Predictors of health-related quality of life of colorectal cancer survivors: a systematic literature review

Abstract

Background. The population of colorectal cancer survivors is growing. A colorectal cancer diagnosis and its treatment can bring along adverse long- and short term effects that influence the health-related quality of life (HRQOL) of survivors. In order to prevent these adverse effects and deteriorating HRQOL, the right care needs to be offered to the right individual at the right time. For early identification of survivors at risk for deteriorating HRQOL, it is important to know which factors are predictive of HRQOL. Therefore, the aim of this study was to identify possible predictors of HRQOL of colorectal cancer survivors. Methods. A systematic literature review was conducted using the search engines MEDLINE/PubMed, EMBASE, and Google Scholar to find available literature on the relation between lifestyle, clinical, and socio-demographic variables and HRQOL in colorectal cancer survivors. Additional articles were found by citation tracking. Results. In total, 29 studies met the inclusion criteria. The most relevant lifestyle predictors of lower HRQOL that were identified were low levels of physical activity and higher BMI. Higher stage, presence of a stoma, having comorbidities, having fecal incontinence, and having rectal cancer were the most relevant clinical predictors of lower HRQOL. The most relevant socio-demographic predictors of lower HRQOL were low income, no private health insurance, negative cancer threat appraisal, low levels of social support, and pessimism. Discussion and conclusion. Evidence suggests that the predictors, found in the studies included in this systematic review, could help in identifying colorectal cancer survivors at increased risk of deteriorating HRQOL. For some predictors the evidence appeared inconclusive or contradictory, and therefore, more research is needed with special focus on these associations. Especially lifestyle predictors are an important area for future research, since these factors are mostly related to modifiable behavior and changing them thus could help in improving HRQOL. The predictors identified in this systematic review can be used for developing, validating, and testing prediction models for HRQOL of colorectal cancer survivors.