Claire J Han1, Biljana Gigic2, Martin Schneider3, Yakup Kulu3, Anita R Peoples4,5, Jennifer Ose4,5, Torsten Kölsch3, Paul B Jacobsen6, Graham A Colditz7, Jane C Figueiredo8, William M Grady1,9,10, Christopher I Li1, David Shibata11, Erin M Siegel12, Adetunji T Toriola7, Alexis B Ulrich3, Karen L Syrjala13,14, Cornelia M Ulrich15,16. 1. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 2. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany. biljana.gigic@med.uni-heidelberg.de. 3. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany. 4. Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA. 5. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA. 6. Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA. 7. Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA. 8. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, California, LA, USA. 9. Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA. 10. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 11. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 12. Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA. 13. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. ksyrjala@fredhutch.org. 14. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. ksyrjala@fredhutch.org. 15. Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA. neli.ulrich@hci.utah.edu. 16. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA. neli.ulrich@hci.utah.edu.
Abstract
PURPOSES: Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (CRC) survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery. METHODS: We included 212 CRC patients with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support, and health-related quality of life (HrQOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress. RESULTS: Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months. CONCLUSION: Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies. IMPLICATIONS FOR CANCER SURVIVORS: Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.
PURPOSES: Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (CRC) survivors. We examined changes over time and risk factors for distress in CRCpatients over the first year after surgery. METHODS: We included 212 CRCpatients with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support, and health-related quality of life (HrQOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress. RESULTS: Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months. CONCLUSION:Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies. IMPLICATIONS FOR CANCER SURVIVORS: Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.
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