Patient stratification in medical rehabilitation after colorectal cancer: clinical, functional, and psychosocial profiles

Introduction. After radical treatment for colorectal cancer (CRC), some patients continue to experience functional limitations and psychosocial distress, which necessitates profile-oriented rather than uniform rehabilitation programs. Aim. To identify target rehabilitation groups based on the combination of functional status and psychosocial well-being and to describe recovery trajectories over a 6-month period. Methodology. A single-center observational clinical and functional study was conducted at oncology inpatient facilities in Moscow between 2018 and 2023. From the initial cohort of patients with CRC (n = 623), an analytical sample of 104 patients was formed. Assessments were performed after completion of cancer-specific treatment (T0) and at 6 months (T6). The Karnofsky Performance Status (KPS), the SF-36 questionnaire (Physical Component Summary [PCS] and Mental Component Summary [MCS]), the Hospital Anxiety and Depression Scale (HADS), indicators of social support, and employment status were used. Stratification was performed using threshold values of KPS = 80 and MCS = 50, resulting in four profiles based on the combination of physical and mental health status. Results. Groups I–IV included 29 (27.9%), 25 (24.0%), 27 (26.0%), and 23 (22.1%) patients, respectively. Profiles II and IV were characterized by higher levels of distress (HADS ≥ 11: 44.0 % and 52.2 %) and more frequent deficits in social support. At 6 months, KPS and PCS increased in all profiles; the greatest improvement in PCS was observed in profiles III and IV (ΔPCS +24.4 and +19.7). Improvements in MCS were most pronounced in profiles II and IV (ΔMCS +15.2 and +20.1). Return-to-work rates at 6 months were 75.9 %, 52.0 %, 37.0 %, and 26.1 %, respectively. Scientific novelty. Simple stratification based on KPS and MCS identifies clinically and socially distinct profiles with different recovery trajectories. Practical significance. The proposed model can be applied during the initial rehabilitation consultation to select priority rehabilitation modules and to identify high-risk groups at an early stage.