Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
J Cancer Surviv. 2020 Jun;14(3):305-315. doi: 10.1007/s11764-019-00845-y. Epub 2020 Mar 12.
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.
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.
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.
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.
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.
癌症相关的困扰在治疗结束后很长一段时间内仍然存在。结直肠癌（CRC）幸存者中，与困扰相关的因素在很大程度上尚未得到探索。我们研究了手术后第一年 CRC 患者随时间变化的困扰和相关风险因素。
我们纳入了来自德国海德堡 ColoCare 研究的 212 例 CRC 患者，这些患者在手术后 6 个月和 12 个月时的数据可用。在手术前评估了社会人口统计学和生活方式因素、社会支持以及与健康相关的生活质量（HrQOL），以评估其作为癌症相关困扰的预测因素。使用癌症和治疗困扰量表（CTXD）测量困扰。线性回归分析考察了风险因素与困扰之间的关联。
困扰亚量表评分随时间显著变化：健康负担亚量表评分增加（P <.001），而财务（P =.004）、医疗需求（P <.001）和身份（P <.001）亚量表评分随时间降低。不确定性和家庭紧张亚量表评分没有变化。年龄较小、收入较低、肿瘤分期较晚、社会支持较差和基线 HrQOL 较差，预测 6 个月和 12 个月时的困扰水平较高。
手术后癌症相关的困扰仍然没有得到解决。尽管有些风险因素难以改变，但可以更早地识别出处于最高风险的患者，以便采取可能的预防策略。
在手术前筛查风险因素，可以针对那些支持较少的患者采取干预措施，包括改善资源的策略，从而降低 CRC 幸存者的长期困扰。
