Colorectal Cancer Survivors Research Articles

Body compassion in the context of cancer: A novel exploration among colorectal cancer survivors.

Colorectal cancer (CRC) significantly impacts patients' physical well-being, often leading to distress and diminished quality of life (QOL). Body compassion (i.e., viewing one's body with kindness, mindfulness, and common humanity) could be relevant to psychosocial adjustment to cancer but has yet to be explored within the cancer context. This study aimed to introduce a novel measure of body compassion and examine its associations with demographic, medical, and psychosocial variables among CRC patients. Fifty-four patients with CRC completed a one-time survey assessing demographics, body compassion [Body Compassion Scale (BCS)], distress (HADS), loneliness (ULS-8), resilience (CD-RISC-10), and QOL (FACT-C). Descriptive and internal consistency reliability statistics characterized the BCS. Relationships with demographic, medical, and psychosocial variables were examined using correlations, t-tests, and hierarchical linear regressions. The BCS showed excellent internal consistency reliability (α = .94) (M = 82.1, SD = 19.0). Patients with metastatic CRC (vs. non-metastatic; BCS total MDiff = 12.2, CI95% [0.4, 24.0]; defusion MDiff = 5.0, CI95% [-0.4, 10.3]; common humanity MDiff = 5.7, CI95% [-0.5, 12.0]) and those in treatment (vs. not; BCS total MDiff = 14.1, CI95% [0.5, 27.6]; defusion MDiff = 6.2, CI95% [0.1, 12.3]) reported lower body compassion. Higher total body compassion was associated with lower distress (B = -0.235, CI95% [-0.32, -0.15]) and loneliness (B = -0.104, CI95% [-0.18, -0.03]), and higher resilience (B = 0.215, CI95% [0.12, 0.31]) and quality of life (B = 0.811, CI95% [0.50, 1.12]). Among the BCS subscales, defusion demonstrated the most robust associations with medical (time since diagnosis, current ostomy, current treatment, metastatic disease) and psychosocial variables [distress (β = -.334), loneliness (β = -.444), resilience (β = .585)]; acceptance showed strong associations with distress (β = -.310) and quality of life (β = .384). Body compassion appears relevant to psychosocial adjustment to CRC treatment and survivorship and may be particularly germane for patients with high disease burden. Further research on body compassion in cancer is warranted, such as longitudinal and multi-method designs across cancer populations.

Associations Between Dietary Patterns and Quality of Life in a Longitudinal Cohort of Colorectal Cancer Survivors.

To characterize dietary patterns and examine associations with cross-sectional and longitudinal changes in quality of life (QOL) over approximately one year after colorectal cancer (CRC) diagnosis. The ColoCare Study is an international, multi-center, prospective cohort study of newly diagnosed CRC survivors of any stage. A subset of participants with CRC in the United States completed patient-reported outcome measures at 6- and 12-months post-enrollment, including the Food Frequency Questionnaire (FFQ) and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Dietary patterns at 6 months (around the time of treatment completion) were identified using Principal Component Analysis (PCA) with varimax rotation. Adherence scores were calculated for participants within each dietary pattern, with higher scores indicating higher adherence. Mixed models were used to examine the effect of each dietary pattern on changes in QOL at 6- and 12-month follow-ups, controlling for cancer stage, biological sex, body mass index (BMI), smoking status, and age. Participants (N = 174) were, on average, 56 ± 14 years old and were mostly female (51.5%), stage III or IV (51.7%), never smokers (60.2%), non-Hispanic (97.1%), and White (83.3%) with a BMI of 27.9 ± 6.1 kg/m2. PCA revealed two emerging dietary patterns: "Western diet", characterized by processed meats, refined grains, and sugars, and "Prudent diet" characterized by lean proteins, fruits, and vegetables. Higher adherence to a Western diet was associated with worse social functioning at 6-month follow-up (FE = -12.6, p = 0.010). Loss of appetite from 6 to 12 months was associated with higher adherence to both the Western and Prudent dietary patterns (FE = 1.5, p = 0.044; FE = 1.3, p = 0.046, respectively). Neither dietary pattern was associated with global QOL score at 6- or 12-month follow-up (p's > 0.05). Among CRC survivors in the United States, the Western diet was concurrently associated with worse social functioning. Loss of appetite was reported by CRC survivors following both dietary patterns, suggesting that loss of appetite may be a global experience for CRC survivors during this timeframe. Further research is needed to understand specific social challenges experienced by CRC survivors and develop supportive care interventions to address appetite and nutritional concerns.

The lived experiences and unmet needs of prostate and colorectal male cancer survivors in rural Virginia: A qualitative study.

The goal of this study was to gain an in-depth understandingabout the lived experiences and unmet needs of rural male cancer survivors. Focus groups were conducted with male survivors of prostate (N=14) and colorectal cancers (N=10), from rural Virginia. Demographic and clinical information were collected via surveys. A focus group guide contained questions about needs, lifestyles, and social networks of rural male cancer survivors. Focus group data were analyzed using Braun and Clarke's thematic analysis guidelines. Four primary themes emerged from the data: (1) contending with health problems, (2) quality and availability of health care services, (3) coping strategies to navigate survivorship, and (4) advocating for cancer prevention. Survivors had to contend with physical and emotional problems, which were a result of their cancer treatments. Due to their rural location, survivors had difficulty accessing health care services and had a limited understanding of the cancer-related resources that existed in their counties. Family support, religiosity and acceptance served as important coping strategies. Many felt strongly about promoting cancer-related education and awareness. The lived experiences and unmet needs of rural male cancer survivors comprised several challenges, which included health problems and lack of health care access. Coping mechanisms comprised reliance on familial bonds and religion. Findings from this study reveal the need for tailored interventions to target the health care, psychosocial, and informational needs of rural male cancer survivors.

Cancer survivor preferences on the timing and content of interventions to mitigate financial toxicity associated with cancer treatment.

Despite growing research on financial toxicity among cancer survivors, large gaps remain in understanding how to intervene to minimize financial toxicity. Uptake and efficacy of interventions mitigating cancer financial toxicity, though promising, remain limited and inconsistent. To date, survivor preferences for financial toxicity interventions are underexplored. This study aimed to evaluate survivor preferences for timing and content of a survivor-facing intervention to address financial toxicity. Adult survivors (N = 105) of colorectal cancer (N = 55) or Non-Hodgkin Lymphoma (N = 50) from three tertiary care centers self-reported demographic and clinical characteristics, comorbidities, mental health, financial impact of cancer (Comprehensive Score for Financial Toxicity scale), and preferences for intervention timing and content. Chi-square tests examined associations between intervention timing and content preferences with financial toxicity score. ANOVAs and correlation analyses described associations between the number of intervention components survivors endorsed and survivors' characteristics. Regarding intervention timing, 79% of survivors favored intervention before treatment. The most frequently endorsed content was understanding out-of-pocket costs and insurance (48.6%) and applying for aid (39%). Survivors experiencing higher financial toxicity reported greater interest in all intervention components. Survivors with colorectal cancer (p = .018), < 65years (p = .019), higher financial toxicity (p < .001), greater life-altering (p < .001) and care-altering (p = .014) coping behaviors, and poorer mental health (p = .008) endorsed more intervention components. Actionable insights to improve financial toxicity interventions may be to offer assistance earlier than currently provided(i.e. before treatment) and to include certain topics currently rarely offered (e.g., stress management, budget development support) in line with survivors' preferences.

A systematic review of the follow-up priorities of colorectal cancer survivors

Background: Colorectal cancer (CRC) is the third most common cancer worldwide. Survival has improved over recent years and CRC survivors are a growing group of patients living with and beyond a diagnosis of cancer. Aims: This study aims to explore the follow-up priorities of CRC survivors and to determine if all those affected by CRC have been given a voice through current literature. Method: A systematic integrative literature review was performed across three databases— CINAHL, Medline and PsycINFO—from 2014 to 2024. This yielded 12 papers for inclusion. Thematic analysis was undertaken with themes from each paper identified and coded. Common themes were grouped and renamed. Results: Six themes emerged: understanding and managing long-term effects of treatment; the importance of good information; delivery of follow-up care; ease of access to care and investigations; fear of recurrence; and the changing impact of cancer treatment. Ethnic minority groups and non-native language speakers appeared underrepresented in the included studies; only 50% of included studies made ethnicity data available. It was not possible to determine whether other groups had been included, such as members of the LGBTQ+ community, those with learning disabilities or those with mental health conditions. Conclusions: Survivors of CRC require access to information and support to manage the effects of treatment in the short, medium and long term to optimise their quality of life post treatment. The approach to this should be shaped to the preference and need of the individual. Colorectal cancer Clinical Nurse Specialists need to tailor practice and use their expertise to meet the needs of CRC survivors during follow-up care processes. More evidence is needed on the follow-up priorities of CRC survivors from underrepresented groups to ensure that their voices are heard and their needs addressed.

Effects of a culturally tailored patient navigation program on unmet supportive care needs in Hispanic/Latino cancer survivors: A randomized controlled trial.

Patient navigation (PN) is a promising yet underused approach to address Hispanic/Latino (H/L) cancer survivors' unmet supportive care needs. The authors conducted a randomized trial to evaluate the effect of a culturally tailored PN program with the LIVESTRONG Foundation's Cancer Navigation Services (PN-LCNS) on reducing unmet needs in H/L survivors. From 2012 to 2015 at two US sites, 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer were randomized to a PN-LCNS program or to standard PN. Participants assigned to the PN-LCNS program received 3-month PN services; access to phone-based, bilingual, one-on-one support; and additional resources (i.e., guidebook, health journal, and care plan). Participants completed assessments at baseline and at 3, 9, and 15 months post-baseline. The Supportive Care Needs Survey was used to assess unmet needs across five domains: psychological, health system and information, physical and daily living, patient care and support, and sexuality. Intervention effects were tested by using separate multilevel growth models for women and men. Women randomized to the PN-LCNS program, relative to those who received standard PN, had a statistically significant reduction in unmet needs (i.e., overall and for the health systems and information, physical and daily living, and patient care and support domains). Among men, younger age was associated with greater unmet needs at baseline. Prostate cancer survivors reported greater unmet sexual health needs compared with colorectal cancer survivors. There was no significant change in unmet needs among H/L men. A culturally tailored PN program can reduce unmet supportive care needs among H/L women cancer survivors. However, interventions specifically targeting unmet needs in H/L men and sexual health are still necessary (ClinicalTrials.gov identifier NCT02275754). Hispanic/Latino (H/L) cancer survivors often report concerns or needs that are not adequately addressed by the health care team, which could be related to psychological, health system and information, patient care and support, physical and daily living, and sexuality issues. In this randomized controlled trial of 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer, women assigned to a culturally tailored patient navigation program experienced a reduction in unmet needs compared with those who received standard patient navigation. H/L men did not experience a change in unmet needs.

Living with a permanent ostomy: a descriptive phenomenological study on postsurgical experiences in patients with colorectal cancer

ObjectivesTo explore the postsurgery lived experiences of patients with colorectal cancer with a permanent ostomy for informing initiatives to improve patient care and future quantitative research.DesignA descriptive qualitative phenomenological study.SettingWe...

Cardiovascular disease burden and risk factor management in cancer survivors: insights from a large-scale East London cohort

Abstract Introduction Improvements in cancer survival have led to an urgent need to address long-term health issues among survivors, notably increased risk of cardiovascular disease (CVD). Shared risk factors may underpin at least part of this excess risk. Aims To investigate differences in cardiovascular risk profile between cancer survivors and controls; and to assesses the management of hypertension and statin use among cancer survivors compared with controls in a multi-ethnic and socio-economically diverse population. Methods The data were obtained from electronic health records of 1.2 million people registered with general practices in East London. It provides a snapshot of health records at the time of data extraction (01/01/2023). We identify individuals with record of past cancer (grouped into 20 cancer types) and their cardiovascular profile. Each cancer-exposed patient was age- and sex-matched to four non-cancer comparators. Multivariable logistic regression, with extensive adjustment for demographic and health-related variables, was used to elucidate the independent associations of past cancer with a range of cardiovascular outcomes. Patterns of guideline-directed risk factor control among cancer patients with hypertension and ischaemic CVDs (vs non-cancer controls) were assessed. Results The study consisted of 18,839 cancer survivors and 75,356 matched controls (64±15 years, 43% male), with marked ethnic diversity (cancer survivors: 48% White, 24% Black and 22% Asian) and socio-economic deprivation. Compared to matched controls, patients with past cancer had a higher prevalence of hypertension (44% vs. 41%) and chronic kidney disease (18% vs. 14%). We observed a higher prevalence of CVDs including venous thromboembolism (VTE) (5.6% vs. 2.8%), atrial fibrillation (AF) (6.5% vs. 5%), and heart failure (HF) (4.4% vs. 3.4%) among cancer survivors. Regression models fully adjusted for shared risk factors demonstrated an increased risk of a range of CVDs in patients with (any) past cancer, including VTE (OR 2.01), HF (OR 1.31) and AF (OR 1.27). CVD risk varied across cancer types (Figure 1). For example, lung cancer survivors had an elevated risk of VTE (OR 4.02), AF (OR 2.47), IHD (OR 1.45) and peripheral artery disease (OR 1.67) while colorectal cancer survivors had increased risks of VTE (OR 2.68), HF (OR 1.4) and AF (OR 1.32). In subgroup analyses, control of blood pressure and cholesterol did not differ significantly across cancer survivors and matched controls with hypertension and ischaemic CVDs, respectively. Conclusion We show higher burden of VRFs and an increased risk of CVDs among cancer survivors compared with non-cancer controls, with notable variation across cancer types. The lack of difference in control of blood pressure and cholesterol between cancer survivors and controls suggests that these risk factors did not explain the increased risk. Suggesting that an individualised approach to risk management is likely to be warranted.Risk of CVDs in Cancer Survivors

Lifestyle factors before and after colorectal cancer treatment and their association with fatigue

Abstract Background As colorectal cancer (CRC) survivorship increases, so does the challenge of managing cancer-related fatigue, a prevalent condition that severely impacts survivors’ ability to work and overall quality of life. This study delves into the relationship between lifestyle behaviors, assessed using the HEALTHY lifestyle score, and its influence on fatigue among CRC patients. Methods Data was derived from MIRANDA, a multicenter cohort study that enrolls adult CRC patients during a 3-week in-patient rehab within a year after primary CRC treatment. Up to date, n = 438 participants provided information on lifestyle factors at the rehabilitation start (baseline) and then every three months for the first year. The predictors were the HEALTHY lifestyle score and its components (diet, alcohol consumption, physical activity, BMI, and smoking status) calculated at three time points: before surgery, after surgery, and 12 months following rehabilitation. The outcome was fatigue, assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F-FS) scale. Results Participants with a higher HEALTHY lifestyle score after CRC surgery had statistically significantly lower fatigue levels. The components that contributed most to this finding were smoking and physical activity. Participants who engaged in exercise post-surgery or did not smoke before their cancer diagnosis experienced lower fatigue levels during rehabilitation. Conclusions Lifestyle modifications, such as increasing physical activity and smoking cessation, are crucial in preventing or reducing fatigue among CRC patients. Tailored public health initiatives that advocate for these lifestyle adjustments and their incorporation into CRC rehabilitation protocols could significantly advance survivor care, ultimately leading to better health outcomes. Key messages • The HEALTHY score is associated with fatigue of CRC patients during rehabilitation, highlighting the crucial role of lifestyle changes after CRC treatment. • Smoking cessation and physical activity programs may be the most effective measures for decreasing the fatigue burden of these patients.

Experiences and needs of colorectal cancer survivors in resource-limited countries: A qualitative descriptive study in Syria

PurposeColorectal cancer (CRC) is one of the three most prevalent cancers globally, with incidence rates projected to increase. CRC survivors face various challenges due to the disease and its treatments. However, there is limited evidence on the experiences and needs of CRC survivors in resource-constrained countries. This study aimed to explore the experiences and needs of CRC survivors in Syria and to identify perceived opportunities for improvement. MethodsA descriptive qualitative study design was employed, using semi-structured in-depth interviews with 12 adult CRC survivors who had completed treatment at least 6 months prior, selected through purposive sampling. Data were analyzed using an inductive thematic analysis approach. ResultsThe interviews revealed 15 major themes: 11 concerning the experiences of CRC survivors and four related to their needs. The survivors’ experiences included physical burden, psychological expressions, economic burden, social withdrawal, stigmatization, family and friend supports, cultural and social impact, religion and coping mechanisms, relationship with healthcare professionals, support from healthcare system. Their needs encompassed emotional and psychological, informational, financial, and sexual needs. ConclusionThis study highlights the unpredictable psychological, economic and physical burdens experienced by Syrian CRC survivors. Personalized care plans that address unmet needs of survivors are crucial to improving their quality of life. Prioritizing the development of comprehensive survivorship care plans that address the multifaceted needs of CRC survivors is crucial. Additionally, further qualitative research is essential to gain a deeper understanding of the challenges faced by these survivors and to inform the design of effective interventions.

Alcohol consumption and smoking history at time of diagnosis, and risk of colorectal cancer recurrence and mortality: Results from the ColoCare Study.

Findings from studies investigating the impacts of alcohol use and smoking on colorectal cancer (CRC) outcomes are inconclusive. This study aimed to investigate associations between alcohol use and smoking status at the time of diagnosis on recurrence and overall mortality among patients with CRC. The present study included 2,216 stage I-IV patients with CRC from the longitudinal multi-center ColoCare study, with available data on recurrence and CRC-specific mortality. Cox proportional hazards models adjusted for age, sex, race, ethnicity, stage, tumor site, treatment, comorbidities, body mass index, and study site were fit, with imputations for missing data. We observed 235 recurrences and 308 CRC-specific deaths over an average of 3 years of follow-up. After adjusting for confounders, current alcohol consumption and ever smoking, relative to not current consumption and never smoking, respectively, were not statistically significantly associated with CRC recurrence (Alcohol - HR: 0.95. 95% CI: 0.71-1.29; Ever smoking - HR: 0.98, 95% CI: 0.75-1.29) or CRC-specific mortality (Alcohol - HR: 0.95. 95% CI: 0.74-1.22; Ever smoking - HR: 0.98, 95% CI: 0.77-1.24). No associations were observed between alcohol and smoking at diagnosis and clinical outcomes in this well-annotated longitudinal cohort. Our cohort study reports no significant associations; however, limiting alcohol use and avoiding smoking are health behaviors recommended for CRC survivors for prevention of other cancers and chronic conditions.

Factors associated with anxiety in colorectal cancer survivors: a scoping review.

Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety. Using Arksey and O'Malley's (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included. We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used. This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods. This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.

A randomized trial of aerobic exercise in colorectal cancer: Rationale, design, recruitment, and exercise adherence results

BackgroundPhysical activity is associated with improved disease-free survival in colorectal cancer survivors. This report describes the purpose, design, recruitment, and exercise adherence results of the National Cancer Institute (NCI)-sponsored Exercise and Colorectal Cancer Treatment (EXACT) trial. MethodsThe primary objective of the EXACT trial is to determine if randomization to 150 min per week of moderate-intensity aerobic exercise reduces systemic inflammation among stage I-III colorectal cancer survivors compared with a waitlist control group over 12 weeks. Participants were provided with an in-home treadmill and heart rate monitor. Characteristics associated with randomization were identified using χ2 or Fisher's exact test for categorical variables and t-tests or analysis of covariance (ANCOVA). Exercise adherence was calculated as the total minutes exercised by total minutes prescribed. ResultsBetween August 2019 and February 2023, 3082 colorectal cancer survivors were invited to participate, 89 were screened, and 60 were randomized to the study protocol. Younger age (P = 0.02), female sex (P = 0.002), white race (P = 0.01), proximal time since tumor resection (P = 0.02), and regional tumor stage (P < 0.001) were associated with study participation. Average exercise adherence was 92.2 % (95 % CI: 85.5, 98.8) and all study participants achieved ≥80 % exercise adherence. Endpoint data collection was completed for all participants in May 2023. ConclusionThe results from the EXACT trial will characterize the changes that occur from exercise to advance our understanding of the biological mechanisms by which exercise may prevent tumor recurrence and death in colorectal cancer survivors.

Impact Of Multimodal Exercise Intervention On Sarcopenia In Breast, Prostate And Colorectal Cancer Survivors

Impact Of Multimodal Exercise Intervention On Sarcopenia In Breast, Prostate And Colorectal Cancer Survivors

Health-Related Quality of Life in Long-Term Colorectal Cancer Survivors

The aim of our study is to evaluate the relationship between sociodemographic and clinical characteristics of individuals with Colorectal Cancer (CRC), tumour-intrinsic characteristics and treatment received with health-related quality of life (HRQoL). Methods: Cross-sectional analysis of data from 805 survivors from the MCC study was conducted. HRQoL was assessed through a general and specific questionnaire, SF-12 and FCSI (Colorectal Symptom Index). Statistical analyses were performed with linear regression with adjustment for sociodemographic variables, stage at diagnosis and histological grade. Results: Participants had survived a median of 7.9 years from diagnosis (IQR 7.1–8.5 years). Age at diagnosis, sex and area showed a clear association with HRQoL in both physical and mental dimensions of the SF-12 questionnaire. A direct association between CRC recurrence was also found in the PCS-12 and MCS-12 dimensions and radical surgery in the PCS-12. Regarding the scores in FCSI questionnaire, statistically significant differences were observed by sex, age and area, with older women being the most impaired (p &lt; 0.001). Conclusions: Age, sex and area was associated with lower scores of HRQoL among CRC survivors. Knowing the determinants related to HRQoL would allow us to lay the groundwork to develop strategies that help reduce morbidity and mortality, relapses and increase HRQoL.

Abstract C059: Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality

Abstract Introduction: Cancer survivorship often entails considerable psychological distress. Colorectal cancer (CRC) presents distinct stressors including the use of colostomy and multimodality treatments resulting in side effects for many patients. These factors increases the likelihood of social isolation, body image issues, intimacy problems, and marital strain which affect mental health of CRC survivors. However, information about the prevalence of psychological distress in this population and its association with clinical outcomes are lacking. We examined the prevalence of psychological distress and its association with emergency room usage (ER) and all-cause mortality among CRC survivors. Methods: We utilized data from the 2000-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files. The NHIS is an annual cross-sectional, nationally representative, in-person survey of the civilian, noninstitutionalized population in the United States. The main exposure was psychological distress, assessed with the six-item Kessler Psychological Distress Scale (K6) and classified as (no/low, moderate, severe). The outcomes were ER usage during the past 12 months and all-cause mortality. Multivariable logistic and Cox proportional hazards models were used to examine the associations between psychological distress, and ER usage and all-cause mortality, respectively. The models were adjusted for age, gender, survey year, race/ethnicity, marital status, education, smoking, geographic region, visit to mental professionals, general health status, comorbidities, and time since cancer diagnosis. Results: A total of 3198 CRC survivors were included in the study, of whom 4.1% and 19.6% reported severe and moderate psychological distress, respectively. In the 12 months preceding the survey, 29.8% of CRC survivors had ER usage and 41.5% deaths occurred with a median follow-up of 84 months. In the adjusted model, compared to CRC survivors with low/no psychological distress, those with severe (aOR=1.86; 95% CI, 1.11–3.10) or moderate (aOR=1.60; 95% CI, 1.22–2.11) psychological distress had high odds of reporting ER use. Similarly, after adjusting for covariates, CRC survivors with severe (aHR =1.32; 95% CI, 1.30–1.34) or moderate (aHR =1.02; 95% CI, 1.01–1.02) psychological distress had higher risk of all-cause mortality compared with survivors experiencing low/no psychological distress. Conclusion: CRC survivors with severe or moderate psychological distress have higher ER usage and all-cause mortality. This finding emphasizes the significance of timely identifying and addressing psychological distress to improve quality of life and clinical outcomes of patients diagnosed with CRC. Integrating mental health support into routine cancer care may reduce distress levels, potentially leading to fewer ER usage and lower mortality rates among CRC survivors. Citation Format: Mrudula Nair, Pranali Patel, Chaitali S Dagli, Nada Al-Antary, Oluwole A Babatunde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C059.

Abstract A076: Racial disparities in disease-free and overall survival among colorectal cancer patients in the prospective ColoCare cohort

Abstract Background: Despite improvements in screening and treatment, Black and other underserved colorectal cancer survivors continue to experience poorer clinical outcomes. Multicenter prospective cohorts among large cancer centers in the United States (US) offer the unique opportunity to characterize potential multilevel determinants of disparate outcomes while accounting for known contributions of medical access and treatment. We investigated racial and ethnic disparities in disease-free survival (DFS) and overall survival in the ColoCare study, a prospective cohort study of newly diagnosed colorectal cancer patients across six US cancer centers. Method: The ColoCare study population (n=2,471) from six US sites included n=1,950 non-Hispanic White (NHW), n=238 non-Hispanic Black (NHB), and n=114 Hispanic patients. We estimated racial and ethnic differences in baseline patient characteristics using χ2. We investigated disparities in outcomes by estimating associations of race and ethnicity with DFS (among stage I-III) and overall mortality using Cox Proportional Hazards Models, adjusted for sex, stage at diagnosis, age, study center, and anatomic site. Results: The patients were primarily male (53%), had colon tumors (37.5%), with an average age at diagnosis of 58.6 years. Hispanic individuals were on average younger than their counterparts (P=.03), while NHB individuals were more likely to be overweight and obese (P&amp;lt;.01). NHB individuals had statistically significantly poorer DFS than NHW individuals (HR=1.55, 95% CI=1.03-2.32; P=0.03). NHB individuals also had higher risk for overall mortality (HR=1.45, 95% CI=0.97-2.16; P=0.07), though these findings were not statistically significant. Overall, associations of Hispanic ethnicity with DFS and overall survival were close to null. Discussion: NHB individuals had poorer survivorship outcomes in our study despite all patients receiving care at designated comprehensive cancer centers. Our findings highlight the continued need to address disparities in survivorship using targeted, culturally sensitive intervention strategies. Future research efforts should identify actionable factors, such as adiposity, that may disproportionately impact health outcomes among minority colorectal cancer survivors. Citation Format: Esther Jean-Baptiste, Mmadili Ilozumbo, Gazelle Rouhani, Maria F. Gomez, Stephanie R. Hogue, Sheetal Hardikar, Biljana Gigic, Christopher I Li, Jane C Figueiredo, Adetunji T. Toriola, Cornelia M Ulrich, David Shibata, Erin M Siegel, Doratha A. Byrd. Racial disparities in disease-free and overall survival among colorectal cancer patients in the prospective ColoCare cohort [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A076.

Abstract B024: Be your own fan: Who do you get screened for?: A culturally sensitive and community-vetted colorectal cancer awareness campaign tailored for the Filipino community in Los Angeles County

Abstract Background Colorectal cancer is the second most common cancer among Filipina women and third among Filipino men, especially in Los Angeles County with the second largest concentration of Filipinos and immigrants. Recent trends show that Filipino experience late-stage diagnosis and lower survival rates. Despite the large number of Filipinos working in healthcare industry dedicated to caring for others, many Filipinos neglect to prioritize their own health and well-being. In collaboration with the Art Center College of Design, Cedars Sinai Cancer Center Community Outreach and Engagement (COE) developed a colorectal cancer awareness campaign, "Be Your Own Fan: Who do you get screened for?" aiming to evoke emotion and prompt reflection on the importance of health through storytelling, imagery, and tailored health materials (i.e., traditional hand fan, infographics, t-shirts, tote bags, stickers, photocards). Methods To determine relevance of the health campaign, five 1 hour semi-structured focus groups were conducted both in English or Tagalog via Zoom with n=23 adults ages 18 and over who self-identify as Filipino to provide community input on appropriateness of the messaging, colors, symbols, and community engagement approach. Participants were recruited through snowball sampling at in-person community outreach events, and email distribution. Results Participants represented diverse professions such as nursing, home healthcare/caregiving, public health, and accounting. Majority were 69% middle-aged adults, 57% female, and 4% colorectal cancer survivor. Research findings show that Filipinos take pride in their traditional culture, particularly in the use of Philippine flag colors (red, blue, yellow, and white) in health materials as opposed to other hues or tints. Either English or conversational Tagalog were preferred languages since it may be challenging to represent over 100 different languages spoken by Filipinos. Lastly, featuring stories and images of trusted community figures like healthcare professionals, church and community leaders, and family members are effective in pulling the heartstrings of the Filipinos to empower them to be their own fan/advocate. With this feedback, the campaign has been revised and deployed in the community and preliminary findings with n=77 people reached indicate increased awareness on colorectal cancer and intent to get screened. Conclusion. Developing health campaigns that closely reflect the community they serve can lead to increased awareness, participation, and adherence to health recommendations and behaviors. Citation Format: Reener Balingit, Mark Bondoc, Dong Hee Kim1, Zul Surani. Be your own fan: Who do you get screened for?: A culturally sensitive and community-vetted colorectal cancer awareness campaign tailored for the Filipino community in Los Angeles County [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B024.

Interleukin-15 and high-intensity exercise: relationship with inflammation, body composition and fitness in cancer survivors.

Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth. These anti-oncogenic effects of exercise were associated with the exercise-mediated release of myokines such as interleukin (IL)-15. However, no study has quantified the acute IL-15 response in human cancer survivors, and whether physiological adaptations to exercise training (i.e. body composition and cardiorespiratory fitness) influence this response. In the present study breast, prostate and colorectal cancer survivors (n=14) completed a single bout of high-intensity interval exercise (HIIE) [4×4min at 85-95% heart rate (HR) peak, 3min at 50-70% HR peak] before and after 7months of three times weekly high-intensity interval training (HIIT) on a cycle ergometer. At each time point venous blood was sampled before and immediately after HIIE to assess the acute myokine (IL-15, IL-6, IL-10, IL-1ra) responses. Markers of inflammation, cardiorespiratory fitness and measures of body composition were obtained at baseline and 7months. An acute bout of HIIE resulted in a significant increase in IL-15 concentrations (pre-intervention: 113%; P=0.013, post-intervention: 102%; P=0.005). Post-exercise IL-15 concentrations were associated with all other post-exercise myokine concentrations, lean mass (P=0.031), visceral adipose tissue (P=0.039) and absolute peak (P=0.032). There was no significant effect of 7months of HIIT on pre- or post-HIIE IL-15 concentrations (P>0.05). This study demonstrates HIIE is a sufficient stimulus to increase circulating IL-15 and other myokines including IL-6, IL-10 and IL-1ra which may be clinically relevant in the anti-oncogenic effect of exercise and repetitive exposure to these effects may contribute to the positive relationship between exercise and cancer recurrence. KEY POINTS: Exercise has been demonstrated to reduce the risk of cancer recurrence. Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth, mediated by exercise-induced myokines (IL-6 and IL-15). High-intensity interval exercise significantly increased myokines associated with the anti-oncogenic effect of exercise and the magnitude of response was associated with lean mass, but training did not appear to influence this response. Given IL-15 has been implicated in the anti-oncogenic effect of exercise and is being explored as an immunotherapy agent, high-intensity interval exercise may improve outcomes for people living beyond cancer through IL-15-mediated pathways. Interventions that increase lean mass may also enhance this response.

Investigating Physical, Social, Emotional, and Health Frailties of Cancer Survivors after Cancer Treatment: The Urgent Call for Tailored Multidisciplinary Survivorship Plans in Italy.

Understanding the specific needs of cancer survivors is essential for healthcare policy. In Italy, dedicated studies are lacking, so we aimed to investigate the physical, mental, social, and health difficulties encountered by these patients. We conducted a cross-sectional study on breast or colorectal cancer survivors (people 5+ years free from it and its treatments) using an ad hoc survey including validated questionnaires (Grauer-Palombi, SF-36, PREDIMED). Participants were recruited within the Oncology Unit of the "Policlinico Tor Vergata", Italy. A total of 62 patients (80.6% females; years range: 37-87) agreed to be interviewed. A profile of cancer survivors was drafted: an overaged person with multiple co-morbidities, not well-nourished, adhering to the Mediterranean diet, reporting critical conditions as for physical and functional status. The mean number of co-morbidities was 3.6 ± 2.4 SD, with a statistically significant difference between age groups (under and over 65). Compared to the general population, the sample showed more frailties, especially when >65. The risk of having multimorbidity (four or more co-morbidities) significantly increased in those over 65 (OR: 4.72; CI: 1.43-15.59). There is an urgent need for survivorship care planning for the patient-centered continuum of care. Assessing and monitoring their specific needs will help propose appropriate and tailored responses.