The impact of primary colorectal cancer treatment on physical symptoms and functioning in the first two years: results from the colorectal well-being (CREW) cohort study

Foster, Claire; Haviland, Joanne; Winter, Jane; Grimmett, Chloe; Chivers Seymour, Kim; Calman, Lynn; Corner, Jessica; Din, Amy; Fenlon, Deborah; May, Christine M.; Smith, Peter W.; Richardson, Alison

Abstract

Background: Cancer and its treatment can have a considerable long‐term impact. Relatively little is known about what this means in relation to health and well‐being, how to prepare patients for what to expect, and to tailor support.
Aims: The aim of this study is to describe the impact of colorectal cancer treatment and patient characteristics including self‐efficacy (confidence to self‐manage illness‐related problems) on symptoms and functioning following curative intent surgery.
Methods: Eight hundred fifty‐seven colorectal cancer patients (Dukes' A–C) recruited 2010–2012 from 29 UK centres. Questionnaires pre‐surgery (baseline), 3, 9, 15 and 24 months included assessments of symptoms, functioning and patient characteristics. Regression analyses assessed change in functioning and symptoms over time and associations with socio‐demographic, clinical, treatment and pre‐surgery psychosocial characteristics.
Results: Most problematic symptoms over follow‐up: impotence (45% moderate/severe problems at 24 months), urinary frequency (34%), fatigue (24%), stool frequency (22%), insomnia (20%), flatulence (20%) and pain (16%). Symptoms worsened immediately following surgery and then most improved significantly, generally from 15 months, although some remained as prevalent (impotence and flatulence). Urinary incontinence significantly worsened (mostly changes from none to mild symptoms). From multiple regressions, risk factors consistently statistically significantly associated with worse symptoms and poorer functioning were, worse depression and lower self‐efficacy at baseline, more comorbidities and having a stoma. Tumour site, neo‐adjuvant and adjuvant treatment had little effect.
Conclusions: Most symptoms improve by 15 months following colorectal cancer treatment although some persist. Pre‐surgery self‐efficacy and depression are important predictors of symptoms and functioning, independent of clinical and treatment factors, and amenable to interventions to improve recovery.

Citation

Foster, C., Haviland, J., Winter, J., Grimmett, C., Chivers Seymour, K., Calman, L., Corner, J., Din, A., Fenlon, D., May, C. M., Smith, P. W., & Richardson, A. (2016). The impact of primary colorectal cancer treatment on physical symptoms and functioning in the first two years: results from the colorectal well-being (CREW) cohort study. Psycho-Oncology, 25(S1), 1-22. https://doi.org/10.1002/pon.4077

• Journal Article Type: Article
• Acceptance Date: Jan 4, 2016
• Online Publication Date: Feb 29, 2016
• Publication Date: Mar 30, 2016
• Deposit Date: Mar 14, 2016
• Journal: Psycho-Oncology
• Print ISSN: 1057-9249
• Electronic ISSN: 1099-1611
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: S1
• Pages: 1-22
• DOI: https://doi.org/10.1002/pon.4077
• Public URL: https://nottingham-repository.worktribe.com/output/977721
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/pon.4077/full
• Additional Information: Abstract of the presentation at the British Psychosocial Oncology Society 2016 Annual Conference, 3–4 March 2016, Cambridge, UK.