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.