Quality of Life and Utility Values in Iranian Colorectal Cancer Patients: Using Generic and Specific Instruments
-
Nazila Yousefi
,
Sajad Ahmadkhani
,
Farnoosh Masbough
,
Saeid Taheri
,
Maria Tavakoli Ardestani
,
Paniz Zadehsoleyman
,
Farzad Peiravian
Abstract
Background: Health-related quality of life (HRQoL) is a key indicator in evaluating healthcare outcomes. Given the rising prevalence and high treatment costs of colorectal cancer (CRC) in Iran, assessing patients’ HRQoL is crucial for guiding health policy and effective resource planning. Accordingly, this study aimed to evaluate the QoL of CRC patients in Iran.
Methods: The population of this study included 60 CRC patients (30 cases in the stable state and 30 cases in the progressive state of the disease), who had been referred to hospitals affiliated with Shahid Beheshti University of Medical Sciences in 2019-2020. The patients’ QoL was estimated using EQ-5D-VAS, QLQ-CR29, and QLQ-C30 questionnaires.
Results: The mean VAS score was 0.62 ± 0.07, and the patients’ mean QLQ-CR29 and QLQ-C30 scores were 38.80 ± 9.70 and 48.90 ± 12.10, respectively. Moreover, the utility value of EQ-5D for the EQ-5D health states in the stable and progressive groups was 0.87 ± 0.11 (VAS: 0.82 ± 0.15) and 0.36 ± 0.30 (VAS: 0.44 ± 0.28). The results confirmed a significant difference (P < 0.001) between the two groups. Additionally, having an ostomy, rectal cancer, higher stages of cancer, and metastasis was significantly (P < 0.05) associated with a decreased QoL.
Conclusions: Overall, the QoL of CRC patients in Iran was comparable to that of the general population in stable stages but significantly decreased with disease progression. Consistent findings across EQ-5D, QLQ-C30, and QLQ-CR29 highlight reduced utility in advanced and metastatic cases. Compared with global studies, Iranian patients demonstrated similar or slightly lower QoL, indicating the need for local data in health economic evaluations.
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2. Johnson JA, Ohinmaa A, Murti B, Sintonen H, Coons SJ. Comparison of Finnish and US-based visual analog scale valuations of the EQ-5D measure. Med Decis Making. 2000;20(3):281-9. doi: 10.1177/0272989x0002000304
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4. Hosseini SV, Izadpanah A, Yarmohammadi H. Epidemiological changes in colorectal cancer in Shiraz, Iran: 1980-2000. ANZ J Surg. 2004;74(7):547-9. doi: 10.1111/j.1445-2197.2004.03064.x
5. Pourhoseingholi MA, Baghestani A, Abadi A, Hajizadeh N. Iranian regional cancer incidence is misclassified in neighborhood’s provinces. Gastroenterol Hepatol Bed Bench. 2016;9(2):75-7.
6. Scott NW, Fayers PM, Bottomley A, Aaronson NK, de Graeff A, Groenvold M, et al. Comparing translations of the EORTC QLQ-C30 using differential item functioning analyses. Qual Life Res. 2006;15(6):1103-15. doi: 10.1007/s11136-006-0040-x
7. Ihn MH, Lee SM, Son IT, Park JT, Oh HK, Kim DW, et al. Cultural adaptation and validation of the Korean version of the EORTC QLQ-CR29 in patients with colorectal cancer. Support Care Cancer. 2015;23(12):3493-501. doi: 10.1007/s00520-015-2710-0
8. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727-36. doi: 10.1007/ s11136-011-9903-x
9. Devlin NJ, Brooks R. EQ-5D and the EuroQol group: past, present and future. Appl Health Econ Health Policy. 2017;15(2):127-37. doi: 10.1007/ s40258-017-0310-5
10. Greene ME, Rader KA, Garellick G, Malchau H, Freiberg AA, Rolfson O. The EQ-5D-5L improves on the EQ-5D-3L for health-related quality-oflife assessment in patients undergoing total hip arthroplasty. Clin Orthop Relat Res. 2015;473(11):3383-90. doi: 10.1007/s11999-014-4091-y
11. Stiggelbout AM, Kunneman M, Baas-Thijssen MC, Neijenhuis PA, Loor AK, Jägers S, et al. The EORTC QLQ-CR29 quality of life questionnaire for colorectal cancer: validation of the Dutch version. Qual Life Res. 2016;25(7):1853-8. doi: 10.1007/s11136-015-1210-5
12. Baravelli C, Krishnasamy M, Pezaro C, Schofield P, Lotfi-Jam K, Rogers M, et al. The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up. J Cancer Surviv. 2009;3(2):99-108. doi: 10.1007/s11764-009- 0086-1
13. Polat U, Arpacı A, Demir S, Erdal S, Yalcin S. Evaluation of quality of life and anxiety and depression levels in patients receiving chemotherapy for colorectal cancer: impact of patient education
before treatment initiation. J Gastrointest Oncol. 2014;5(4):270-5. doi: 10.3978/j.issn.2078-6891.2014.034
14. Sanoff HK, Goldberg RM, Pignone MP. A systematic review of the use of quality of life measures in colorectal cancer research with attention to outcomes in elderly patients. Clin Colorectal Cancer. 2007;6(10):700-9. doi: 10.3816/CCC.2007.n.039
15. Hadi M, Gibbons E, Fitzpatrick R. A structured review of patient reported outcome measures for colorectal cancer. Patient-Reported Outcome Measurement Group, Department of Public Health, University of Oxford; 2010. Available from: https://www.ndph.ox.ac.uk/files/research/colorectal-cancer-review-final-2010.pdf.
16. Michalopoulos NV, Theodoropoulos GE, Stamopoulos P, Sergentanis TN, Memos N, Tsamis D, et al. A cost-utility analysis of laparoscopic vs open treatment of colorectal cancer in a public hospital of the Greek National Health System. J BUON. 2013;18(1):86-97.
17. Goudarzi R, Akbari Sari A, Zeraati H, Rashidian A, Mohammad K, Amini S. Valuation of quality weights for EuroQol 5-dimensional health states with the time trade-off method in the capital of Iran. Value Health Reg Issues. 2019;18:170-5. doi: 10.1016/j.vhri.2019.01.007
18. Goudarzi R, Zeraati H, Akbari Sari A, Rashidian A, Mohammad K. Population-based preference weights for the EQ-5D health states using the visual analogue scale (VAS) in Iran. Iran Red Crescent Med J. 2016;18(2):e21584. doi: 10.5812/ircmj.21584
19. Huang W, Yang J, Liu Y, Liu C, Zhang X, Fu W, et al. Assessing healthrelated quality of life of patients with colorectal cancer using EQ- 5D-5L: a cross-sectional study in Heilongjiang of China. BMJ Open.2018;8(12):e022711. doi: 10.1136/bmjopen-2018-022711
20. Bennett L, Zhao Z, Barber B, Zhou X, Peeters M, Zhang J, et al. Healthrelated quality of life in patients with metastatic colorectal cancer treated with panitumumab in first- or second-line treatment. Br J Cancer. 2011;105(10):1495-502. doi: 10.1038/bjc.2011.409
21. Kameyama H, Shimada Y, Yagi R, Yamada S, Hotta S, Tajima Y, et al. [Quality of life of patients after colorectal cancer surgery as assessed using EQ-5D-5L scores]. Gan To Kagaku Ryoho. 2017;44(12):1083-5. [Japanese].
22. Färkkilä N, Sintonen H, Saarto T, Järvinen H, Hänninen J, Taari K, et al. Health-related quality of life in colorectal cancer. Colorectal Dis. 2013;15(5):e215-22. doi: 10.1111/codi.12143
23. Yousefi M, Safari H, Akbari Sari A, Raei B, Ameri H. Assessing the performance of direct and indirect utility eliciting methods in patients with colorectal cancer: EQ-5D-5L versus C-TTO. Health Serv Outcomes Res Methodol. 2019;19(4):259-70. doi: 10.1007/s10742-019- 00204-5
24. Montazeri A, Hole DJ, Milroy R, McEwen J, Gillis CR. Quality of life in lung cancer patients: does socioeconomic status matter? Health Qual Life Outcomes. 2003;1:19. doi: 10.1186/1477-7525-1-19
25. Arraras JI, Suárez J, Arias de la Vega F, Vera R, Asín G, Arrazubi V, et al. The EORTC quality of life questionnaire for patients with colorectal cancer: EORTC QLQ-CR29 validation study for Spanish patients. Clin Transl Oncol. 2011;13(1):50-6. doi: 10.1007/s12094-011-0616-y
26. van der Hout A, Neijenhuijs KI, Jansen F, van Uden-Kraan CF, Aaronson NK, Groenvold M, et al. Measuring health-related quality of life in colorectal cancer patients: systematic review of measurement properties of the EORTC QLQ-CR29. Support Care Cancer. 2019;27(7):2395-412. doi: 10.1007/s00520-019-04764-7
27. Allal AS, Bieri S, Pelloni A, Spataro V, Anchisi S, Ambrosetti P, et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer. 2000;82(6):1131-7. doi: 10.1054/bjoc.1999.1052
28. Akhondi-Meybodi M, Akhondi-Meybodi S, Vakili M, Javaheri Z. Quality of life in patients with colorectal cancer in Iran. Arab J Gastroenterol. 2016;17(3):127-30. doi: 10.1016/j.ajg.2016.06.001
29. Downing A, Morris EJ, Richards M, Corner J, Wright P, Sebag- Montefiore D, et al. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol. 2015;33(6):616-24. doi:10.1200/jco.2014.56.6539
importance and relevance. Cancer J. 2009;15(5):435-40. doi: 10.1097/ PPO.0b013e3181b9c5b9
2. Johnson JA, Ohinmaa A, Murti B, Sintonen H, Coons SJ. Comparison of Finnish and US-based visual analog scale valuations of the EQ-5D measure. Med Decis Making. 2000;20(3):281-9. doi: 10.1177/0272989x0002000304
3. Dimitrova B. Carr AJ, Higginson IJ, Robinson PG. Quality of life. London: BMJ Books, 2003. 133 pp. ISBN 0-7279-1544 4. Eur J Public Health. 2005;15(6):668. doi: 10.1093/eurpub/cki178
4. Hosseini SV, Izadpanah A, Yarmohammadi H. Epidemiological changes in colorectal cancer in Shiraz, Iran: 1980-2000. ANZ J Surg. 2004;74(7):547-9. doi: 10.1111/j.1445-2197.2004.03064.x
5. Pourhoseingholi MA, Baghestani A, Abadi A, Hajizadeh N. Iranian regional cancer incidence is misclassified in neighborhood’s provinces. Gastroenterol Hepatol Bed Bench. 2016;9(2):75-7.
6. Scott NW, Fayers PM, Bottomley A, Aaronson NK, de Graeff A, Groenvold M, et al. Comparing translations of the EORTC QLQ-C30 using differential item functioning analyses. Qual Life Res. 2006;15(6):1103-15. doi: 10.1007/s11136-006-0040-x
7. Ihn MH, Lee SM, Son IT, Park JT, Oh HK, Kim DW, et al. Cultural adaptation and validation of the Korean version of the EORTC QLQ-CR29 in patients with colorectal cancer. Support Care Cancer. 2015;23(12):3493-501. doi: 10.1007/s00520-015-2710-0
8. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727-36. doi: 10.1007/ s11136-011-9903-x
9. Devlin NJ, Brooks R. EQ-5D and the EuroQol group: past, present and future. Appl Health Econ Health Policy. 2017;15(2):127-37. doi: 10.1007/ s40258-017-0310-5
10. Greene ME, Rader KA, Garellick G, Malchau H, Freiberg AA, Rolfson O. The EQ-5D-5L improves on the EQ-5D-3L for health-related quality-oflife assessment in patients undergoing total hip arthroplasty. Clin Orthop Relat Res. 2015;473(11):3383-90. doi: 10.1007/s11999-014-4091-y
11. Stiggelbout AM, Kunneman M, Baas-Thijssen MC, Neijenhuis PA, Loor AK, Jägers S, et al. The EORTC QLQ-CR29 quality of life questionnaire for colorectal cancer: validation of the Dutch version. Qual Life Res. 2016;25(7):1853-8. doi: 10.1007/s11136-015-1210-5
12. Baravelli C, Krishnasamy M, Pezaro C, Schofield P, Lotfi-Jam K, Rogers M, et al. The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up. J Cancer Surviv. 2009;3(2):99-108. doi: 10.1007/s11764-009- 0086-1
13. Polat U, Arpacı A, Demir S, Erdal S, Yalcin S. Evaluation of quality of life and anxiety and depression levels in patients receiving chemotherapy for colorectal cancer: impact of patient education
before treatment initiation. J Gastrointest Oncol. 2014;5(4):270-5. doi: 10.3978/j.issn.2078-6891.2014.034
14. Sanoff HK, Goldberg RM, Pignone MP. A systematic review of the use of quality of life measures in colorectal cancer research with attention to outcomes in elderly patients. Clin Colorectal Cancer. 2007;6(10):700-9. doi: 10.3816/CCC.2007.n.039
15. Hadi M, Gibbons E, Fitzpatrick R. A structured review of patient reported outcome measures for colorectal cancer. Patient-Reported Outcome Measurement Group, Department of Public Health, University of Oxford; 2010. Available from: https://www.ndph.ox.ac.uk/files/research/colorectal-cancer-review-final-2010.pdf.
16. Michalopoulos NV, Theodoropoulos GE, Stamopoulos P, Sergentanis TN, Memos N, Tsamis D, et al. A cost-utility analysis of laparoscopic vs open treatment of colorectal cancer in a public hospital of the Greek National Health System. J BUON. 2013;18(1):86-97.
17. Goudarzi R, Akbari Sari A, Zeraati H, Rashidian A, Mohammad K, Amini S. Valuation of quality weights for EuroQol 5-dimensional health states with the time trade-off method in the capital of Iran. Value Health Reg Issues. 2019;18:170-5. doi: 10.1016/j.vhri.2019.01.007
18. Goudarzi R, Zeraati H, Akbari Sari A, Rashidian A, Mohammad K. Population-based preference weights for the EQ-5D health states using the visual analogue scale (VAS) in Iran. Iran Red Crescent Med J. 2016;18(2):e21584. doi: 10.5812/ircmj.21584
19. Huang W, Yang J, Liu Y, Liu C, Zhang X, Fu W, et al. Assessing healthrelated quality of life of patients with colorectal cancer using EQ- 5D-5L: a cross-sectional study in Heilongjiang of China. BMJ Open.2018;8(12):e022711. doi: 10.1136/bmjopen-2018-022711
20. Bennett L, Zhao Z, Barber B, Zhou X, Peeters M, Zhang J, et al. Healthrelated quality of life in patients with metastatic colorectal cancer treated with panitumumab in first- or second-line treatment. Br J Cancer. 2011;105(10):1495-502. doi: 10.1038/bjc.2011.409
21. Kameyama H, Shimada Y, Yagi R, Yamada S, Hotta S, Tajima Y, et al. [Quality of life of patients after colorectal cancer surgery as assessed using EQ-5D-5L scores]. Gan To Kagaku Ryoho. 2017;44(12):1083-5. [Japanese].
22. Färkkilä N, Sintonen H, Saarto T, Järvinen H, Hänninen J, Taari K, et al. Health-related quality of life in colorectal cancer. Colorectal Dis. 2013;15(5):e215-22. doi: 10.1111/codi.12143
23. Yousefi M, Safari H, Akbari Sari A, Raei B, Ameri H. Assessing the performance of direct and indirect utility eliciting methods in patients with colorectal cancer: EQ-5D-5L versus C-TTO. Health Serv Outcomes Res Methodol. 2019;19(4):259-70. doi: 10.1007/s10742-019- 00204-5
24. Montazeri A, Hole DJ, Milroy R, McEwen J, Gillis CR. Quality of life in lung cancer patients: does socioeconomic status matter? Health Qual Life Outcomes. 2003;1:19. doi: 10.1186/1477-7525-1-19
25. Arraras JI, Suárez J, Arias de la Vega F, Vera R, Asín G, Arrazubi V, et al. The EORTC quality of life questionnaire for patients with colorectal cancer: EORTC QLQ-CR29 validation study for Spanish patients. Clin Transl Oncol. 2011;13(1):50-6. doi: 10.1007/s12094-011-0616-y
26. van der Hout A, Neijenhuijs KI, Jansen F, van Uden-Kraan CF, Aaronson NK, Groenvold M, et al. Measuring health-related quality of life in colorectal cancer patients: systematic review of measurement properties of the EORTC QLQ-CR29. Support Care Cancer. 2019;27(7):2395-412. doi: 10.1007/s00520-019-04764-7
27. Allal AS, Bieri S, Pelloni A, Spataro V, Anchisi S, Ambrosetti P, et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer. 2000;82(6):1131-7. doi: 10.1054/bjoc.1999.1052
28. Akhondi-Meybodi M, Akhondi-Meybodi S, Vakili M, Javaheri Z. Quality of life in patients with colorectal cancer in Iran. Arab J Gastroenterol. 2016;17(3):127-30. doi: 10.1016/j.ajg.2016.06.001
29. Downing A, Morris EJ, Richards M, Corner J, Wright P, Sebag- Montefiore D, et al. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol. 2015;33(6):616-24. doi:10.1200/jco.2014.56.6539
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| Issue | Vol 9 No 4 (2025) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v9i4.20666 | |
| Keywords | ||
| Cancer Colorectal Quality of Life Utility EQ-5D VAS QLQ-CR29 QLQ-C30 | ||
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How to Cite
1.
Yousefi N, Ahmadkhani S, Masbough F, Taheri S, Tavakoli Ardestani M, Zadehsoleyman P, Peiravian F. Quality of Life and Utility Values in Iranian Colorectal Cancer Patients: Using Generic and Specific Instruments. Health Tech Ass Act. 2025;9(4).
