The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review.
The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review.
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DOI：
10.11124/jbisrir-2016003282
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发表时间：
2017-02-01
期刊：
影响因子：
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通讯作者：
Hines, Sonia
中科院分区：
文献类型：
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作者：
Cabilan, C J;Hines, Sonia
背景技术背景：身体活动、功能状态和生活质量（QoL）是结直肠癌（CRC）治疗后生活质量（QoL）的重要决定因素;然而，对治疗如何影响这些结果知之甚少。有了这样的理解可以帮助临床医生制定和实施策略，将提高或维持CRC患者的生活质量。（手术加或不加放疗和/或化疗）对治疗或诊断后一年内身体活动、功能状态和生活质量的影响。年龄在18岁及以上的结直肠癌幸存者。干预类型：根治性CRC治疗，即手术加或不加放疗和/或化疗。研究类型：术前和术后观察和实验研究。结局：体力活动、日常生活活动能力（功能状态）和生活质量（QoL）。研究策略：使用CINAHL、Embase、MEDLINE、OpenGrey和ProQuest论文和论文获取英文版的已发表和未发表研究。方法学质量：所有研究均由两名评价者独立评估相关性、合格性和方法学质量。数据提取：使用改良的数据提取工具提取纳入文献的数据。数据综合：术后和基线值之间的差异使用Review Manager 5.3.5（哥本哈根：北欧科克伦中心，科克伦）计算器计算，并表示为平均差异及其相应的95%置信区间。在可能的情况下，在统计荟萃分析中汇总研究结果。体力活动，功能状态和一些生活质量的结果是在一个叙述和表格form.RESULTS：共23项研究包括在本次审查：两项研究（N = 2019例患者）评估体力活动，两项研究（N = 6908例患者）评估功能状态和22项研究（N = 2890例患者）测量生活质量。 治疗后6个月，观察到体力活动减少。CRC患者的功能状态下降，尤其是老年人（结果1和2总结）。至于生活质量，只有身体和功能方面的下降，长达6个月，但评分几乎恢复到基线水平，在治疗后一年。在统计荟萃分析中汇总了使用欧洲癌症研究和治疗组织QLQ-C30工具的QoL研究，并在结果总结2中进行了总结。由于研究的异质性和最近研究的稀缺性，必须仔细解释结果。结论：尽管存在局限性，但CRC幸存者的身体和功能能力在治疗后可能会恶化。诊断和治疗之间的时期为临床医生提供了实施干预措施的机会（如运动干预），可以增强或恢复CRC幸存者的身体和功能能力。研究意义：研究的缺乏和异质性需要得到解决。结肠癌和直肠癌幸存者、造口者和非造口者的结局必须单独分析。
BACKGROUND: Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients.OBJECTIVES: To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis.INCLUSION CRITERIA TYPES OF PARTICIPANTS: Colorectal cancer survivors aged 18 years and over.TYPES OF INTERVENTIONS: Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy.TYPES OF STUDIES: Pre- and post-observational and experimental studies.OUTCOMES: Physical activity, ability to perform activities of daily living (functional status) and QoL.SEARCH STRATEGY: CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015.METHODOLOGICAL QUALITY: All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.DATA EXTRACTION: Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software.DATA SYNTHESIS: The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form.RESULTS: A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies.CONCLUSION: In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment.IMPLICATIONS FOR PRACTICE: The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors.IMPLICATIONS FOR RESEARCH: The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.