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Risk factors for cancer-related distress in colorectal cancer survivors: one year post surgery

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Abstract

Purposes

Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (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 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 (HrQOL) 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

Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months.

Conclusion

Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies.

Implications for Cancer Survivors

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.

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Acknowledgments

ColoCare Study protocols, questionnaires, and procedures were developed in collaboration with ColoCare investigators at the Fred Hutchinson Cancer Research Center. The authors thank all patients who participated in the ColoCare Study, as well as the ColoCare Study team: Judith Kammer and Susanne Jakob (patient recruitment and follow-up), Dr. Clare Abbenhardt-Martin (initial set-up of the study), Dr. Petra Schrotz-King and Dr. Jürgen Böhm (study coordination), and Dr. Werner Diehl and Rifraz Farook (data management).

Disclaimer

The views expressed are those of the authors and do not necessarily those of the National Cancer Institute.

Funding

This work was supported by the German Consortium for Translational Cancer Research (DKTK) and the German Cancer Research Center; the Matthias Lackas Foundation, Stiftung LebensBlicke, the ERA-NET on Translational Cancer Research (TRANSCAN) project 01KT1503 (Federal Ministry of Education and Research, Germany), and Claussen–Simon–Stiftung (Germany); grants from the National Institutes of Health/National Cancer Institute (U01 CA206110, R01 CA189184, R01 CA211705, and R01 CA207371, P30 CA042014, to C.M. Ulrich); and the Huntsman Cancer Foundation.

First author, CJ Han, was supported by the National Cancer Institute (NCI) Training Program in Biobehavioral Cancer Prevention and Control (T32 CA092408) at the University of Washington, Public Health and Health Service Departments, and Fred Hutchinson Cancer Research Center, Seattle, WA.

KL Syrjala was supported by grants from NCI, R01 CA215134, Cancer Center Support Grant P30 CA015704, R01 CA204378, and R01 CA201179.

WM Grady was supported by grants from NCI (U01CA152756), R.A.C.E. Charity, Cottrell Family Fund, Listwin Foundation, Seattle Translational Tumor Research program, and Rodger C. Haggitt Endowed Chair.

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Author notes

  1. Karen L. Syrjala, Biljana Gigic, and Cornelia M. Ulrich contributed equally to this work, as three co-corresponding authors.

Authors and Affiliations

  1. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

    Claire J. Han, William M. Grady, Christopher I. Li & Karen L. Syrjala

  2. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany

    Biljana Gigic, Martin Schneider, Yakup Kulu, Torsten Kölsch & Alexis B. Ulrich

  3. Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA

    Anita R. Peoples, Jennifer Ose & Cornelia M. Ulrich

  4. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA

    Anita R. Peoples, Jennifer Ose & Cornelia M. Ulrich

  5. Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA

    Paul B. Jacobsen

  6. Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA

    Graham A. Colditz & Adetunji T. Toriola

  7. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, California, LA, USA

    Jane C. Figueiredo

  8. Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA

    William M. Grady

  9. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

    William M. Grady & Karen L. Syrjala

  10. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    David Shibata

  11. Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA

    Erin M. Siegel

Authors
  1. Claire J. Han
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  2. Biljana Gigic
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  3. Martin Schneider
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  17. Karen L. Syrjala
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  18. Cornelia M. Ulrich
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Correspondence to Biljana Gigic, Karen L. Syrjala or Cornelia M. Ulrich.

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Han, C.J., Gigic, B., Schneider, M. et al. Risk factors for cancer-related distress in colorectal cancer survivors: one year post surgery. J Cancer Surviv 14, 305–315 (2020). https://doi.org/10.1007/s11764-019-00845-y

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