Long-term Colorectal Cancer Survivors Research Articles

Dietary Patterns Differ between Urban and Rural Older, Long-Term Survivors of Breast, Prostate, and Colorectal Cancer and Are Associated with Body Mass Index

BackgroundOlder adult cancer survivors are at greater risk of cancer recurrence and other comorbidities that can be prevented through improved diet and weight management. The tertiary prevention needs of rural-dwelling survivors can be even greater, yet little is known about rural and urban differences in lifestyle factors among this high-risk population. ObjectivesTo compare dietary patterns of urban and rural cancer survivors and to examine associations of dietary patterns with body mass index (BMI). DesignA secondary analysis was performed of baseline data from the Reach Out to Enhance Wellness (RENEW) trial, a diet and exercise intervention among overweight, long-term (≥5 years), older survivors of colorectal, breast, and prostate cancer. Survivors in the present analysis (n=729) underwent two 45- to 60-minute telephone surveys, which included two 24-hour dietary recalls. Principal components analysis and multivariable general linear models were used to derive dietary patterns and to evaluate associations between dietary patterns and BMI, respectively. ResultsPrincipal components analysis identified three primary dietary patterns among rural dwellers (high sweets and starches, high reduced-fat dairy, cereal, nuts, and fruits, and mixed) and three among urban dwellers (high fruits and vegetables, high meat and refined grains, and high sugar-sweetened beverages). Among rural survivors, greater adherence to the high reduced-fat dairy, cereal, nuts, and fruits pattern was positively associated with lower BMI (P trend <0.05), whereas higher scores on the mixed pattern was associated with greater BMI (P trend <0.05). Greater adherence to the high fruits and vegetables pattern among urban survivors was inversely associated with BMI (P trend <0.05). ConclusionsUrban and rural differences in dietary intake behavior should be considered in designing public health interventions among the increasing population of older cancer survivors. In addition, targeting overall dietary patterns might be one approach to help reduce the burden of obesity among this population.

After the Treatment Phase of Colorectal Cancer Care: Survivorship and Follow-Up

The number of long-term colorectal cancer (CRC) survivors has increased substantially over the past three decades due to both ongoing advances in early detection and improvements in cancer therapies. Adult survivors of CRC experience chronic health conditions due to normal issues associated with aging, which is further compounded by the long-term adverse effects of having had cancer and anti-cancer therapies. In addition, they are at a higher risk for CRC recurrences, new primary cancers, and other co-morbidities. This article will provide an overview of the clinical care of adult survivors of CRC. Epidemiologic data will be presented followed by a discussion of the approach to the care of long-term adult survivors of CRC, including surveillance of recurrences and new primary cancers, interventions to manage both physical and psychological consequences of cancer and its treatments, and strategies to address concerns related to unemployment and disability. Finally, we will explore the challenges of healthcare delivery, especially with respect to the coordination of follow-up between cancer specialists and primary care physicians, so as to ensure that all of the survivor’s health needs are met promptly and appropriately.

A qualitative study of unmet needs and interactions with primary care among cancer survivors

Introduction:Despite increasing numbers, there is little research investigating the long-term needs of cancer survivors. The aim of this study is to explore the experiences of individuals who have survived at least 5 years following a cancer diagnosis, and to describe perceived unmet needs and interactions with primary care.Methods:Forty long-term survivors of breast, colorectal and prostate cancer were purposively selected for an in-depth qualitative study. We aimed for a maximum variation sample according to cancer site, gender, time since diagnosis, cancer needs, anxiety and depression. Interviews were audio recorded and transcribed verbatim. Transcripts were coded thematically using a grounded theory approach.Results:Analysis of the interview data is presented in four subthemes: the role they perceived for the general practitioner (GP), unmet needs, reasons for not using primary care for needs they perceived as cancer related, and ongoing care for cancer-related issues. The majority of cancer survivors did not see a role for their GP in their long-term care related to their cancer diagnosis as most considered that they did not need active follow-up, but some expressed a need for psychological services and information on possible long-term effects. Cancer survivors cited three main reasons for not using GP services in relation to their cancer diagnosis: GPs were seen as non-experts in cancer; they were perceived as too busy; and a lack of continuity within primary care made it difficult to talk about long-term issues. There was a wide variation in schedules and notification of PSA tests among the prostate cancer survivors.Discussion:The results from this project suggest that some cancer survivors have specific emotional and physical needs that could benefit from input from their primary care team, but not all cancer survivors look to their GP for their long-term cancer-related care. Better information care planning is required from specialists in order to identify those who would benefit most.

Health-Related Quality of Life Among Long-Term Survivors of Colorectal Cancer: A Population-Based Study

The number of long-term colorectal cancer survivors is increasing. Cancer and its treatment can cause physical and psychological complications, but little is known about how it impacts quality of life (QOL) over the long term-5, 10, and 15 years after diagnosis. Cancer survivors were randomly selected from three tumor registries in France, diagnosed in 1990 (±1 year), 1995 (±1 year), and 2000 (±1 year). Controls were randomly selected from electoral rolls, stratifying on gender, age group, and residence area. Participants completed two QOL questionnaires, a fatigue questionnaire, an anxiety questionnaire, and a life conditions questionnaire. An analysis of variance was used to compare QOL scores of cancer survivors by period of diagnosis (5, 10, and 15 years) with those of controls, adjusted for sociodemographic data and comorbidities. We included 344 colon cancer and 198 rectal cancer survivors and 1,181 controls. In a global analysis, survivors reported a statistically and clinically significant lower score in social functioning 5 years after diagnosis and higher scores in diarrhea symptoms 5 and 10 years after diagnosis. In subgroup analyses, rectal cancer affected QOL in the physical dimensions at 5 years and in the fatigue dimensions at 5 and 10 years. Survivors of colorectal cancer may experience the effects of cancer and its treatment up to 10 years after diagnosis, particularly for rectal cancer. Clinicians, psychologists, and social workers must pay special attention to rectal cancer survivors to improve overall management.

Abstract ED02-04: Intersection of cancer, aging, and survivorship

Abstract Cancer is a disease associated with aging, with approximately 60% of cancer diagnoses occurring in patients age 65 and older. Of 10.8 million cancer survivors in the US, approximately 6.8 million are age 65 or older. With the aging of the baby boomer population and rises in life expectancy, the number of cancer cases and the number of cancer survivors is anticipated to grow over the coming decades.1 Optimal care of this growing population of older adult cancer survivors will require an understanding of the interaction between cancer, cancer therapy, and the aging process. In particular there is a gap in knowledge regarding whether cancer and/or cancer treatment accelerates the aging process, and if so whether the accelerated aging is transient or permanent. This lecture will provide an overview of the available data regarding the intersection between aging and survivorship, as well as specific considerations in the assessment and treatment of older adult survivors. Cancer and cancer treatment has a potential long term impact on the health status and physical function of older adults.2–3 The Health and Retirement study evaluated the health and functional status of older cancer survivors in comparison to controls. Older cancer survivors were less likely to report excellent or good health (P&amp;lt;0.001), reported more mobility limitations (P&amp;lt;0.001), and reported more limitations with activities of daily living (P=0.01). Among older cancer survivors, obesity, lack of exercise, and poor diet are associated with a poorer quality of life.4 A randomized study tested the benefits of an exercise and diet intervention in older cancer survivors and demonstrated that the intervention was associated with a decrease in self-reported functional decline.5 Older cancer survivors have an increased number of comorbid conditions in comparison to individuals without a history of cancer.2 The NIA/NCI Collaborative Study on Cancer and Comorbidity in the Elderly provided summary data on the comorbidity of 7,600 patients age 55 and older with a history of cancer. The most common comorbid conditions included hypertension (43%), heart conditions (39%) and arthritis (35%).6 Patients may be at increased risk for specific comorbid conditions based on their preexisting comorbid conditions and the therapeutic exposures received. For example, therapy with doxorubicin is associated with an increased risk of congestive heart failure and cardiomyopathy.7–8 Risk factors include a history of diabetes mellitus, coronary artery disease, and hypertension. Therapy with an aromatase inhibitor is associated with a loss in bone mineral density and this risk is most pronounced in patients with pre-existing bone loss.9 These examples highlight the need to better understand the association between a history of cancer, patient characteristics (including pre-existing comorbid conditions), specific therapeutic exposure, and the subsequent development or acceleration of comorbid conditions. Although our knowledge of the potential survivorship issues facing older adults is growing, several gaps in knowledge remain.10 As the number of cancer survivors is on the rise, it is critical to improve our evidence-based knowledge to identify and reduce the risk of late side effects from treatment. Prospective longitudinal studies of the long term impact of cancer therapies and interventions to decrease the risk are needed.

6017 POSTER DISCUSSION Quality of Life and Reintegration of Long-Term Survivors of Colorectal Cancer: a Population-Based Study

6017 POSTER DISCUSSION Quality of Life and Reintegration of Long-Term Survivors of Colorectal Cancer: a Population-Based Study

Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: prevalence, determinants, and associations with quality of life

Background:As research on quality of life of colorectal cancer (CRC) survivors has mainly focused on downsides of cancer survivorship, the aim of this study is to investigate benefit finding (BF) and post-traumatic growth (PTG) in long-term CRC survivors.Methods:Benefit finding, PTG, and quality of life were assessed 5 years after diagnosis in a population-based cohort of 483 CRC patients using the benefit finding scale, the post-traumatic growth inventory, and the EORTC QLQ-C30. Prevalence of BF and PTG, determinants of moderate-to-high BF and PTG, and the association between BF, PTG, and quality of life were investigated.Results:Moderate to high levels of BF and PTG were experienced by 64% and 46% of the survivors, respectively. Survivors with the highest level of education and with higher depression scores reported less BF and PTG. The PTG increased with increasing stage and self-reported burden of diagnosis. Quality of life only correlated weakly with PTG (Pearson's r=0.1180, P=0.0112) and not with BF (r=0.0537, P=0.2456).Conclusion:Many long-term CRC survivors experience BF and PTG. As these constructs were not strongly correlated with quality of life, focusing solely on quality of life after cancer misses an important aspect of survivorship.

Gender Differences in Quality of Life Among Long-Term Colorectal Cancer Survivors With Ostomies

To describe how gender shapes the concerns and adaptations of long-term (i.e., more than five years) colorectal cancer survivors with ostomies. Qualitative study using content analysis of focus group content. Oregon, southwestern Washington, and northern California. Four female and four male focus groups (N = 33) selected from 282 quantitative survey participants with health-related quality-of-life (HRQOL) scores in the highest or lowest quartile. Eight focus groups discussed the challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. HRQOL domains of physical, psychological, social, and spiritual well-being. All groups reported avoiding foods that cause gas or rapid transit and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality and intimacy. Coping and adjustment difficulties mostly were discussed by women, with men only discussing these issues to a small extent. Difficulties with sleep primarily were identified by women with low HRQOL. Problems with body image and depression were discussed only by women with low HRQOL. Common issues included diet management, physical activity, social support, and sexuality. Although both genders identified challenges, women described more specific psychological and social issues than men. Application of these gender-based differences can inform educational interventions for colorectal cancer survivors with ostomies.

Self-Reported Causes Of Functional Limitations In Older, Long-term Cancer Survivors

In order to provide the best preventative and rehabilitative care, it is necessary to understand the reasons why older adults limit their performance of daily activities. PURPOSE: The purpose of this pilot study was to examine the primary causes of functional limitations as reported by a subsample (n = 32) of older, long-term colorectal cancer survivors who participated in a survey study (N = 938). METHODS: The subsample (mean age = 78 yrs) came into the laboratory for objective function testing using the Continuous-Scale Physical Function Test and balance testing using a balance platform, and also completed the SF-36 function subscale and a newly developed scale, the Physical Function Perception Scale (PFPS). The PFPS assesses functional limitations for 20 activities and asks individuals what they perceive to be the cause of their limitations (e.g., health, pain, fatigue, balance problems or other), and was administered as part of the survey battery in an attempt to validate this measure for future use with older adults. RESULTS: Results indicated that there was a significant correlation (r = -0.82) between the total score of the PFPS and the SF-36 function subscale. In addition, eight specific PFPS items were found to correlate significantly (p < 0.05) with the function tests. Pain (43%) was reported to be the most common reason for functional limitations among this subsample followed by balance problems (23%), fatigue (22%), health (< 1%) and other reasons (< 1%). CONCLUSION: It is concluded that the primary causes of functional limitations as measured by the PFPS are pain, balance problems, and fatigue. The PFPS demonstrates good construct validity, and may provide information regarding self-reported causes of functional impairment. Supported by the Aging and Cancer Program, University of Wisconsin Carbone Comprehensive Cancer Center through NIH grant numbers P20 CA103697 and P30 CA14520

The supportive care needs of the partners and family members of long-term survivors of breast, colorectal and prostate cancer

Introduction and aimsThere are an estimated 2 million cancer survivors in the UK today, with earlier diagnosis and improved treatments leading to an increasing number of long-term survivors. Partners and/or...

PS3-19: The Association Between Body Mass Index and Intestinal Stoma-Related Problems

Background: Colorectal cancer (CRC) survivors with an intestinal stoma (or ostomy) may have multiple problems related to their stoma. Some evidence suggests that weight change is linked to increased problems with an ostomy. Aim: To examine the association between BMI and stoma-related problems in a sample of long-term (>5 years post-diagnosis) CRC survivors that received an ostomy. Methods: Long-term CRC survivors from three regions of Kaiser Permanente (Northwest, Northern California, and Hawaii) completed a mailed survey. The response rate for respondents with an ostomy was 53% (283/529). The survey included questions about weight and height at time of surgery and at time of survey, stoma location, stoma-related problems, and time to complete daily stoma care. A gain or loss of BMI between time of surgery and survey was defined as change in BMI of 1.5 points or more. Differences in stoma-related problems were analyzed based on demographic and clinical characteristics. Results: Of the 268 patients with complete data 41.4% (111 of 268) had a stable BMI, 21.3% (57 of 268) had a decrease in BMI, and 37.3% (100 of 268) had an increase in BMI. Younger (<75 years) survivors were more likely to have problems with clothing caused by stoma location (23% vs. 13%, p=.04). The odds that the location of the stoma caused problems, except clothing issues, were two times greater among survivors whose BMI increased compared to survivors with stable BMI (OR=2.21, 95% CI 1.10–4.47). Moreover survivors with either a BMI increase or decrease were more likely to spend more than 30 minutes per day on stoma care than those with stable BMI (OR BMI increase=2.37, 95% CI 1.12–5.03; OR BMI decrease=2.67 95% CI 1.13–6.29). No significant differences in stoma-related problems were noted related to other demographic or clinical measures. Conclusion: Change in BMI is associated with stoma-related problems among long-term colorectal cancer survivors. CRC survivors with an intestinal stoma whose BMI changes may need to adapt equipment and care practices to changes in abdominal shape. Health-care providers should caution patients that significant changes in BMI may lead to stoma-related problems.

Routine Preventive Care and Cancer Surveillance in Long-Term Survivors of Colorectal Cancer: Results From National Surgical Adjuvant Breast and Bowel Project Protocol LTS-01

National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol LTS-01 examines routine preventive care and cancer surveillance in long-term colorectal cancer (CRC) survivors previously treated in NSABP adjuvant trials. Long-term CRC survivors (≥5 years) from five completed NSABP trials (Protocols C-05, C-06, C-07, R-02, and R-03) at 60 study sites were recruited and surveyed using preventive health care items from the National Health Interview Survey (NHIS). A 3:1 comparison cohort case-matched by age, sex, race, and education was created from the 2005 NHIS. Contingency tables and multivariate models were used to compare cohorts and determine predictors of preventive care and cancer surveillance. A total of 708 patients in protocol LTS-01 (681 patients with colon cancer, 27 patients with rectal cancer) completed the interview: 57.1% male, mean age 66.2 years (standard deviation=10.6), median survival 8 years. Patients in the LTS-01 protocol were more likely to have a usual source of health care (97.7% v 93.8%, P<.0001), have received a flu shot in the past 12 months (67.5% v 44.3%, P<.0001), and have undergone cancer screening by Pap smear (67.3% v 54.8%, P<.0001), mammogram (80.4% v 70.7%, P<.0001), and prostate-specific antigen test (84.5% v 74.5%, P<.0001) than patients in the NHIS cohort. For CRC surveillance, 96.5% of patients in protocol LTS-01 had a colonoscopy, 88.2% had a carcinoembryonic antigen test, and 66.4% had a computed tomography scan in the previous 5 years. Health insurance was the best predictor of cancer screening for all three methods (odds ratio=2.6 to 4.5). No factor was uniformly associated with CRC surveillance. This select population of long-term CRC survivors who participated in clinical trials achieved better routine preventive care and cancer screening than the general population and high rates of cancer surveillance.

Quality of life among long-term (⩾5 years) colorectal cancer survivors – Systematic review

BackgroundDue to the growing number of long-term (⩾5years) colorectal cancer survivors, investigation of their quality of life (QoL) is important for an evaluation of chronic or late effects of the disease and treatment and to adjust treatment strategies to patients’ needs. MethodTo summarise current research results, multiple databases including PubMed, EMBASE and CINAHL were used to identify articles about long-term QoL of colorectal cancer survivors. The content of 10 included studies was independently extracted by two reviewers. ResultsColorectal cancer survivors indicated a good overall QoL, but may have slightly lower physical QoL than the general population. Furthermore, survivors had worse depression scores and reported to suffer from long-term symptoms such as bowel problems and distress regarding cancer. Apart from stoma and recurrence of the disease, mainly general and health-related factors such as age, social network size, income, education, BMI and number of comorbidities were associated with QoL. Studies were mainly conducted in the United States (US) (n=7) and were heterogeneous with respect to the QoL instrument used and the adjustment to covariates. QoL assessment was cross-sectional in all studies. ConclusionDespite an overall good QoL, colorectal cancer survivors have specific physical and psychological problems. The reported determinants of QoL may serve to identify survivors with special needs. But further studies are needed that focus on problems like distress, depression and bowel problems of long-term colorectal cancer survivors.

Quality of life and symptoms in long-term survivors (LTS) of colorectal cancer (CRC): Results from NSABP protocol LTS-01.

9035 Background: Little is known about health-related quality of life (HRQL) in LTS of CRC. The NSABP LTS-01 surveyed CRC survivors previously treated on NSABP adjuvant trials (Protocols C-05, C-06...

C-C4-02: Improving Survivorship Care for Long-Term Colorectal Cancer Survivors: Key Findings of a 5-Year Study

Aims: Understand the determinants of health related quality of life (HRQOL) and the lived experiences among colorectal cancer (CRC) survivors, and identify strategies to help maintain or enhance CRC survivors’ HRQOL. Methods: Mail survey and focus groups. Subjects were 283 ostomy and 392 anastomosis long-term CRC survivors within an HMO. Focus groups for subjects with ostomy were divided by gender and high and low HRQOL. Outcome measures were the modified City of Hope Quality of Life (mCOH-QOL)-Ostomy (abridged for anastomosis) and SF-36v2 questionnaires. The SF-6D scoring algorithm was used to calculate an overall HRQOL score from SF-36v2 data. Focus groups were conducted to explore ostomy-related barriers to effective self-care and adaptation strategies. Results: CRC survivors with an ostomy experienced multiple persistent HRQOL losses that differ between men and women. Women CRC survivors with ostomies, for example, reported more sleep disruption and fatigue than men. Living with an ostomy, co-morbidities, socioeconomic status, self-reported depression, and employment status were independent predictors of SF-6D scores. Among CRC survivors with ostomy, fistulas had important implications for HRQOL. Psychological wellbeing among CRC survivors was positively associated with income. Intestinal stomas significantly influenced spiritual HRQOL. Provision or withdrawal of a partners’ support affected both short- and long-term psychosocial adjustment of female CRC ostomy patients. Focus group participants identified dietary changes to control bowel output and odor, demands of coping and adjustment, and the time it took to accept the reality of daily living with an ostomy as significant challenges. Conclusions: The greatest challenges reported by CRC survivors confirmed the IOMs findings that survivorship is a distinct, chronic phase of cancer care, and that cancer effects are broad and pervasive. CRC survivors could benefit from dietary and behavioral interventions even 5+ years after their cancer surgery. Women with ostomies seem to do worse than men with ostomies and report a different profile of HRQOL challenges, including sleep disruption and fatigue. Depression screening and psychosocial interventions should be part of survivorship care for CRC patients. CRC survivors should be assessed for income and financial need. Survivorship care should aim at minimizing hospitalizations, depression, and ostomy-related complications among long- term CRC survivors.

Cancer screening and preventative care among long-term cancer survivors in the United Kingdom

Background:Long-term cancer survivors in the United Kingdom are mostly followed up in a primary care setting by their general practitioner; however, there is little research on the use of services. This study examines whether cancer survivors receive adequate screening and preventative care in UK primary care.Patients and methods:We identified a cohort of long-term survivors of breast, colorectal and prostate cancer with at least a 5-year survival using the General Practice Research Database, with controls matched for age, gender and practice. We compared adherence with cancer screening and the use of preventative care between cancer survivors and controls.Results:The cancer survivors’ cohort consisted of 18 612 breast, 5764 colorectal and 4868 prostate cancer survivors. Most cancer survivors receive cancer screening at the same levels as controls, except for breast cancer survivors who were less likely to receive a mammogram than controls (OR=0.78, 95% CI: 0.66–0.92). Long-term cancer survivors received comparable levels of influenza vaccinations and cholesterol tests, but breast (OR 0.81, 95% CI: 0.74–0.87) and prostate cancer survivors (OR=0.70, 95% CI: 0.57–0.87) were less likely to receive a blood pressure test. All survivors were more likely to receive bone densitometry.Conclusion:The provision and uptake of preventive care in a primary care setting in the United Kingdom is comparable between the survivors of three common cancers and those who have not had cancer. However, long-term breast cancer survivors in this cohort were less likely to receive a mammogram.

Early and Late Complications Among Long-Term Colorectal Cancer Survivors With Ostomy or Anastomosis

Among long-term (>or=5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life. The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood. Participants (284 survivors with ostomies and 395 survivors with anastomoses) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaires from 2002 to 2005. Information on colorectal cancer, surgery, comorbidities, and complications was obtained from computerized data and analyzed by use of survival analysis and logistic regression. Ostomy and anastomosis survivors were followed up for an average of 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy survivors and 10% of anastomosis survivors experienced complications (P < .01). From 31 days on, the percentages were 69% and 67% (after adjustment, P < .001). Bleeding and postoperative infection were common early complications. Common long-term complications included hernia, urinary retention, hemorrhage, skin conditions, and intestinal obstruction. Ostomy was associated with long-term fistula (odds ratio, 5.4; 95% CI 1.4-21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (P < .05). Complication rates remain high despite recent advances in methods of surgical treatment. Survivors with ostomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the 2 groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life.

Gender Differences in Sleep Disruption and Fatigue on Quality of Life Among Persons with Ostomies

The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL). Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related "greatest challenges." The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The "sleep disruption" and "fatigue" items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p < 0.05. On the ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p < 0.01), adjusted for age, and greater levels of fatigue (p < 0.01), adjusted for time since surgery. Women's PCS and MCS scores indicated poorer HR-QOL compared to men, and differences were clinically meaningful. Qualitative narrative comments suggested that sleep disruption could stem from ostomy-associated fear of or actual leakage during sleep. Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population.

Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors.

Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, to the authors' knowledge, little is known regarding the health behaviors of older cancer survivors and the associations of those behaviors with quality-of-life outcomes, especially during the long-term post-treatment period. In total, 753 older (aged > or =65 years) long-term survivors (> or =5 years postdiagnosis) of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for a diet and exercise intervention trial. The interviews assessed exercise, diet, weight status, and quality of life. Older cancer survivors reported a median of 10 minutes of moderate-to-vigorous exercise per week, and only 7% had Healthy Eating Index scores >80 (indicative of healthful eating habits relative to national guidelines). Despite their suboptimal health behaviors, survivors reported mental and physical quality of life that exceeded age-related norms. Greater exercise and better diet quality were associated with better physical quality-of-life outcomes (eg, better vitality and physical functioning; P < .05), whereas greater body mass index was associated with reduced physical quality of life (P < .001). The current results indicated a high prevalence of suboptimal health behaviors among older, long-term survivors of breast, prostate, and colorectal cancer who were interested in lifestyle modification. In addition, the findings pointed to the potential negative impact of obesity and the positive impact of physical activity and a healthy diet on physical quality of life in this population.

Routine preventive care and cancer surveillance in long-term survivors (LTS) of colorectal cancer: Results from NSABP Protocol LTS-01

6500 Background: Little is known about the use of routine preventive care and cancer surveillance in long-term colorectal cancer survivors. NSABP LTS-01 is a study that examines the use of such services in long-term colorectal cancer survivors previously treated in NSABP adjuvant trials. Methods: Long-term colorectal cancer survivors (≥ 5 years) were recruited from five completed NSABP treatment trials (Protocols C-05, C-06, C-07, R-02, R-03) at 65 study sites. A survey battery for long-term survivors of colorectal cancer (LTS-01) was developed. A 1:4 comparison cohort case-matched by age, gender, race, and education was created from the 2005 National Health Interview Survey. Contingency tables and multivariate models were used to compare cohorts and determine predictors of preventive care and cancer surveillance. Results: 649 LTS-01 patients (625 colon, 24 rectal) completed the interview; 57% male, mean age 66.1yr (SD 10.5), median survival 8 yrs. LTS-01 patients were more likely to have a usual source of healthcare than the NHIS cohort (98% vs. 93%, p &lt; 0.0001). The number of ER visits in the previous 12 months was not significantly different between the two groups. LTS-01 patients were more likely to have received a flu shot in the past 12 months (68% vs. 42%, p &lt; 0.0001) and were also more likely to have undergone cancer screening by Pap smear (67% vs. 54%, p &lt; 0.001), mammogram (85% vs. 71%, p &lt; 0.001), and PSA test (84% vs. 75%, p &lt; 0.001). For CRC surveillance, 3% did not have a colonoscopy, 13% had not had a CEA test, and 34% did not have a CT scan in the last 5 years. The best predictor of the receipt of these cancer screening tests was the presence of health insurance (OR 2.6–4.5). No factor was uniformly associated with colorectal cancer surveillance. Conclusions: Long-term survivors of colorectal cancer achieve better routine preventive care including cancer screening than the general population. However in these stage II and stage III cancer patients cancer surveillance is variably performed. No significant financial relationships to disclose.