Introduction

Colorectal cancer currently ranks third in terms of morbidity and second in terms of cancer mortality among men in Poland [1,2]. Colorectal cancer is one of the four most common cancers of the 21st century. Globally, data for 2022 indicate that colorectal cancer is the third most common cancer (9.6%) [3]. Lung cancer accounts for the most cancer-related deaths (18.7%), followed by colon, rectosigmoid, and rectal cancers (9.3%). Incidence and mortality are projected to increase over the next 25 years [4]. Due to the increasing incidence of cancer and evolving treatment methods, the quality of life of oncology patients has become a key area of modern medicine in the context of nursing [5]. Colorectal cancer is one of the most frequently diagnosed malignancies in Poland, and chemotherapy is a key element of treatment – both primary, adjuvant, and palliative. Typically, cytotoxic therapy is administered on a day-patient basis, meaning patients receive treatment in a hospital setting and return home the same day. This method allows patients to continue functioning in their family, social, and professional environments without the risk of isolation and multi-day hospital stays [6]. Nurses, who are the closest contacts with patients most frequently, are responsible not only for the safe administration of cytostatics and monitoring of adverse effects, but also for health education, emotional support, and building a sense of security in the patient [7]. A holistic approach to the patient and providing practical tips on self-care at home promote understanding of the disease, reduce anxiety, and generally improve mental well-being. Understanding the factors that influence the quality of life of patients undergoing daytime chemotherapy is crucial for clinical practice and oncological care planning. It is also an important element of the work of medical staff, whose goal is to ensure that patients receive not only effective anticancer therapy but also the highest possible quality of life during treatment [8].

Objective

The aim of this study was to assess the quality of life of patients undergoing chemotherapy in day hospitalization for colorectal cancer.

Material and Methods

A survey was conducted among patients treated at the Daytime Chemotherapy Ward of the Specialist Hospital in Brzeziny. The study utilized the standardized EORTC QLQ-C30 (Version 3) questionnaire, adapted in Polish, to assess the quality of life of patients undergoing daytime chemotherapy for colorectal cancer. A proprietary sociodemographic data survey was added to the questionnaire. The surveys were completely anonymous. Each participant was informed of the study’s purpose and provided informed consent, with the option to withdraw at any stage without providing a reason. This work was written in accordance with the Declaration of Helsinki. To answer the research questions, statistical analyses were conducted using the IBM SPSS Statistics 29 package. Basic descriptive statistics were analyzed using the Kolmogorov-Smirnov test, the Mann-Whitney U test, the Kruskal-Wallis ANOVA test, and Spearman’s rho correlation analysis. The level of significance was set at p <0.05.

Results

The study involved 200 participants, of whom the vast majority 71% (N=142) were men, and the remaining 29% (N=58) were women. Patients were categorized into six age groups: 18-25 years (N=0), 26-35 years 1% (N=2), 36-45 years 9% (N=18), 46-55 years 28% (N=56), 56-65 years 35% (N=70), and over 65 years 27% (N=54). The vast majority of respondents were urban residents 74% (N=148), while only one in four respondents 26% (N=152) indicated rural areas as their place of residence. Patients were also asked about their education. Respondents could choose from several available options: primary education 25% (N=50), vocational education 34% (N=68), then secondary education 25% (N=50) and higher education 16% (N=32). Respondents were also asked about their marital status, revealing that 16% (N=32) of the survey participants declared they were single or in informal relationships. The vast majority of respondents declared they were married 53% (N=106). Divorced individuals constituted 11% (N=22) of the sample, and 21% (N=42) declared they were widows/widowers. Additionally, the vast majority of patients 70% (N=140) had children. The question regarding social status revealed that the largest group 49% (N=98) were retired or receiving a disability pension. Only 31% (N=62) were professionally active. Respondents were also asked about their financial situation. Half of the respondents (N=100) selected the lowest income threshold of no more than PLN 4.806 per month. Earnings between PLN 4.807 and PLN 6.500 per month were selected by 33% (N=66) of respondents. Monthly income in the range of PLN 6.501–PLN 8.500 was selected by 14% (N=28) of respondents. The highest monthly income range, above PLN 8.501, was declared by only 3% of patients (N=6). To answer the research questions, a statistical analysis was performed to determine the relationship between respondents’ gender and their quality of life. The analysis revealed statistically significant differences between groups only in terms of dyspnea severity. It turned out that dyspnea severity in the women group was higher compared to the men group. The effect size coefficient indicates that these differences were weak. The remaining differences between groups were statistically insignificant. Patients’ quality of life levels were then compared based on marital status. A Kruskal-Wallis ANOVA test revealed statistically significant differences between groups only for dyspnea severity. The effect size coefficient indicated that these differences were weak. Post-hoc tests (Dunn-Bonferroni pairwise comparison tests) were performed to determine which results were statistically significantly different. However, this analysis did not reveal statistically significant differences between groups. Therefore, uncorrected difference tests were performed, which showed that individuals in informal relationships had lower dyspnea levels compared to widows/widowers (p = 0.011) and single individuals (p = 0.048). Furthermore, married individuals had lower dyspnea levels compared to widows/widowers (p = 0.023). The remaining pairwise comparisons were statistically insignificant.

The next step was to compare patients’ quality of life levels based on their professional status. For this purpose, the Kruskal-Wallis ANOVA test was repeated. The analysis revealed statistically significant differences between groups for physical and cognitive functioning, as well as for the severity of fatigue, loss of appetite, constipation, and diarrhea. The effect size coefficient values indicate that these differences were moderately strong for cognitive functioning and weak for the remaining five conditions. Post-hoc tests (Dunn-Bonferroni pairwise comparison tests) were performed to determine which results differed statistically significantly.

In the case of physical functioning, higher levels were observed in the employed group compared to retirees/pensioners (p = 0.004). In the case of cognitive functioning, higher levels were observed in employed individuals compared to retirees/pensioners (p = 0.001) and individuals identifying their status as „other” (p = 0.049). In the case of fatigue, significantly higher levels were observed in retirees/ pensioners compared to employed individuals (p = 0.002). The same was true for constipation (p = 0.017). In the case of loss of appetite, more severe symptoms occurred in individuals identifying their situation as „other” compared to employed individuals (p = 0.002). Regarding diarrhea, differences at the statistical trend level (p = 0.079) were noted between the unemployed and retirees/pensioners, with retirees/pensioners experiencing higher rates of this type of symptom. Other pairwise comparisons were statistically insignificant.

The study also compared respondents’ quality of life based on whether they had children or not, using the Mann-Whitney U test. The analysis revealed no statistically significant differences between groups. This indicates that the level of quality of life was similar regardless of whether they had children. The relationship between respondents’ age, place of residence, education, and income and their quality of life was also statistically analyzed. Spearman’s rho correlation analysis was performed (Table 1).

The analysis revealed several statistically significant correlations. Age was statistically significantly and negatively correlated with physical functioning and positively correlated with fatigue and constipation. This indicates that physical functioning decreased with age, while fatigue and constipation increased. All of these correlations were weak. Furthermore, the size of the place of residence correlated negatively with the severity of diarrhea and positively with financial difficulties, indicating that diarrhea severity decreased and financial difficulties increased with increasing the size of the place of residence. Both of these correlations were weak.

Education level, in turn, was weakly and positively associated with physical functioning and negatively with nausea, vomiting, and diarrhea. This means that as education level increased, physical functioning increased and the severity of nausea, vomiting, and diarrhea decreased. The remaining correlations were statistically insignificant, including all correlations related to income.

Discussion

Cancer is a growing problem in today’s society, and therefore the issue of quality of life for patients undergoing chemotherapy should be further explored. Cytostatic drugs have many side effects, which impact the well-being, physical functioning, and social and family aspects of cancer patients.

The study used the EORTC QLQ-C30 questionnaire (version 3) in its Polish translation. The study involved 200 patients receiving cytostatic drug infusions for colorectal cancer diagnosed at the Day Chemotherapy Ward at the Specialist Hospital in Brzeziny. Statistical analysis demonstrated that younger individuals, those who were professionally active, and those with higher education demonstrated a higher level of quality of life. The study also demonstrated that having children and income did not differentiate quality of life. Regarding the occurrence of dyspnea, women and single individuals were more likely to experience it during treatment. Individuals living in rural areas or smaller towns were at greater risk of diarrhea.

More comprehensive data on the quality of life of patients undergoing chemotherapy could be obtained by expanding the study group to include individuals receiving 24-hour infusions of cytostatic drugs due to differences in hospitalization methods. This would certainly reveal a different type of patient problems based on changes in circadian rhythms and family, social, and professional isolation. The study could also be expanded to include the QLQ-HDC29 questionnaire, designed for patients undergoing high-dose chemotherapy, or the QLQ-CR29 module, which typically addresses patients with colorectal cancer. This would allow for the examination of further aspects of quality of life needed to further explore the patients’ problems. An interesting avenue of research into the quality of life of colorectal cancer patients would be to compare the group of individuals with a colostomy with those without. The quality of life of patients undergoing chemotherapy can vary depending on the treatment cycle, so exploring this aspect could yield interesting results.

In a study conducted by Fatih Teker, titled „Quality of life in colorectal cancer patients during chemotherapy in the era of monoclonal antibody therapies,” the EORTC QLQ-C30 questionnaire was used, as in the author’s study. The author examined 101 patients with colorectal cancer. The survey included individuals who regularly received cytotoxic drug infusions. Comparing the two studies, it was noted that the hypothesis indicating a correlation between age and quality of life was confirmed. In both cases, it was shown that older individuals have a lower quality of life. Furthermore, both studies did not show a significant statistical difference between quality of life and gender. Another common element of the studies was the demonstration that education differentiates the quality of life of patients undergoing chemotherapy for colorectal cancer. However, the studies also revealed a certain difference. Fatih Teker’s study demonstrated that income differentiates quality of life, but the author’s study, which surveyed almost twice as many patients, demonstrated that income and quality of life do not significantly correlate. It is worth emphasizing that the author’s study was conducted in Poland, and the study’s „Quality of life in colorectal cancer patients during chemotherapy in the era of monoclonal antibody therapies” participants lived in Turkey, so the differences in the results may be due to cultural and socioeconomic differences in the two countries [9].

Another study that also used the EORTC QLQ-C30 questionnaire to examine the quality of life of patients receiving cytotoxic infusion therapy for gastrointestinal cancer, including colorectal cancer, was a study by Polish author Olgia Kulpecka, titled „Quality of Life in Patients with Gastrointestinal Cancer.” Additional tools used in the aforementioned study were the Rotterdam Symptom Checklist (RSCL) and the Acceptance of Illness Scale (AIS). Similar to the original study, the study examined patients from a single department, in this case 100 patients from the Department of General and Oncological Surgery. The results show that patients’ quality of life differs depending on their age, education, marital status, and professional situation. Similar conclusions were obtained in the original study, despite examining twice as many patients from a department with a different focus. The difference in the results of the compared studies, similar to the study mentioned in the previous paragraph, was the importance of income. The study by Olgia Kulpecka demonstrates that economic situation influences the quality of life of cancer patients, but the author’s study shows that patients’ income does not affect their physical or mental well-being [10].

A German study by Beate Mayrbäurl, titled „Quality of life across chemotherapy lines in patients with advanced colorectal cancer: a prospective single-center observational study,” analyzed the responses of 100 patients diagnosed with colorectal cancer. However, unlike her own study, the author statistically analyzed the relationship between subsequent chemotherapy cycles and patients’ quality of life, while her own study compared the relationship between demographic characteristics and quality of life. Beate Mayrbäurl demonstrated that subsequent chemotherapy cycles negatively impacted the quality of life of the study participants. A small number of patients undergoing palliative chemotherapy achieved a therapeutic effect and the intended improvement in quality of life. However, most patients experienced a decline in quality of life during subsequent chemotherapy cycles due to increasing shortness of breath, increased fatigue, decreased appetite, increased pain, and decreased physical performance. The study covered a very interesting aspect of cytostatic treatment, and extending it to include sociodemographic aspects would certainly yield interesting results [11].

In the study entitled „Long-term quality of life in patients with rectal cancer treated with preoperative (chemo)-radiotherapy within a randomized trial” by M Tiv, the quality of life of patients with rectal cancer was assessed. The EORTC-QLQ-C30 questionnaire and the EORTC QLQ-CR38 module were used to survey 207 French patients. The results showed that diarrhea was the most common symptom in cancer patients. The study expanded on demographic aspects and demonstrated that people living in smaller towns and rural areas were more susceptible to diarrhea [12].

Due to the growing incidence of colorectal cancer and the increasingly frequent use of chemotherapy in oncology patients, there is increasing interest in the quality of life of patients undergoing systemic treatment. For this reason, there is a growing number of studies assessing the mental, physical, and social functioning of such patients. The results of this study and those of other authors whose work is presented in the discussion often overlap. Age has been shown to be a factor in differentiating quality of life. Older people are often at risk of a lower quality of life than younger individuals. Furthermore, numerous studies have demonstrated that higher education predisposes to a higher quality of life. An aspect worth exploring in the context of oncology patients’ quality of life is the relationship between economic conditions and quality of life. The compared studies have shown differences in this respect and require additional research. Further research in this area will allow for a greater understanding of oncology patients and increase nursing staff’s awareness of how to effectively implement a care plan.

Conclusions