Functional and Participation Outcomes of Colorectal Cancer With Peritoneal Metastasis and Pseudomyxoma Peritonei Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC): A Cross-Sectional Survivorship Study.

Abstract

Objective: To assess the longer-term functional and participation outcomes in survivors with colorectal cancer with peritoneal metastasis (CRCPM) and pseudomyxoma peritonei (PMP) following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy intervention (CRS-HIPEC).

Method: Adult CRCPM/PMP in the community following CRS-HIPEC completed validated questionnaires. Descriptive statistics summarized participant characteristics, while multivariate linear regression (p < 0.05) identified predictors of functional and psychosocial outcomes, and a binary logistic regression model identified factors associated with poorer quality of life (QoL).

Results: Of 100 participants (59 CRCPM, 41 PMP), mean age: 59.1±12.2 years, 52% male, mean time since CRS-HIPEC: 2.4±2.5 years, overall, many reported persistent issues: fatigue (86%), fear of recurrence (79%), pain (58%), insomnia (52%) and bowel dysfunction (32%). Despite this, overall functional recovery was good (Clinical Functioning Information Tool median [IQR]: 28 [19.3-52.5]), with low perceived psychological impact (Depression Anxiety Stress Scale total: 6 [0-17.5]) and relatively preserved QoL (European Quality of Life VAS score: 78 [60-85]). The CRC-specific QoL was poorer (Functional Assessment of Cancer Therapy-Colorectal: 106 [91-115.6]) and community integration was modest (Community Integration Questionnaire: 20.3 [16-24]). The PMP cohort reported a lower persistent symptom burden and a more favourable QoL. Overall, older age and unemployment were strong predictors of poorer outcomes. Employment status and symptom burden independently predicted longer-term functional and participation outcomes in CRCPM survivorship, with female gender, stoma, and radiotherapy as additional influencing factors.

Conclusion: Overall, despite participants being functionally well, many experience substantial longer-term symptom burden and participation-related challenges (especially in CRCPM) following CRS-HIPEC, reflecting significant unmet rehabilitation needs. Systematic integration of rehabilitation across the CRC care continuum is therefore essential to optimise longer-term functional and participation outcomes in this population.