Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment

Abstract

BackgroundThis longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors.Patients and methodsA population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors.ResultsDistinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain.ConclusionAlthough HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors.

Candidate Predictors of Health-Related Quality of Life of Colorectal Cancer Survivors: A Systematic Review

“…In 3 studies (2 longitudinal), less perceived social support and worse social network measures (e.g., fewer social contacts) were found to be associated with lower HRQoL reported by CRC survivors 5 or more years postdiagnosis [35,47,70]. Regarding socioeconomic factors, 2 longitudinal studies in CRC survivors observed significantly lower HRQoL 2-5 years postdiagnosis among survivors who did not have private health insurance at 5-6 months postdiagnosis [31,35].…”

“…Evidence was graded inconsistent for tumor stage and localization. Either associations of higher tumor stage with lower HRQoL were observed [29,33,35,40,42,43,47,48] or there was no significant association between tumor stage and HRQoL [32,39,41,[49][50][51]. Similarly, studies observed either no significant association between tumor localization and HRQoL [29,32,42,51] or that rectal cancer survivors reported lower HRQoL than colon cancer survivors [35,48].…”

“…Evidence was graded inconsistent for education level, work status, and marital status. One study observed associations of lower educational attainment with lower HRQoL of CRC survivors [31], whereas nine other studies did not observe an association between education level and HRQoL [29,34,35,37,47,48,50,54,55]. Additionally, either working [56] or not working [36] was observed to be associated with lower HRQoL of CRC survivors, or no significant association between HRQoL and work status was observed [48].…”

“…Regarding socioeconomic factors, 2 longitudinal studies in CRC survivors observed significantly lower HRQoL 2-5 years postdiagnosis among survivors who did not have private health insurance at 5-6 months postdiagnosis [31,35]. Furthermore, 7 studies (1 longitudinal) found that lower household income or lower SES were associated with lower HRQoL reported by CRC survivors between 5 months and 10 years postdiagnosis [36,37,41,42,47,49,71]. Finally, 3 studies (2 longitudinal) observed that perceiving more problems with provision of information by care providers (e.g., about the diagnosis, illness, treatments, complications, and care services) was associated with lower HRQoL reported by both CRC survivors and rectal cancer survivors 2-4 years postdiagnosis [69,72,73].…”

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

“…The different aspects of HRQOL are parts of the well-being of every person and influence a person's health status 9 . HRQOL can be predicted by a number of variables.…”