Population Of Colorectal Cancer Survivors Research Articles

Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL ABC): feasibility randomised controlled trial protocol

BackgroundTargeting modifiable lifestyle factors including diet and physical activity represents a potentially cost-effective strategy that could support a growing population of colorectal cancer survivors and improve their health outcomes. Currently, effective, evidence-based interventions and resources helping people after bowel cancer to adopt new lifestyle habits are lacking. The aim of this trial is to test the Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL-ABC) intervention to inform a future definitive randomised controlled trial.Methods/designThis is a feasibility randomised controlled trial. A total of 72 survivors who have completed surgery and all anticancer treatments will be recruited. The intervention group will receive HEAL-ABC resources based on behaviour change theory combined with supportive telephone calls informed by motivational interviewing every 2 weeks during the 3-month intervention, and once a month for 6 months to follow-up. Participants in the control group will follow usual care and have access to resources available in the public domain. The study is testing feasibility of the intervention including adherence and ability to collect data on anthropometry, body composition, diet, physical activity, behaviour change, quality of life, blood markers, contact with healthcare services, morbidities and overall survival.DiscussionThe proposed study will add to the evidence base by addressing an area where there is a paucity of data. This study on lifestyle interventions for people after colorectal cancer follows the Medical Research Council guidance on evaluating complex interventions in clinical practice. It focuses on people living after treatment for colorectal cancer and targets an important research area identified by cancer survivors as a research priority reported by the National Cancer Institute and James Lind Alliance UK.Trial registrationClinicalTrials.gov NCT04227353 approved on the 13th of January 2020

Prospective, longitudinal study of risk factors for cancer-related distress in colorectal cancer survivors from prior to surgery until one year after surgery: Results from the ColoCare study.

146 Background: Although cancer-related distress is known to persist long after completion of colorectal cancer (CRC) treatment, factors related to distress are largely unexplored in 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 who consented pre-surgery, 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 (QOL) 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: Although overall mean of six distress subscales did not change from 6 to 12 months, distress subscale scores varied over time: health burden subscale score increased ( p < .001), while finances ( p = .004), medical demands ( p < .001), and identity ( p < .001) subscale scores decreased from 6 to 12 months. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced cancer stage, poorer social support, and poorer baseline QOL scores predicted worse distress at 6 and 12 months. Conclusions: Cancer-related distress continues unresolved at 6 and 12 months post-surgery in this population of CRC survivors. Although some risk factors are difficult to alter, lack of social support may be modifiable and those at risk can be identified early after diagnosis. 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.

Usefulness and Usability of a Personal Health Record and Survivorship Care Plan for Colorectal Cancer Survivors: Survey Study.

BackgroundAs a result of improvements in cancer screening, treatment, and supportive care, nearly two-thirds of individuals diagnosed with colorectal cancer (CRC) live for 5 years after diagnosis. An ever-increasing population of CRC survivors creates a need for effective survivorship care to help manage and mitigate the impact of CRC and its treatment. Personal health records (PHRs) and survivorship care plans provide a means of supporting the long-term care of cancer survivors.ObjectiveThe purpose of this study is to characterize the usefulness of a CRC PHR and survivorship care plan and to describe the usability of these technologies in a population of CRC survivors. To our knowledge, this is the first study to assess a PHR and survivorship care plan specifically targeting CRC survivors.MethodsTwenty-two patients with CRC were recruited from surgery clinics of an academic medical center and Veterans Affairs hospital in Indianapolis and provided access to an online Colorectal Cancer Survivor’s Personal Health Record (CRCS-PHR). Survey data were collected to characterize the usefulness of the CRCS-PHR and describe its usability in a population of CRC survivors. CRC survivors were surveyed 6 months after being provided online access. Means and proportions were used to describe the usefulness and ease of using the CRC website. Open-ended questions were qualitatively coded using the constant comparative method.ResultsCRC survivors perceived features related to their health care (ie, summary of cancer treatment history, follow-up care schedule, description of side effects, and list of community resources) to be more useful than communication features (ie, creating online relationships with family members or caregivers, communicating with doctor, and secure messages). CRC survivors typically described utilizing traditional channels (eg, via telephone or in person) to communicate with their health care provider. Participants had overall positive perceptions with respect to ease of use and overall satisfaction. Major challenges experienced by participants included barriers to system log-in, lack of computer literacy or experience, and difficulty entering their patient information.ConclusionsFor CRC, survivors may find the greater value in a PHR’s medical content than the communication functions, which they have available elsewhere. These findings regarding the usefulness and usability of a PHR for the management of CRC survivorship provide valuable insights into how best to tailor these technologies to patients’ needs. These findings can inform future design and development of PHRs for purposes of both cancer and chronic disease management.

Osteoporosis in colorectal cancer survivors: analysis of the linkage between SWOG trial enrollees and Medicare claims.

In the USA, the population of colorectal cancer survivors (CRCS) is on the rise. Calcium and vitamin D are the common thread between colorectal cancer and osteoporosis. We set to explore the patterns and prevalence of osteoporosis (OP) and osteoporotic fractures (OF) in CRCS who received fluorouracil-based therapy on SWOG trials. Data for CRCS from three SWOG phase III treatment trials between 1994 and 2000 (N = 3775) were linked to Medicare claims (N = 1233). OP was identified using ICD9 and HCPCS codes; OF was defined using a more restricted set of codes. We compared patterns of OP, OF, and screening for OP by gender in CRCS. Given the gender disparities in the rates of OP and OF, we used data from the National Health Interview Survey (NHIS) and the National Hospital Discharge Survey (NHDS) to assess the ratio of OF in females and males in general population. Forty-seven percent of females and 15% of men CRCS had OP claims. Female CRCS were more likely than males to have OP (HR = 4.76 [3.77-6.01], p < 0.0001) and OF (HR = 2.64 [2.04-3.42], p < 0.0001). In the general population, the female to male ratio of OF was 1.67 as opposed to 2.90 in CRCS, indicating a significantly larger gender disparity of OF in CRCS (p < 0.001). Only 7% of men and 27% of women CRCS had OP screening. Despite a low rate of OP screening, the gender disparity of OF in CRCS is more pronounced than the general population. These findings provide an impetus for studying OP and OF in CRCS.

Abstract C36: Receipt, interest, and preferences for communication of cancer survivorship plans for colorectal cancer

Abstract Introduction: With a growing number of approximately 1.2 million colorectal cancer (CRC) survivors, there is an urgent need for coordinated follow-up care for this population. National guidelines recommend implementing Cancer Survivorship Plans (CSPs) as the standard of care for CRC survivors. Despite this recommendation, little is known about the use of CSPs in clinical practice and patients' interests and preferences. This study evaluated receipt and interest in CSPs and preferred modes of receiving CSPs in an ethnically and geographically diverse population of colorectal cancer survivors in New Mexico. Methods: Men and women with a history of local or regional stage colorectal cancer at diagnosis were identified through the New Mexico Tumor Registry. A mailed English- and Spanish-language survey was distributed to CRC survivors with a 62% cooperation rate. Survey items included interest, receipt, and communication preferences regarding CSPs. Descriptive statistics and chi square analysis were used to characterize respondents by ethnicity, primary language spoken at home, and rural urban commuting area (RUCA) codes. Results: Two hundred eighty-nine CRC survivors responded to the survey of whom 42% were Hispanic and 58% were non-Hispanic (NH). The median age was 63 (± 7.6) years and 52% were male. Overall, only 13% of patients reported they had received a CSP with an equal distribution amongst Hispanics and NHs. Only 23% of participants reported that their physician talked to them about a CSP. A significantly higher percentage of Hispanics reported being interested in receiving a CSP (76%) compared to NHs (35%) (p &amp;lt; .001). There was also a significance difference in interest in receiving a CSP based on primary language spoken at home (p= .004). The most commonly cited preferred mode of receiving a CSP was via a booklet for both Hispanics (53%) and NH (45%). Desire for receipt of a CSP via a DVD was far greater among Hispanics (24%) compared to NHs (8%) (p&amp;lt; .001). There were no differences in receipt, interest, or communication preferences by urban or rural residence. Conclusions: CSPs have the potential to improve the overall quality of life, health, and care delivery for CRC survivors. Although interest in CSPs was high, only a small percentage of CRC survivors reported having received a CSP. Ethnicity and primary language spoken at home are factors that contribute to interest in CSPs and may influence the preferred mode of delivery for CSPs. Citation Format: Jessie Padilla Medina, Kristina Fllores, Myra Murillo, Jean McDougall, Anita Kinney. Receipt, interest, and preferences for communication of cancer survivorship plans for colorectal cancer [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C36.

What are colorectal cancer survivors\u2019 preferences for dietary advice? A best-worst discrete choice experiment

PurposeStudies on healthy lifestyle interventions in survivors of colorectal cancer have been disappointing, demonstrating only modest changes. This study aims to quantify people’s preferences for different aspects of dietary intervention.MethodA best-worst discrete choice experiment was designed and incorporated into a questionnaire including participants’ characteristics and a self-assessment of lifestyle.ResultsThe response rate was 68% and 179 questionnaires were analysed. When analysing aggregate preferences, the modes of information provision selected as the most preferred were “face-to-face” (willingness to pay (WTP) £63.97, p ≤ 0.001) and “telephone” (WTP £62.36, p < 0.001) discussions whereas group discussions were preferred least (WTP −£118.96, p ≤ 0.001). Scenarios that included hospitals were most preferred (WTP £17.94, p = 0.031), and the favoured provider was bowel cancer nurses (WTP £75.11, p ≤ 0.001). When investigating preference heterogeneity, three sub-groups were identified: Firstly, “technophiles” preferring email (WTP £239.60, p ≤ 0.001) were male, were younger and had fewer risk factors. Secondly, a “one-to-one” group had strong preference for interventions over the telephone or at their local doctors and were older (WTP £642.13, p ≤ 0.001). Finally, a “person-centred” group preferred face-to-face individual or group sessions (WTP £358.79, p < 0.001) and had a high risk lifestyle.ConclusionFor survivors of colorectal cancer, there is not one approach that suits all when it comes to providing dietary advice.Implications for Cancer SurvivorsThis is important information to consider when planning healthy lifestyle interventions which include dietary advice for survivors of colorectal cancer. Aligning services to individuals’ preferences has the potential to improve patient experience and outcomes by increasing uptake of healthy lifestyle advice services and promoting a more tailored approach to dietary modifications, acknowledging sub-groups of people within the total population of colorectal cancer survivors.

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

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.