Introduction Surgery is perceived as curative for ulcerative colitis but may not restore full health. Health-related QoL in ulcerative colitis is often measured using disease-specific instruments (eg, the Inflammatory Bowel Disease Questionnaire, IBD-Q) and less commonly using generic instruments (eg, EuroQol EQ5D). The generic approach measures QoL on a common “utility” scale ranging from 0 (dead) to 1 (full health). This allows for more useful comparison of impaired QoL relative to a healthy population or to individuals with other diseases. To examine the impact on surgery on patients' QoL, this study captured data on both disease-specific and generic QoL on patients post-colectomy where published data are limited, as well as patients without colectomy. Utility scores of patients across the full spectrum of disease severity in UC were also evaluated.
Methods 230 UC patients (including 30 post-surgery patients) were recruited along with 100 age and gender matched controls. Participants completed an online survey which comprised the Simple Clinical Colitis Activity Index, EuroQol EQ-5D and the IBD-Q. Basic sociodemographic and clinical data were also collected. Disease severity was categorised using established cut-off values for the IBD-Q. EQ-5D utility scores were compared across disease severity, among post-surgery patients vs non-surgery patients, and among post-surgery patient vs controls.
Results EQ-5D utility scores demonstrate a clear relationship with disease severity as categorised by the IBDQ (ANOVA F(2,329)=5.544, p=0.004) with post-surgery patients reporting poorer QoL than non-surgery patients (p=0.016) or controls (p=0.03). Those with the most severe disease report values comparable to colorectal cancer (Tappenden, 2007).
Conclusion Global QoL (utilities) among post-surgical patients was significantly poorer than both age and gender matched population controls and patients in remission or with mildly active colitis, suggesting that identification of effective new drug therapies for severe disease remains the goal for optimising long term QoL.
Competing interests P Swinburn Grant/Research Support from: Abbott Laboratories Ltd, H Elwick Grant/Research Support from: Abbott Laboratories Ltd, K Bean: None Declared, A Curry: None declared, S Patel: None declared, K Bodger Consultant for: Abbott Laboratories Ltd, A Lloyd Grant/Research Support from: Abbott Laboratories Ltd.
Reference 1. Tappenden P, Chilcott J, Eggington S, et al. Option appraisal of population-based colorectal cancer screening programmes in England. Gut 2007;56:677–84.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.