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A five-year prospective study of quality of life after colorectal cancer

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Long-term (≥5 years) quality of life after colorectal cancer is not well described. The present study assessed quality of life (QOL) and psychological distress in colorectal cancer survivors more than 5 years to describe changes over time and antecedents of long-term outcomes.


A prospective survey of a population-based sample of 763 colorectal cancer patients assessed socio-demographic variables, health behaviors, optimism, threat appraisal, and perceived social support at 5 months post-diagnosis as predictors of QOL and psychological distress 5 years post-diagnosis.


QOL improved over time (P < 0.01 for each measure); however, measures of psychological distress remained stable (P > 0.07 for each measure). Risk factors for poorer QOL and/or greater psychological distress included: later stage disease, having a permanent stoma, rectal cancer, fatigue, smoking, being single, low social support, low optimism, and a more negative cancer threat appraisal. Being women, having a pet, having a private health insurance, and receiving both surgery and adjuvant treatment were protective.


Consistent with response shift theory, the antecedents of QOL after colorectal cancer are multifactorial and include predisposing socio-demographic, medical, and psychological variables. Psychosocial interventions that target both social support and threat appraisal may be effective for this patient group. Additional stepped-up support may be needed for people from a poorer social environment who have multiple risk factors for poorer adjustment. Health system effects require further investigation.

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Quality of life


Colorectal cancer


Body mass index


Physical activity


Functional Assessment of Cancer Therapy-Colorectal


Functional Assessment of Cancer Therapy-General


Brief Symptoms Inventory-18


Global Severity Index




Long term


  1. Ferlay, J., Shin, H., Bray, F., Forman, D., Mathers, C., & Parkin, D. (2010). GLOBOCAN 2008, Cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Retrieved February 1, 2010 from

  2. Australian Institute of Health and Welfare (AIHW). (2010). Australian cancer incidence and mortality (ACIM) books. Retrieved April 4, 2011 from

  3. Cheng, L., Eng, C., Nieman, L. Z., Kapadia, A. S., & Du, X. L. (2011). Trends in colorectal cancer incidence by anatomic site and disease stage in the United States from 1976 to 2005. American Journal of Clinical Oncology. doi:10.1097/COC.0b013e31822dfd3c.

  4. Center, M. M., Jemal, A., & Ward, E. (2009). International trends in colorectal cancer incidence rates. Cancer Epidemiology, Biomarkers and Prevention, 18(6), 1688–1694.

    Article  PubMed  Google Scholar 

  5. Coleman, M. P., Forman, D., Bryant, H., Butler, J., Rachet, B., Maringe, C., et al. (2011). Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): An analysis of population-based cancer registry data. Lancet, 377(9760), 127–138.

    Article  PubMed  CAS  Google Scholar 

  6. Baade, P. D., Youlden, D. R., & Chambers, S. K. (2011). When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects. Medical Journal of Australia, 194(2), 73–77.

    PubMed  Google Scholar 

  7. Jansen, L., Koch, L., Brenner, H., & Arndt, V. (2010). Quality of life among long-term (≥5 years) colorectal cancer survivors—systematic review. European Journal of Cancer, 46(16), 2879–2888.

    Article  PubMed  CAS  Google Scholar 

  8. Steginga, S. K., Lynch, B. M., Hawkes, A., Dunn, J., & Aitken, J. (2009). Antecedents of domain-specific quality of life after colorectal cancer. Psychooncology, 18(2), 216–220.

    Article  PubMed  Google Scholar 

  9. Lynch, B. M., Steginga, S. K., Hawkes, A. L., Pakenham, K. I., & Dunn, J. (2008). Describing and predicting psychological distress after colorectal cancer. Cancer, 112(6), 1363–1370.

    Article  PubMed  Google Scholar 

  10. Carver, C. S., Smith, R. G., Antoni, M. H., Petronis, V. M., Weiss, S., & Derhagopian, R. P. (2005). Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer. Health Psychology, 24(5), 508–516.

    Article  PubMed  Google Scholar 

  11. Chambers, S. K., Lynch, B. M., Aitken, J., & Baade, P. (2009). Relationship over time between psychological distress and physical activity in colorectal cancer survivors. Journal of Clinical Oncology, 27(10), 1600–1606.

    Article  PubMed  Google Scholar 

  12. Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992–1003.

    Article  PubMed  CAS  Google Scholar 

  13. Folkman, S., Lazarus, R. S., Gruen, R. J., & DeLongis, A. (1986). Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology, 50(3), 571–579.

    Article  PubMed  CAS  Google Scholar 

  14. Helgeson, V. S., & Cohen, S. (1996). Social support and adjustment to cancer: Reconciling descriptive, correlational, and intervention research. Health Psychology, 15(2), 135–148.

    Article  PubMed  CAS  Google Scholar 

  15. Lynch, B. M., Baade, P., Fritschi, L., Leggett, B., Owen, N., Pakenham, K., et al. (2007). Modes of presentation and pathways to diagnosis of colorectal cancer in Queensland. Medical Journal of Australia, 186(6), 288–291.

    PubMed  Google Scholar 

  16. Meyerhardt, J. A., Giovannucci, E. L., Holmes, M. D., Chan, A. T., Chan, J. A., Colditz, G. A., et al. (2006). Physical activity and survival after colorectal cancer diagnosis. Journal of Clinical Oncology, 24(22), 3527–3534.

    Article  PubMed  Google Scholar 

  17. Meyerhardt, J. A., Giovannucci, E. L., Ogino, S., Kirkner, G. J., Chan, A. T., Willett, W., et al. (2009). Physical activity and male colorectal cancer survival. Archives of Internal Medicine, 169(22), 2102–2108.

    Article  PubMed  Google Scholar 

  18. Booth, M., Owen, N., Bauman, A., & Gore, C. (1996). Relationship between a 14-day recall measure of leisure time physical activity and a submaximal test of physical work capacity in a population sample of Australian adults. Research Quarterly for Exercise and Sport, 67(2), 221–227.

    PubMed  CAS  Google Scholar 

  19. Booth, M. L., Owen, N., Bauman, A. E., & Gore, C. J. (1996). Retest reliability of recall measures of leisure-time physical activity in Australian adults. International Journal of Epidemiology, 25(1), 153–159.

    Article  PubMed  CAS  Google Scholar 

  20. Australian Institute of Health and Welfare (AIHW). (2003). The Active Australia Survey: A guide and manual for implementation, analysis and reporting. Canberra: AIHW.

    Google Scholar 

  21. Brown, W., Trost, S., Bauman, A., Mummery, K., & Owen, N. (2004). Test–retest reliability of four physical activity measures used in population surveys. Journal of Science and Medicine in Sport, 7, 205–215.

    Article  PubMed  CAS  Google Scholar 

  22. Scheier, M., Carver, C., & Bridges, M. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem: A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078.

    Article  PubMed  CAS  Google Scholar 

  23. Fife, B. L. (1995). The measurement of meaning in illness. Social Science and Medicine, 40(8), 1021–1028.

    Article  PubMed  CAS  Google Scholar 

  24. Siegett, R., Patten, D., & Walkey, F. (1987). Development of a brief social support questionnaire. New Zealand Journal of Psychology, 16, 79–83.

    Google Scholar 

  25. Sprangers, M. A. (1999). Quality-of-life assessment in colorectal cancer patients: Evaluation of cancer therapies. Seminars in Oncology, 26(6), 691–696.

    PubMed  CAS  Google Scholar 

  26. Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570–579.

    PubMed  CAS  Google Scholar 

  27. Ward, W. L., Hahn, E. A., Mo, F., Hernandez, L., Tulsky, D. S., & Cella, D. (1999). Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Quality of Life Research, 8(3), 181–195.

    Article  PubMed  CAS  Google Scholar 

  28. Diener, E., Emmons, R., Larsen, R., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75.

    Article  PubMed  CAS  Google Scholar 

  29. Derogatis, L., & Lopez, M. (2000). Brief Symptom Inventory 18: Administration, scoring and procedures manual. Minneapolis: National Computer Systems Inc.

    Google Scholar 

  30. Sun, G. W., Shook, T. L., & Kay, G. L. (1996). Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. Journal of Clinical Epidemiology, 49(8), 907–916.

    Article  PubMed  CAS  Google Scholar 

  31. Stefanek, M. E., Derogatis, L. P., & Shaw, A. (1987). Psychological distress among oncology outpatients. Prevalence and severity as measured with the Brief Symptom Inventory. Psychosomatics, 28(10), 530–532, 537–539.

    Google Scholar 

  32. Slade, T., Johnston, A., Oakley Browne, M. A., Andrews, G., & Whiteford, H. (2009). 2007 National Survey of Mental Health and Wellbeing: Methods and key findings. Australian and New Zealand Journal of Psychiatry, 43(7), 594–605.

    Article  PubMed  Google Scholar 

  33. Rhodes, G., & Lakey, B. (1999). Social support and psychological disorder: Insights from social psychology. In R. Kowlski & M. Leary (Eds.), The social psychology of emotional and behavioural problems: Interfaces of social and clinical psychology (pp. 281–309). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  34. Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science and Medicine, 48(11), 1507–1515.

    Article  PubMed  CAS  Google Scholar 

  35. Donohoe, J. E. (2011). To what extent can response shift theory explain the variation in prostate cancer patients’ reactions to treatment side-effects? A review. Quality of Life Research, 20(2), 161–167.

    Article  PubMed  Google Scholar 

  36. Schwartz, C. E. (2010). Applications of response shift theory and methods to participation measurement: A brief history of a young field. Archives of Physical Medicine and Rehabilitation, 91(9 Suppl), S38–S43.

    Article  PubMed  Google Scholar 

  37. Chambers, S. K., Schover, L., Halford, K., Clutton, S., Ferguson, M., Gordon, L., et al. (2008). ProsCan for couples: Randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer who receive radical prostatectomy. BMC Cancer, 8, 226.

    Article  PubMed  Google Scholar 

  38. Porter, L. S., Keefe, F. J., Garst, J., Baucom, D. H., McBride, C. M., McKee, D. C., et al. (2011). Caregiver-assisted coping skills training for lung cancer: Results of a randomized clinical trial. Journal of Pain and Symptom Management, 41(1), 1–13.

    Google Scholar 

  39. Chambers, S. K., Pinnock, C., Lepore, S. J., Hughes, S., & O’Connell, D. L. (2011). A systematic review of psychosocial interventions for men with prostate cancer and their partners. Patient Education and Counseling. 85(2), 14. doi:10.1016/j.pec.2011.01.027.

  40. Baade, P., Dasgupta, P., Aitken, J., & Turrell, G. (2011). Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Medical Journal of Australia, 195(6), 350–354.

    Article  PubMed  Google Scholar 

  41. Sellar, M., & Courneya, K. (2011). Physical activity and gastrointestinal survivorship. In K. S. Courneya & C. M. Friedenreich (Eds.), Physical activity and cancer (pp. 237–253). Berlin, Germany: Springer.

    Google Scholar 

  42. Courneya, K. S., & Friedenreich, C. M. (2010). Physical activity and cancer. Berlin, Germany: Springer.

  43. Holland, J., Watson, M., & Dunn, J. (2011). The IPOS new international standard of quality cancer care: Integrating the psychosocial domain into routine care. Psychooncology, 20(7), 677–680.

    Google Scholar 

  44. Hutchison, S. D., Steginga, S. K., & Dunn, J. (2006). The tiered model of psychosocial intervention in cancer: A community based approach. Psychooncology, 15(6), 541–546.

    Article  PubMed  Google Scholar 

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This project was funded by the Cancer Council Queensland. We thank Rachel Austin and Monica West for research support.

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Correspondence to Suzanne K. Chambers.

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Chambers, S.K., Meng, X., Youl, P. et al. A five-year prospective study of quality of life after colorectal cancer. Qual Life Res 21, 1551–1564 (2012).

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