PURPOSE: This study investigated perioperative changes in quality of life (QOL) and the impact of preoperative QOL on the time to return to work (RTW) after surgery in patients with colorectal cancer. METHODS: Patients with clinical stage I-III colorectal cancer who were employed at the diagnosis and scheduled for curative surgery between 2019 and 2020 were prospectively enrolled at 7 hospitals in Japan. The patients' EORTC-QLQ-C30 scores and employment status were collected before and at 6 and 12 months after surgery and compared using a paired t test. The Kaplan-Meier method and multivariable Cox regression model were applied to examine the impact of preoperative QOL on the time to RTW. RESULTS: A total of 127 patients were analyzed. Regarding financial difficulties, 48% of patients had low preoperative scores, which significantly improved at 6 (preoperatively: 21.7 vs 6 months: 11.3
p <
0.001) and 12 months (6 months: 11.3
12 months: 7.9
p = 0.016) postoperatively. RTW was significantly delayed in patients with a low preoperative cognitive function (p = 0.039) and severe fatigue (p = 0.024). The adjusted hazard ratio was 0.73 for a low cognitive function and 0.62 for strong fatigue. CONCLUSION: Working patients with colorectal cancer experienced severe financial difficulties preoperatively, which decreased postoperatively. The preoperative cognitive function and fatigue affected the postoperative time to RTW.