Changes in quality of life in colorectal cancer screening: A multicentre trial in populations in China

Abstract

Objective

Evidence is scarce about whether colorectal cancer screening can affect the quality of life of participants, particularly in terms of novel screening strategies in Eastern populations.

Methods

From 2018 to 2021, the TARGET-C trial randomly allocated 19,373 participants to one of three screening strategies: (A) one-time colonoscopy; (B) annual faecal immunochemical test with positives referred for colonoscopy; and (C) annual risk-adapted screening with low-risk participants referred for faecal immunochemical test and high-risk participants referred for colonoscopy. Two rounds of follow-up after baseline screening were conducted over the 3-year period. Based on the TARGET-C, a EuroQol five-dimensional questionnaire-based quality of life survey was administrated to the participants, and utility scores and related changes were used as the main outcomes.

Results

Taking by-strategy utility scores for participants before being screened at baseline as the comparators (n = 2921), the changes in utility scores after baseline screening were −0.008 (P < 0.050) for strategy A, 0.006 (P < 0.050) for strategy B and 0.000 (P > 0.050) for strategy C, and the overall difference in quality of life changes among the three strategies was significant (P < 0.001). Taking the same comparators as above, the changes in utility scores for participants in the second round of follow-up (n = 9201) were 0.011 (P < 0.050), 0.011 (P < 0.050) and 0.005 (P < 0.050), respectively, and the overall difference was neither clinically meaningful nor statistically significant (P = 0.113).

Conclusions

None of the three colorectal cancer screening strategies had a major effect on the participants’ quality of life over the 3 years. Within one round of screening, incorporating risk-adapted screening and/or faecal immunochemical test might offset the quality of life impact from colonoscopy screening.