Introduction

Colorectal cancer (CRC) is the second leading cause of cancer death in the US each year. It is estimated that in 2002 there were 148 300 new cases and 56 600 deaths from CRC. Direct evidence from randomized trials and indirect evidence from case-control and cohort studies– suggest that screening affects 5-year survival. Specifically, screening can identify pre-cancerous lesions and prevent development of CRC or identify CRC in earlier stages (I and II) when it can be treated more effectively. The relative 5-year survival rates for early-stage disease (I and II) and advanced disease have been estimated at 65%–90% and 9%, respectively. Because most patients diagnosed with CRC have not undergone screening, most CRCs are diagnosed after local or regional spread, and nearly half of all patients so diagnosed will die from it.

Treatment for CRC is based on the stage and location of disease and includes surgery, chemotherapy, and/or radiation therapy. These modalities may be associated with substantial toxicity, including hair loss, profound nausea and vomiting, and fecal incontinence. Furthermore, therapy for CRC may result in the formation of a permanent or temporary stoma. All of these treatments may have side effects that have an important effect on health-related quality of life (HRQOL).

Treatment for colon cancer includes surgical resection for stage I and II disease, and surgery plus chemotherapy for stage III and selected patients with stage IV disease. Palliative care is provided to patients with unresectable disease.