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Adjudication committee
- First opponent: Professor of Surgery Jim Khan, Portsmouth Hospitals, UK
- Second opponent: Professor Helle Pappot, University of Copenhagen, Denmark
- Third member and chair of the evaluation committee: Professor Kjersti Flatmark, University of Oslo
Chair of the Defence
Professor Per Henrik Randsborg, University of Oslo
Principal Supervisor
Associate Professor Johannes Kurt Schultz, University of Oslo
Summary
Adjuvant chemotherapy for colon cancer and neoadjuvant radiotherapy for locally advanced rectal cancer improves survival but might affect QoL.
One of the aims was to compare recurrence rates and survival in stage III colon cancer patients treated with or without adjuvant chemotherapy and to assess the impact of extensive mesenterectomy, lymph node stage, and vascular invasion on the outcome.
The LaTE project aimed to investigate long-term QoL after curative treatment of colon and rectal cancer and to explore the impact of chemotherapy for colon cancer and the impact of radiotherapy for rectal cancer patients on both general and disease-specific QoL.
In a first retrospective cohort of 216 patients operated for stage III colon cancer at Akershus University Hospital between 2005-2015, survival of patients who had or had not received adjuvant chemotherapy was compared. To balance the two groups, adjustments for age and comorbidity were made.
The LaTE study, invited all stage I-III colon (30.09.2007-01.10.2019) and rectal cancer (30.09.2007-01.10.2020) patients operated in Norway before the age of 75 years, identified through the Cancer Registry of Norway by ICD-10 codes to answer an electronic questionnaire. Balanced groups were achieved by inverse probability weights based on a multiple logistic regression model with pre-chosen confounders. Gastrointestinal Quality of Life Index was the primary outcome measure.
The findings imply that subgroups of stage III colon cancer patients have a good prognosis without adjuvant chemotherapy. The LaTE study shows that both adjuvant chemotherapy and neoadjuvant radiotherapy are associated with significantly reduced long-term QoL after colorectal cancer.
For many colorectal cancer patients, the survival benefit from these modalities is very low and must be weighed against the loss in QoL. Shared decision-making between the patient and the physician is encouraged especially when the benefit of (neo)adjuvant treatment is uncertain.
Additional information
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