Supportive Care in Cancer

, Volume 23, Issue 3, pp 741–751 | Cite as

Distance from treating hospital and colorectal cancer survivors’ quality of life: a gendered analysis

  • Audrey Alforque ThomasEmail author
  • Pamela Gallagher
  • Alan O’Céilleachair
  • Alison Pearce
  • Linda Sharp
  • Michal Molcho
Original Article



Distance from residence to hospital has been associated with clinical outcomes for colorectal cancer patients. However, little is known about the association of remoteness with quality of life (QoL) for colorectal cancer survivors. We examined the relationship between distance from hospital and colorectal cancer survivors’ QoL, with a specific focus on gender.


Colorectal cancer survivors in Ireland who were more than 6-months postdiagnosis completed the European Organization for Research and Treatment of Cancer QLQ-C30, measuring global health status (GHS) and physical, role, cognitive, social, and emotional functioning. Bootstrap linear regression was used to evaluate the association between remoteness and QoL scales, controlling for demographic and clinical variables. Separate models were generated for the full sample, for women, and for men.


The final analytical sample was 496 colorectal cancer survivors; 186 women and 310 men. Living remote from the treating hospital was associated with lower physical functioning (coefficient −4.38 [95 % confidence interval −8.13, −0.91]) and role functioning (coeff. −7.78 [−12.64, −2.66]) among all colorectal cancer survivors. In the separate gender models, remoteness was significantly associated with lower physical (coeff. −7.00 [−13.47, −1.49]) and role functioning (coeff. −11.50 [−19.66, −2.65]) for women, but not for men. Remoteness had a significant negative relationship to GHS (coeff. −4.31 [−8.46, −0.27]) for men.


Aspects of QoL are lower among colorectal cancer survivors who live far from their treating hospital. There are gender differences in how remoteness is related to QoL domains. The results of this study suggest that policy makers, service providers, and health care professionals should consider the specific QoL needs of remote colorectal cancer survivors, and be attuned to and prepared to address the differing needs of men and women.


Colorectal cancer Cancer survivors Quality of life Health services accessibility Remote patients Gender 



Data collection for this study was supported by the Health Research Board (SA/2004/1). This analysis was supported by Health Research Board Interdisciplinary Capacity Enhancement Award (ICE/2012/09). We thank Aileen Timmons at the National Cancer Registry Ireland for feedback on analysis and a draft of the manuscript, Eamonn O’Leary at the National Cancer Registry Ireland for statistical advice, and Ciaran O’Neill at National University of Ireland, Galway for reviewing a draft of the manuscript. Geographic information system support was provided by Neil McCluskey and Sandra Deady at the National Cancer Registry Ireland. Finally, we are grateful to the tumor registration officers and data team at the National Cancer Registry Ireland.




  1. 1.
    Fazio L, Cotterchio M, Manno M et al (2005) Association between colonic screening, subject characteristics, and stage of colorectal cancer. Am J Gastroenterol 100:2531–2539. doi: 10.1111/j.1572-0241.2005.00319.x PubMedCrossRefGoogle Scholar
  2. 2.
    Jones AP, Haynes R, Sauerzapf V et al (2008) Travel times to health care and survival from cancers in Northern England. Eur J Cancer 44:269–274. doi: 10.1016/j.ejca.2007.07.028 PubMedCrossRefGoogle Scholar
  3. 3.
    Campbell NC, Elliott AM, Sharp L et al (2002) Impact of deprivation and rural residence on treatment of colorectal and lung cancer. Br J Cancer 87:585–590PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Jones AP, Haynes R, Sauerzapf V et al (2008) Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer. Eur J Cancer 44:992–999. doi: 10.1016/j.ejca.2008.02.001 PubMedCrossRefGoogle Scholar
  5. 5.
    Goldsbury D, Harris MF, Pascoe S et al (2012) Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study. BMJ Open 2. doi: 10.1136/bmjopen-2012-001070
  6. 6.
    Baade PD, Dasgupta P, Aitken JF et al (2011) Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 195:350–354PubMedCrossRefGoogle Scholar
  7. 7.
    Cramb SM, Mengersen KL, Turrell G et al (2012) Spatial inequalities in colorectal and breast cancer survival: premature deaths and associated factors. Health Place 18:1412–1421PubMedCrossRefGoogle Scholar
  8. 8.
    Dunn J, Ng SK, Breitbart W et al (2013) Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment. Health Qual Life Outcomes 11:46PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Lundy JJ, Coons SJ, Wendel C et al (2009) Exploring household income as a predictor of psychological well-being among long-term colorectal cancer survivors. Qual Life Res 18:157–161PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Ramsey SD, Andersen MR, Etzioni R et al (2000) Quality of life in survivors of colorectal carcinoma. Cancer 88:1294–1303. doi: 10.1002/(SICI)1097-0142(20000315)88:6<1294::AID-CNCR4>3.0.CO;2-M PubMedCrossRefGoogle Scholar
  11. 11.
    Schultz AA, Winstead-Fry P (2001) Predictors of quality of life in rural patients with cancer. Cancer Nurs 24:12–19PubMedCrossRefGoogle Scholar
  12. 12.
    Phipps E, Braitman LE, Stites S et al (2008) Quality of life and symptom attribution in long-term colon cancer survivors. J Eval Clin Pract 14:254–258. doi: 10.1111/j.1365-2753.2007.00842.x PubMedCrossRefGoogle Scholar
  13. 13.
    Mullan F (1985) Seasons of survival: reflections of a physician with cancer. N Engl J Med 313:270–273. doi: 10.1056/NEJM198507253130421 PubMedCrossRefGoogle Scholar
  14. 14.
    A National Action Plan for Cancer Survivorship: advancing Public Health Strategies. Center for Disease Control and the Lance Armstrong Foundation 2004. Accessed 11 Mar 2014
  15. 15.
    Mullan F (1984) Re-entry: the educational needs of the cancer survivor. Health Educ Q Published Online First: Accessed 14 Feb 2014
  16. 16.
    Taylor PJ (1975) Distance decay models in spatial interactions. Accessed 14 Mar 2014
  17. 17.
    Arcury TA, Gesler WM, Preisser JS et al (2005) The effects of geography and spatial behavior on health care utilization among the residents of a Rural Region. Health Serv Res 40:135–156. doi: 10.1111/j.1475-6773.2005.00346.x PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Baldwin L-M, Cai Y, Larson EH et al (2008) Access to cancer services for rural colorectal cancer patients. J Rural Health Off J Am Rural Heal Assoc Natl Rural Health Care Assoc 24:390–399. doi: 10.1111/j.1748-0361.2008.00186.x CrossRefGoogle Scholar
  19. 19.
    Bain NS, Campbell NC, Ritchie LD et al (2002) Striking the right balance in colorectal cancer care—a qualitative study of rural and urban patients. Fam Pract 19:369–374PubMedCrossRefGoogle Scholar
  20. 20.
    Archampong D, Borowski D, Wille-Jørgensen P et al (2012) Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 3, CD005391. doi: 10.1002/14651858.CD005391.pub3 PubMedGoogle Scholar
  21. 21.
    McIntyre P (2004) Ireland’s bumpy road to a world-class cancer service. Cancer World 54–8Google Scholar
  22. 22.
    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRefGoogle Scholar
  23. 23.
    Groenvold M, Klee MC, Sprangers MA et al (1997) Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 50:441–450PubMedCrossRefGoogle Scholar
  24. 24.
    Fayers P, Aaronson N, Bjordal K et al (2001) The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer. Accessed 1 Oct 2013
  25. 25.
    Bazzoli GJ, Lee W, Hsieh H-M et al (2012) The effects of safety net hospital closures and conversions on patient travel distance to hospital services. Health Serv Res 47:129–150. doi: 10.1111/j.1475-6773.2011.01318.x PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Thomas AA, Timmons A, Molcho M et al Quality of life in urban and rural settings: a study of head and neck cancer survivors. Oral Oncol, in PressGoogle Scholar
  27. 27.
    Jansen L, Koch L, Brenner H et al (2010) Quality of life among long-term (≥5 years) colorectal cancer survivors–systematic review. Eur J Cancer 46:2879–2888PubMedCrossRefGoogle Scholar
  28. 28.
    Bloom JR, Petersen DM, Kang SH (2007) Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psychooncology 16:691–706. doi: 10.1002/pon.1208 PubMedCrossRefGoogle Scholar
  29. 29.
    StataCorp (2011) Stata Statistical Software: Release 12. StataCorp LP, College StationGoogle Scholar
  30. 30.
    McGowan EL, Speed-Andrews AE, Rhodes RE et al (2013) Sport participation in colorectal cancer survivors: an unexplored approach to promoting physical activity. Support Care Cancer 21:139–147PubMedCrossRefGoogle Scholar
  31. 31.
    Grimmett C, Bridgewater J, Steptoe A et al (2011) Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res 20:1237–1245. doi: 10.1007/s11136-011-9855-1 PubMedCrossRefGoogle Scholar
  32. 32.
    Courneya KS, Friedenreich CM, Quinney HA et al (2003) A randomized trial of exercise and quality of life in colorectal cancer survivors. Eur J Cancer Care (Engl) 12:347–357. doi: 10.1046/j.1365-2354.2003.00437.x CrossRefGoogle Scholar
  33. 33.
    Vlassoff C, Moreno CG (2002) Placing gender at the centre of health programming: challenges and limitations. Soc Sci Med 54:1713–1723PubMedCrossRefGoogle Scholar
  34. 34.
    Hanly P, Céilleachair AÓ, Skally M et al (2013) How much does it cost to care for survivors of colorectal cancer? Caregiver’s time, travel and out-of-pocket costs. Support Care Cancer 21:2583–2592PubMedCrossRefGoogle Scholar
  35. 35.
    Lengerich EJ, Kluhsman BC, Bencivenga M et al (2007) Development of community plans to enhance survivorship from colorectal cancer: community-based participatory research in rural communities. J Cancer Surviv 1:205–211. doi: 10.1007/s11764-007-0025-y PubMedCrossRefGoogle Scholar
  36. 36.
    Giudice MED, Grunfeld E, Harvey BJ et al (2009) Primary care physicians’ views of routine follow-up care of cancer survivors. J Clin Oncol 27:3338–3345. doi: 10.1200/JCO.2008.20.4883 PubMedCrossRefGoogle Scholar
  37. 37.
    Snyder CF, Earle CC, Herbert RJ et al (2008) Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med 23:254–259. doi: 10.1007/s11606-007-0497-5 PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Arndt V, Merx H, Stegmaier C et al (2006) Restrictions in quality of life in colorectal cancer patients over three years after diagnosis: a population based study. Eur J Cancer 42:1848–1857. doi: 10.1016/j.ejca.2006.01.059 PubMedCrossRefGoogle Scholar
  39. 39.
    Ramsey SD, Berry K, Moinpour C et al (2002) Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol 97:1228–1234PubMedCrossRefGoogle Scholar
  40. 40.
    Gray NM, Hall SJ, Browne S et al Predictors of anxiety and depression in people with colorectal cancer. Support Care Cancer 1–8. doi: 10.1007/s00520-013-1963-8
  41. 41.
    Traa MJ, De Vries J, Roukema JA et al (2012) Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 23:19–27PubMedCrossRefGoogle Scholar
  42. 42.
    Milbury K, Cohen L, Jenkins R et al (2013) The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer 21:793–802PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Audrey Alforque Thomas
    • 1
    Email author
  • Pamela Gallagher
    • 2
  • Alan O’Céilleachair
    • 3
  • Alison Pearce
    • 4
  • Linda Sharp
    • 4
  • Michal Molcho
    • 5
  1. 1.Health Promotion Research CentreNational University of IrelandGalwayIreland
  2. 2.School of Nursing and Human SciencesDublin City UniversityDublin 9Ireland
  3. 3.Centre for Policy StudiesUniversity College CorkCorkIreland
  4. 4.National Cancer Registry IrelandCorkIreland
  5. 5.School of Health SciencesNational University of IrelandGalwayIreland

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