Quality of life, distress, and posttraumatic growth 5 years after colorectal cancer diagnosis according to history of inpatient rehabilitation

Abstract

Purpose In Germany, almost every other colorectal cancer (CRC) patient undergoes inpatient cancer rehabilitation (ICR), but research on long-term outcomes is sparse. We aimed to assess health-related quality of life (HRQOL), distress, and posttraumatic growth among former rehabilitants and non-rehabilitants as well as respective differences and to estimate disease-related quality of life deficits in both groups. Methods HRQOL (EORTC-QLQ-C30/CR29), distress (QSC-R10), and posttraumatic growth (PTGI) were assessed according to past ICR in patients 5-year post-CRC-diagnosis in the German DACHS study. Least square mean differences in HRQOL scores and elevated distress levels (QSC-R10 > 14 points) by ICR were estimated by confounder-adjusted linear and logistic regression, respectively. Differences in PTGI scales were tested for statistical significance. EORTC-QLQ-C30 reference scores from population controls were accessed from the LinDE study to estimate disease-related deficits in both treatment groups. Results 49% of the included 1906 CRC survivors had undergone ICR. Rehabilitants reported lower HRQOL scores than non-rehabilitants in several dimensions of the EORTC-QLQ-C30/CR29. Differences were pronounced among younger survivors (< 70 years). In younger survivors, past ICR also predicted elevated distress. However, rehabilitants showed higher posttraumatic growth. When compared to 934 population controls, non-rehabilitants and older rehabilitants reported HRQOL scores (EORTC-QLQ-C30) similar to controls except higher levels of bowel dysfunctions, whereas younger rehabilitants experienced deficits regarding most scales (13/15). Conclusion Our findings suggest a high disease burden 5 years after diagnosis in particular among younger CRC survivors who had undergone ICR. Observed HRQOL deficits are possibly linked to the initial indication for ICR and rehabilitants may benefit from effective follow-up concepts after ICR.

Posttraumatic growth and health‐related quality of life in cancer survivors: Does fatigue moderate the link?

“…This might have resulted in a weaker association of PTG and global HRQoL compared to assessments closer to diagnosis. However, considering PTG as a process that continues even years after cancer diagnosis and treatment and previous studies (Cormio et al., 2017; Scherer‐Trame et al., 2022) investigating PTG in cancer patients up to four or 5 years after diagnosis may nevertheless indicate that the timing of the PTG assessment was adequate. Further, our sample may not be completely representative because patients who were extremely fatigued or traumatised may have been unable to participate in the survey, which could have led to fatigue being underreported.…”

“…This might have resulted in a weaker association of PTG and global HRQoL compared to assessments closer to diagnosis. However, considering PTG as a process that continues even years after cancer diagnosis and treatment and previous studies (Cormio et al, 2017;Scherer-Trame et al, 2022) T A B L E 2 Summary of moderated hierarchical multiple regression analysis of the relationship between posttraumatic growth, fatigue and global health-related quality of life (HRQoL) (all at T1).…”

Posttraumatic growth in colorectal cancer survivors: A systematic review

“…In addition, in the follow‐up study, Scherer‐Trame et al (2021) put forward that results were differentiated according to whether survivors had participated in a rehabilitant programme containing nutritional guidance, physical therapy and colostomy care, patient education and psychological support. For participants younger than 70‐year‐old at follow‐up, rehabilitants reported higher levels of ‘new possibilities’ and ‘appreciation of life’, and in the 70‐year‐old‐plus rehabilitant group, participants reported higher scores in ‘new possibilities’ and ‘spiritual enhancement’ compared with non‐rehabilitant group.…”

The effect of a couple‐based posttraumatic growth intervention in supporting couples coping with colorectal cancer: A randomized controlled study

“…Existing intervention studies on PTG in CRC only targeted the patients 15–18 . The intervention elements involved cancer‐related cognition, managing emotions, coping with cancer, social interaction, and reappraisal of cancer, which are consistent with the elements in the PTG affective‐cognitive processing model 13 .…”