-General questionnaire (FACT-G), which estimates QoL in any cancer patient regardless of the cancer type. Functional Assessment of Cancer Therapy–Colorectal cancer questionnaire (FACT-C) was used to assess CRC specific QoL, using a Kiswahili working translation developed by the study team. QoL scores were then correlated with ECOG clinical performance status for external validity. Good QoL was based on a total score of >81 by FACT-G, >21 by FACT-C and 0 or 1 by ECOG. Pearson chi square test of homogeneity was used to test the association between QoL scores as determined by FACT-C compared to the already validated FACT-G to determine the content validity of FACT-C. Results: A total of 90 participants were enrolled, 55.6% (N=50) were female and 30% (N=27) aged >61 years. The predominant histological type was adenocarcinoma, with 48.9% (N=44) having advanced disease. Good clinical performance status by ECOG was observed in 63.3% (N=57), who also had good QoL scores on both FACT-G and FACT-C. Characteristics associated with good QoL included early disease stage and higher level of education; surgery and advanced disease were associated with poor QoL. QoL scores by FACT-G deteriorated significantly (p=0.000) when subjected to FACT-C, suggesting content validity of FACT-C that specifically addresses CRC symptomatology, which may not be highlighted by FACT-G. Conclusion: Characteristics associated with good QoL were early disease stage and higher education level. Surgery and advanced disease were associated with poor QoL. Kiswahili working translation of FACT-C demonstrated external validity and content validity. Recommendations: QoL assessment should be done in CRC patients using the disease specific FACT-C questionnaire. Pre-and post-surgical counselling should be done to address potential complications. A multi-center study is recommended for comparability in order to inform evidence based local guidelines on QoL determination in CRC.