Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study

Wheelwright, Sally; Permyakova, Natalia Vadimovna; Calman, Lynn; Din, Amy; Fenlon, Deborah; Richardson, Alison; Sodergren, Samantha; Smith, Peter; Winter, Jane N.; Foster, Claire

doi:10.1371/journal.pone.0231332

Cited by 22 publications

(46 citation statements)

References 37 publications

(50 reference statements)

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“…Quality of Life (QoL) is complex; it is highly individual, influenced by values, expectations and cultures, manifesting in an individuals' perception of their physical, psychological, social and functional well-being [1,2]. Colorectal cancer (CRC) survivors' QoL may improve over time, and for some, may reach levels that are comparable to normative populations and pre-diagnosis [3][4][5]. Despite this, a substantial proportion of CRC survivors may experience distressing physical, psychological and social effects, persisting for years beyond diagnosis [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer

2021

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Purpose This study aims to explore the prevalence of CRC survivorship issues and their impact on survivors’ quality of life (QoL). Methods This study utilised a mixed methods sequential explanatory design. Adult CRC survivors between 6- and 60-months post-diagnosis (n = 304) were purposively recruited from three hospitals and twenty-one cancer support centres in Ireland. QoL was evaluated using the EuroQol and FACT-C questionnaires and results compared to population norms. 22 survey participants took part in semi-structured interviews exploring the impact of survivorship issues on their daily lives. Results While CRC survivors reported QoL outcomes comparable to or better than normative populations, 54% were dissatisfied with their QoL. The most common survivorship issues reported included negative body image (74%), fatigue (68%), sexual dysfunction (66%) and sleep disturbance (59%). Thematic analysis of the qualitative data illustrated survivors’ attempts to live with the impact of cancer and its treatment (loss, fear, impact) and striving to contextualise, reframe and understand the consequences of cancer and its treatment (control, vigilance, benefit). Within these themes, the cross-domain impact of less prevalent symptoms including bowel dysfunction (28–57%) and peripheral neuropathy (47%) were widely discussed. Conclusions Although cancer survivors report positive QoL outcomes, many experience distressing physical, psychological and social effects. The findings suggest less common and difficult to manage symptoms are the greatest source of distress and unmet need. Support and information must be tailored to address survivors’ individual needs and preferences for support, informed by holistic person-centred assessment.

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Section: Introductionmentioning

confidence: 99%

Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer

2021

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“…With respect to CRC, findings are similar, with HRQoL dropping significantly below the preoperative values one month following the surgery and fatigue being identified as the most troublesome problem 1 and 5 weeks postoperatively [ 6 ]. Regarding long-term recovery, approximately 40% of the patients reported a worse HRQoL 6 months after surgery and about one-third did not return to pre-surgery levels five years after treatment [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, when aiming to improve patient-centered care, where the individual’s perspective is emphasized, it becomes important to find interventions that could enhance HRQoL and reduce fatigue severity following CRC and LC resections [ 4 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…HRQoL is a multidimensional construct encompassing patients’ perceptions of domains such as physical, emotional, social, and cognitive functions [ 35 ], and these perceptions are influenced not only by exercise capacity [ 20 ], but also by clinical factors such as the administration of adjuvant chemotherapy [ 36 , 37 ], specific symptoms such as fatigue and pain [ 38 , 39 , 40 ], the extent of surgical resection [ 12 , 13 , 40 , 41 ], and psychosocial determinants such as anxiety, depression, self-efficacy, and social support [ 14 ]. Furthermore, evidence on the effects of pre- and/or postoperative exercise training on HRQoL has been limited to reviews that only included preoperative assessments [ 28 , 30 ], have not provided information on important health dimensions such as global quality of life and cancer-specific symptoms such as fatigue [ 34 ], and included non-randomized control trials in the quantitative synthesis [ 27 ], which tend to result in larger effect estimates [ 42 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-Analysis

Machado

Pimenta

Oliveiros

et al. 2021

Cancers

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Surgical treatment affects health-related quality of life (HRQoL) and increases fatigue symptoms in patients with lung cancer (LC) and colorectal cancer (CRC). We aimed to systematically review the effect of exercise training on HRQoL and fatigue after LC and CRC surgery. Randomized controlled trials published before 21 March 2021, were searched in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro. Eligible trials compared the effect of exercise interventions initiated preoperatively or in the first 3 months after surgery versus usual care on postoperative HRQoL and fatigue. Standardized mean differences (SMD) were pooled using random-effects models. Twelve studies with a total of 777 patients were included. In LC patients (10 studies, n = 651), exercise training in general led to a moderate improvement in the physical domain of HRQoL (0.68: 95% CI: [0.47; 0.89]) and a small reduction in fatigue levels after surgery (SMD = 0.28: 95% CI: [0.02; 0.53]), while no effects were found in other HRQoL domains. In CRC (two studies, n = 126), exercise training showed no effects on HRQoL and fatigue after surgery. Exercise training is an effective intervention to improve physical function and fatigue after LC surgery. Further studies are necessary to clarify the effects of exercise on HRQoL and fatigue after CRC surgery.

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“…The flow of participants through the study has been reported elsewhere. 54 A total of 872 people provided full consent, with response rates between 88% at baseline and 71% at 60 months. Of the consented participants, 790 had a sexual well-being outcome on at least one time point throughout the study and are included in table 1 (baseline characteristics), and figure 1 (prevalence of poor sexual well-being).…”

Section: Participantsmentioning

confidence: 99%

Prevalence and predictors of poor sexual well-being over 5 years following treatment for colorectal cancer: results from the ColoREctal Wellbeing (CREW) prospective longitudinal study

et al. 2020

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ObjectivesTo describe prevalence and predictors of poor sexual well-being for men and women over 5 years following treatment for colorectal cancer.DesignProspective longitudinal study, from presurgery to 5 years postsurgery, with eight assessment points. Logistic regression models predicted sexual well-being from presurgery to 24 months and 24 months to 60 months; time-adjusted then fully adjusted models were constructed at each stage.SettingTwenty-nine hospitals in the UK.ParticipantsPatients with Dukes’ stage A–C, treated with curative intent, aged ≥18 years and able to complete questionnaires were eligible.Outcome measuresThe dependent variable was the Quality of Life in Adult Cancer Survivors sexual function score. Independent variables included sociodemographic, clinical and psychosocial characteristics.ResultsSeven hundred and ninety participants provided a sexual well-being score for at least one time point. Thirty-seven per cent of men and 14% of women reported poor sexual well-being at 5 years. Baseline predictors for men at 24 months included having a stoma (OR 1.5, 95% CI 1.02 to 2.20) and high levels of depression (OR 2.69/2.01, 95% CI 1.68 to 4.32/1.12 to 3.61); men with high self-efficacy (OR confident 0.33/0.48, 95% CI 0.18 to 0.61/0.24 to 1.00; very confident 0.25/0.42, 95% CI 0.13 to 0.49/0.19 to 0.94) and social support (OR 0.52/0.56, 95% CI 0.33 to 0.81/0.35 to 0.91) were less likely to report poor sexual well-being. Predictors at 60 months included having a stoma (OR 2.30/2.67, 95% CI 1.22 to 4.34/1.11 to 6.40) and high levels of depression (OR 5.61/2.58, 95% CI 2.58 to 12.21/0.81 to 8.25); men with high self-efficacy (very confident 0.14, 95% CI 0.047 to 0.44), full social support (OR 0.26; 95% CI 0.13 to 0.53) and higher quality of life (OR 0.97, 95% CI 0.95 to 0.98) were less likely to report poor sexual well-being. It was not possible to construct models for women due to low numbers reporting poor sexual well-being.ConclusionsSeveral psychosocial variables were identified as predictors of poor sexual well-being among men. Interventions targeting low self-efficacy may be helpful. More research is needed to understand women’s sexual well-being.

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Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study

Cited by 22 publications

References 37 publications

Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer

Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer

Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-Analysis

Prevalence and predictors of poor sexual well-being over 5 years following treatment for colorectal cancer: results from the ColoREctal Wellbeing (CREW) prospective longitudinal study

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