Abstract
BACKGROUND: Colon cancer treatment has evolved significantly through earlier detection, less invasive surgery, optimised perioperative care and shortening chemotherapy duration from 6 to 3 months in 2017. These multidisciplinary improvements may contribute to better health-related quality of life (HRQoL), yet population-based data on their real-world impact on HRQoL and functional outcomes remain limited. METHODS: This cross-sectional study used data from the Dutch Prospective PLCRC cohort, including patients with stage I-III colon cancer who completed patient-reported outcome measures (PROMs) at 12 or 24 months post-diagnosis. HRQoL was assessed using EORTC QLQ-C30, QLQ-CR29 and the LARS score. Patients diagnosed in 2014-2016 (Group A) were compared with those from 2017 to 2019 (Group B). Propensity score matching (1:4) was applied for age, sex and tumour stage. Multivariable analyses were adjusted accordingly, minimally important differences (MIDs) guided clinical relevance and the values were compared with Dutch population values. RESULTS: A total of 1,749 patients were included in the analysis. Following propensity score matching, no clinically meaningful differences in the EORTC QLQ-C30 functional or symptom scales were observed at 12 months post-diagnosis between patients diagnosed in 2014-2016 (Group A) and those diagnosed in 2017-2019 (Group B). At 24 months, Group B demonstrated a modestly better QLQ-C30 summary score (mean difference + 1.3; 95% CI: 0.6-1.9), as well as statistically significant but clinically negligible improvements in role and cognitive functioning, and lower reported levels of fatigue, appetite loss and financial difficulties. Functional outcomes assessed via QLQ-CR29 and LARS score were comparable between groups, with a non-significant trend towards fewer major LARS cases in Group B at 24 months (14.6% vs. 19.9%; p = 0.068). CONCLUSION: Dutch colon cancer patients reported good HRQoL and functional outcomes up to 2 years post-diagnosis, with no clinically relevant differences between 2014-2016 and 2017-2019. These findings suggest a consistently high standard of care nationwide. Ongoing monitoring remains essential to address individual symptom burden and evaluate the impact of evolving treatment strategies.