Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. https://doi.org/10.3322/caac.21442.

    Article  PubMed  Google Scholar 

  2. Manitta V, Zordan R, Cole-Sinclair M, Nandurkar H, Philip J. The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manage. 2011;42(3):432–42. https://doi.org/10.1016/j.jpainsymman.2010.12.008.

    Article  PubMed  Google Scholar 

  3. Miles A, McClements PL, Steele RJ, Redeker C, Sevdalis N, Wardle J. Perceived diagnostic delay and cancer-related distress: a cross-sectional study of patients with colorectal cancer. Psych Oncol. 2017;26(1):29–36. https://doi.org/10.1002/pon.4093.

    Article  Google Scholar 

  4. Averyt JC, Nishimoto PW. Psychosocial issues in colorectal cancer survivorship: the top ten questions patients may not be asking. J Gastrointest Oncol. 2014;5(5):395–400. https://doi.org/10.3978/j.issn.2078-6891.2014.058.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Holland JC, Andersen B, Breitbart WS, Buchmann LO, Compas B, Deshields TL, et al. NCCN clinical practice guidelines in oncology (NCCN) guidelines: distress management. J National Comprehensive Cancer Network. 2013;11(2):190–209.

    Article  Google Scholar 

  6. Bidstrup PE, Johansen C, Mitchell AJ. Screening for cancer-related distress: summary of evidence from tools to programmes. Acta Oncologica. 2011;50(2):194–204. https://doi.org/10.3109/0284186X.2010.533192.

    Article  PubMed  Google Scholar 

  7. Smith SK, Loscalzo M, Mayer C, Rosenstein DL. Best practices in oncology distress management: beyond the screen. Am Soc Clin Oncol Educ Book. 2018;38:813–21. https://doi.org/10.1200/EDBK_201307.

    Article  PubMed  Google Scholar 

  8. Abrahamson K. Dealing with cancer-related di stress. Am J Nurs. 2010;110(4):67–9. https://doi.org/10.1097/01.NAJ.0000370162.07674.f6.

    Article  PubMed  Google Scholar 

  9. Deimling GT, Brown SP, Albitz C, Burant CJ, Mallick N. The relative importance of cancer-related and general health worries and distress among older adult, long-term cancer survivors. Psych Oncol. 2017;26(2):182–90. https://doi.org/10.1002/pon.4015.

    Article  Google Scholar 

  10. Gibbons A, Groarke A, Sweeney K. Predicting general and cancer-related distress in women with newly diagnosed breast cancer. BMC Cancer. 2016;16(1):935.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Syrowatka A, Motulsky A, Kurteva S, Hanley JA, Dixon WG, Meguerditchian AN, et al. Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Res Treat. 2017;165(2):229–45. https://doi.org/10.1007/s10549-017-4290-9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Graves KD, Arnold SM, Love CL, Kirsh KL, Moore PG, Passik SD. Distress screening in a multidisciplinary lung cancer clinic: prevalence and predictors of clinically significant distress. Lung Cancer. 2007;55(2):215–24. https://doi.org/10.1016/j.lungcan.2006.10.001.

    Article  PubMed  Google Scholar 

  13. Howes J, Simpson J, McLeod D, Digout C, Spencer J, Maginley D, et al. Best practice guideline for the management of cancer-related distress in adults. Supportive Care Cancer Site Team, Cancer Care Nova Scotia 10/30/2014.

  14. Occhipinti S, Chambers SK, Lepore S, Aitken J, Dunn J. A longitudinal study of post-traumatic growth and psychological distress in colorectal cancer survivors. PLoS One. 2015;10(9):e0139119. https://doi.org/10.1371/journal.pone.0139119.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Worster B, Holmes S. The preoperative experience of patients undergoing surgery for colorectal cancer: a phenomenological study. Eur J Oncol Nurs. 2008;12(5):418–24. https://doi.org/10.1016/j.ejon.2008.05.007.

    Article  PubMed  Google Scholar 

  16. Taylor C. Body image concerns after colorectal cancer surgery. Br J Nurs. 2015;24(10):8-S14. https://doi.org/10.12968/bjon.2015.24.Sup10.S8.

    Article  Google Scholar 

  17. Behrenbruch C, Shembrey C, Paquet-Fifield S, Mølck C, Cho HJ, Michael M, et al. Surgical stress response and promotion of metastasis in colorectal cancer: a complex and heterogeneous process. Clin Exp Metastasis. 2018;35(4):333–45. https://doi.org/10.1007/s10585-018-9873-2.

    Article  PubMed  Google Scholar 

  18. Pereira MG, Figueiredo AP, Fincham FD. Anxiety, depression, traumatic stress and quality of life in colorectal cancer after different treatments: a study with Portuguese patients and their partners. Eur J Oncol Nurs. 2012;16(3):227–32. https://doi.org/10.1016/j.ejon.2011.06.006.

    Article  Google Scholar 

  19. Jakobsson J, Idvall E, Kumlien C. The lived experience of recovery during the first 6 months after colorectal cancer surgery. J Clin Nurs. 2017;26(23–24):4498–505. https://doi.org/10.1111/jocn.13780.

    Article  PubMed  Google Scholar 

  20. Syrjala KL, Sutton SK, Jim HS, Knight JM, Wood WA, Lee SJ, et al. Cancer and treatment distress psychometric evaluation over time: A BMT CTN 0902 secondary analysis. Cancer. 2017;123(8):1416–23. https://doi.org/10.1002/cncr.30454.

    Article  PubMed  Google Scholar 

  21. Kuba K, Esser P, Scherwath A, Schirmer L, Schulz-Kindermann F, Dinkel A, et al. A cancer-and-treatment–specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Psych Oncol. 2017;26(8):1164–71. https://doi.org/10.1002/pon.4295.

    Article  Google Scholar 

  22. Mosher CE, Winger JG, Given BA, Helft PR, O'Neil BH, Mosher CE, et al. Mental health outcomes during colorectal cancer survivorship: a review of the literature. Psych Oncol. 2016;25(11):1261–70. https://doi.org/10.1002/pon.3954.

    Article  Google Scholar 

  23. Lynch BM, Steginga SK, Hawkes AL, Pakenham KI, Dunn J. Describing and predicting psychological distress after colorectal cancer. Cancer. 2008;112(6):1363–70. https://doi.org/10.1002/cncr.23300.

    Article  PubMed  Google Scholar 

  24. Landsbergen KM, Prins JB, Brunner HG, Van Duijvendijk P, Nagengast FM, Van Krieken JH, et al. Psychological distress in newly diagnosed colorectal cancer patients following microsatellite instability testing for Lynch syndrome on the pathologist’s initiative. Familial Cancer. 2012;11(2):259–67. https://doi.org/10.1007/s10689-012-9510-1.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Geue K, Rieckhof S, Buttstaedt M, Singer S. Do cancer patients with high levels of distress benefit more than less distressed patients from outpatient art therapy? Eur J Oncol Nurs. 2017;30:1–7. https://doi.org/10.1016/j.ejon.2017.07.004.

    Article  PubMed  Google Scholar 

  26. Gigic B, Boeing H, Toth R, Böhm J, Habermann N, Scherer D, et al. Associations between dietary patterns and longitudinal quality of life changes in colorectal cancer patients: the ColoCare study. Nutr Cancer. 2018;70(1):51–60. https://doi.org/10.1080/01635581.2018.1397707.

    Article  PubMed  Google Scholar 

  27. Liesenfeld DB, Grapov D, Fahrmann JF, Salou M, Scherer D, Toth R, et al. Metabolomics and transcriptomics identify pathway differences between visceral and subcutaneous adipose tissue in colorectal cancer patients: the ColoCare study. Am J Clin Nutr. 2015;102(2):433–43. https://doi.org/10.3945/ajcn.114.103804.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. Ulrich CM, Gigic B, Böhm J, Ose J, Viskochil R, Schneider M, et al. The ColoCare study - a paradigm of transdisciplinary science in colorectal cancer outcomes. Cancer Epidemiol Biomark Prev. 2018;28(3):591–601. https://doi.org/10.1158/1055-9965.EPI-18-0773.

    Article  Google Scholar 

  29. Vaglio J, Conard M, Poston WS, O'Keefe J, Haddock CK, House J, et al. Testing the performance of the ENRICHD social support instrument in cardiac patients. Health Qual Life Outcomes. 2004;2:24.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Investigators ENRICHD. Enhancing recovery in coronary heart disease (ENRICHD) study intervention: rationale and design. Psychosom Med. 2001;63(5):747–55.

    Google Scholar 

  31. Cordes A, Herrmann-Lingen C, Büchner B, Hessel A. Repräsentative Normierung des ENRICHD- Social-Support-Instrument (ESSI) – Deutsche Version. 2009;2:16–32.

  32. Scott N, Fayers P, Aaronson N, Bottomley A, de Graeff A, Groenvold M, et al. EORTC QLQ-C30. Reference values. Brussels: Belgium EORTC; 2008.

    Google Scholar 

  33. Jocham HR, Dassen T, Widdershoven G, Halfens R. Reliability and validity of the EORTC QLQ-C30 in palliative care cancer patients. Cent Eur J Med. 2009;4(3):348–57. https://doi.org/10.2478/s11536-009-0032-7.

    Article  Google Scholar 

  34. Syrjala KL, Yi JC. SL Langer. SL. Psychometric properties of the cancer and treatment distress (CTXD) measure in hematopoietic cell transplantation patients. Psych Oncol. 2016;25(5):529–35. https://doi.org/10.1002/pon.3861.

    Article  Google Scholar 

  35. Rischer J, Scherwath A, Zander AR, Koch U, Schulz-Kindermann F. Sleep disturbances and emotional distress in the acute course of hematopoietic stem cell transplantation. Bone Marrow Transplant. 2009;44(2):121–8. https://doi.org/10.1038/bmt.2008.

    CAS  Article  PubMed  Google Scholar 

  36. Knight JM, Syrjala KL, Majhail NS, Martens M, Le-Rademacher J, Logan BR, et al. Patient-reported outcomes and socioeconomic status as predictors of clinical outcomes after hematopoietic stem cell transplantation: a study from the blood and marrow transplant clinical trials network 0902 trial. Biol Blood Marrow Transplant. 2016;22(12):2256–63. https://doi.org/10.1016/j.bbmt.2016.08.016.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018;68(2):153–65. https://doi.org/10.3322/caac.21443.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Burgoyne MJ, Bingen K, Leuck J, Dasgupta M, Ryan P, Hoffmann RG. Cancer-related distress in young adults compared to middle-aged and senior adults. J Adolesc Young Adult Oncol. 2015;4(2):56–63. https://doi.org/10.1089/jayao.2014.0005.Epub.

    Article  PubMed  Google Scholar 

  39. Kavitha R, Jayan C. Role of social support on cancer distress among breast cancer patients. Behavioral Social Sciences. 2014;2(1):247–51.

    Google Scholar 

  40. Sharma A, Walker LG, Monson JR. Baseline quality of life factors predict long term survival after elective resection for colorectal cancer. Int J Surg Oncol. 2013;2013:269510. https://doi.org/10.1155/2013/269510.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Seber GA, Lee AJ. Linear regression analysis. Vol. 329. John Wiley & Sons; 2012.

  42. Sharp L, Patel D, Clarke S. The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psych Res. 2011;70(5):395–402. https://doi.org/10.1016/j.jpsychores.2010.11.003.

    Article  Google Scholar 

  43. Neo J, Fettes L, Gao W, Higginson IJ, Maddocks M. Disability in activities of daily living among adults with cancer: a systematic review and meta-analysis. Cancer Treat Rev. 2017;61:94–106. https://doi.org/10.1016/j.ctrv.2017.10.006.

    Article  PubMed  Google Scholar 

  44. Rasmussen S, Larsen PV, Søndergaard J, Elnegaard S, Svendsen RP, Jarbøl DE. Specific and non-specific symptoms of colorectal cancer and contact to general practice. Fam Pract. 2015;32(4):387–94. https://doi.org/10.1093/fampra/cmv032.

    Article  PubMed  Google Scholar 

  45. Barber FD. Effects of social support on physical activity, self-efficacy, and quality of life in adult cancer survivors and their caregivers. In Oncol Nurs Forum. 2013;40(5):481–9. https://doi.org/10.1188/13.ONF.481-489.

    Article  Google Scholar 

  46. Trunzo JJ, Pinto BM. Social support as a mediator of optimism and distress in breast cancer survivors. J Consult Clin Psychol. 2003;71(4):805–11. https://doi.org/10.1037/0022-006X.71.4.805.

    Article  PubMed  Google Scholar 

  47. Maisey NR, Norman A, Watson M, Allen MJ, Hill ME, Cunningham D. Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer. 2002;38(10):1351–7. https://doi.org/10.1016/S0959-8049(02)00098-9.

    CAS  Article  PubMed  Google Scholar 

  48. Ahlberg KT, Ekman T, Gaston-Johansson F. Fatigue, psychological distress, coping resources, and functional status during radiotherapy for uterine cancer. In Oncol Nurs Forum. 2005;32(3):633–40. https://doi.org/10.1188/05.ONF.633-640.

    Article  Google Scholar 

  49. Mitchell AJ. Short screening tools for cancer-related distress: a review and diagnostic validity meta-analysis. J Natl Compr Cancer Netw. 2010;8(4):487–94.

    Article  Google Scholar 

  50. Savard J, Ivers H. The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics. J Psychosom Res. 2013;74(4):354–60. https://doi.org/10.1016/j.jpsychores.2012.12.013.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Biljana Gigic, Karen L. Syrjala or Cornelia M. Ulrich.

Ethics declarations

Conflict of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 37 kb)

ESM 2

(PDF 265 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-019-00845-y

Keywords

  • Colorectal neoplasms
  • Cancer
  • Quality of life
  • Distress
  • Surgical oncology
  • Clinical management