Social support following diagnosis and treatment for colorectal cancer and associations with health-related quality of life: Results from the UK ColoREctal Wellbeing (CREW) cohort study

The time course of health-related Quality of Life in rectal cancer patients undergoing combined modality treatment

Background and purpose

This exploratory prospective observational study investigated the changes in Health-related Quality of Life (HRQoL) in rectal cancer patients (RCPs), from diagnosis to one-year-post-surgery follow-up and explored the role of physical symptoms and psychological determinants on HRQoL at the different time points.

Materials and methods

We assessed HRQoL, psychological distress, coping, affectivity, alexithymia and social support in 43 RCPs treated with preoperative (chemo)radiation and surgery, at three different assessment time points: diagnosis (T0), one month after the end of preoperative treatment (T1), one month after resection surgery (T2), and at follow-up (T3).

Results

The data showed that HRQoL decreased during active treatments, especially between T1 and T2 (p = 0.005), before increasing again at follow-up (p = 0.002).Baseline intestinal symptoms (p < 0.001) and negative affectivity trait (p = 0.03) significantly predicted HRQoL at T0. Baseline pain (p < 0.001), intestinal (p = 0.003) and urinary (p = 0.009) symptoms at T1 significantly predicted HRQoL at T1. A fatalistic coping style at T1 (p = 0.013), psychological distress (p = 0.003), mouth symptoms (p = 0.001) at T2 significantly predicted HRQoL at T2. Similarly, a fatalistic coping style at T1 (p = 0.006), psychological distress (p = 0.004), mouth (p = 0.002) and pain symptoms (p = 0.002) at T3 significantly predicted HRQoL at T3.

Conclusion

Several physical and psychological factors are involved in the changes occurring after diagnosis in RCPs' HRQoL. While cancer-related symptoms and treatment-related physical side effects are the main predictors of HRQoL at diagnosis and during active treatments, early psychological reactions have a higher predictive weight in post-treatment HRQoL.These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.

Patient perspective on adapting to bowel dysfunction after rectal cancer surgery

AIM

Bowel dysfunction continues to be a clinically significant consequence of rectal cancer surgery, affecting quality of life. Rectal cancer patients value self-empowerment and adaptation to change to improve their quality of life in the context of bowel dysfunction. There are limited qualitative data addressing patients' perspectives on adapting to bowel dysfunction. The aim of this study is to evaluate patients' perspectives on adapting to bowel dysfunction after rectal cancer surgery.

METHOD

Adult patients who underwent rectal cancer surgery with sphincter preservation at a single colorectal referral centre from July 2017 to July 2020 were included. Patients were excluded if they had surgery <1 year since recruitment, received a permanent stoma or developed recurrence or metastasis. Semistructured interviews were held by phone and transcribed verbatim. Bowel dysfunction was assessed via the low anterior resection syndrome (LARS) score. Thematic analysis was used to identify adaptations which patients found helpful for improving bowel dysfunction after rectal cancer surgery.

RESULTS

A total of 54 patient interviews were included. The distribution of patients with no, minor and major LARS was 39%, 22% and 39%, respectively. Four main themes were conceived from the analysis: implementing lifestyle changes, fostering supportive relationships and self-compassion, communication and access to resources, and adapting to social and cultural challenges. Associated subthemes were identified, namely forward planning, self-compassion and addressing social stigma.

CONCLUSION

Patients' valuable perspective on adapting to bowel dysfunction involve subtle themes which expand the existing literature. These themes inform a patient-centred approach, which may improve outcomes and quality of care for rectal cancer patients.

Emotional Distress Symptoms, Coping Efficacy, and Social Support: A Network Analysis of Distress and Resources in Persons With Cancer

BACKGROUND

The study's main aim was to analyze the structure and configuration of distress symptoms and resource factors.

PURPOSE

Common methods of assessing distress symptoms in cancer patients (i) do not capture the configuration of individual distress symptoms and (ii) do not take into account resource factors (e.g., social support, coping, caring health professionals). Network analysis focuses on the configuration and relationships among symptoms that can result in tailored interventions for distress. Network analysis was used to derive a symptom-level view of distress and resource factors.

METHODS

Nine hundred and ninety-two cancer patients (mixed diagnoses) completed an abridged Distress Screening Schedule that included 24 items describing symptoms related to distress (depression, anxiety) and resource factors (social support, coping, caring health professionals).

RESULTS

In network analysis, the centrality strength index (CSI) is the degree to which an item is connected to all other items, thus constituting an important focal point in the network. A depression symptom had the highest CSI value: felt lonely/isolated (CSI = 1.30). In addition, resource factors related to coping efficacy (CSI = 1.20), actively seeking support (CSI = 1.10), perceiving one's doctor as caring (CSI = 1.10), and receiving social support (CSI = 1.10) also all had very high CSI scores.

CONCLUSIONS AND IMPLICATIONS

These results emphasize the integral importance of the social symptoms of loneliness/isolation in distress. Thus, distress symptoms (loneliness) and resource factors (coping efficacy, seeking social support, and perceiving medical professionals as caring) should be integral aspects of distress management and incorporated into assessment tools and interventions to reduce distress.

Social support during re-entry period and long-term quality of life in breast cancer survivors: a 10-year longitudinal cohort study

PURPOSE

This study evaluated the association between social support during the re-entry period and long-term health-related quality of life (HRQoL) in breast cancer survivors using a longitudinal cohort study.

METHODS

This is a prospective cohort study with 275 breast cancer survivors who reported HRQoL at 5 and 10 years after diagnosis. Social support for the re-entry period was measured 3 years after diagnosis using the Medical Outcome Study Social Support Survey (MOS-SSS). HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and Breast Cancer-Specific Module (BR-23). Multivariable linear regression analysis was performed to evaluate HRQoL at 5 and 10 years after diagnosis by level of social support during the re-entry period.

RESULTS

The mean (SD) of social support during re-entry period was 68.5. The low social support (LSS, score < 55) group during the re-entry period had a significantly lower HRQoL (mean difference =  - 12.93) compared to moderate or high social support (MHSS, score ≥ 55) group. 5 and 10 years after diagnosis, the LSS group continued to demonstrate lower HRQoL (5 years: - 7.17; 10 years: - 7.85) compared to the MHSS group. The LSS group were more likely to have lower role and social function scores, and higher fatigue, pain, and financial problems compared to the MHSS group at 10 years after diagnosis.

CONCLUSIONS

Breast cancer survivors who received lower social support during the re-entry period were more likely to experience poorer HRQoL in the long term than those who did not.

Resilience provides mediating effect of resilience between fear of progression and sleep quality in patients with hematological malignancies

BACKGROUND

Hematological tumors are common malignant tumors, with high morbidity and mortality rates. Most patients with hematological malignancies develop sleep disorders that seriously affect their life and health because of acute onset of disease, rapid progression, high recurrence rates, complex treatment methods, and treatment costs.

AIM

To explore the mediating effect of resilience on fear of disease progression and sleep quality in patients with hematological malignancies.

METHODS

A cross-sectional analysis of 100 patients with hematological malignancies, treated in the First Affiliated Hospital of Jinzhou Medical University between August 2022 and August 2023, was conducted. Patients were assessed using a general data survey, a simplified scale for the fear of progression (FoP) of disease, a resilience scale, and the Pittsburgh Sleep Quality Index. Statistical analysis was conducted to determine the relationship between various patient characteristics and FoP, resilience, and sleep quality. Spearman's correlation analysis was used to examine the correlations between mental resilience, FoP, and sleep quality.

RESULTS

The total FoP score mean value in patients with hematological malignancies was 38.09 ± 5.16; the total resilience score mean value was 40.73 ± 7.04; and the Pittsburgh Sleep Quality Index score mean value was 10.72 ± 1.90. FoP, resilience, and sleep quality of the patients were associated with family per capita monthly income and patient education level (P < 0.05). Spearman correlation analysis revealed that FoP was negatively correlated with resilience and sleep quality scores (r = -0.560, -0.537, P < 0.01), respectively, and resilience was significantly associated with sleep quality scores (r = 0.688, P < 0.01). Mediation analysis showed that the mediating effect of resilience between FoP and sleep quality in patients with hematological malignancies was -0.100 and accounted for 50.51% of the total effect. This indicated that FoP directly and indirectly affected sleep quality through the mesomeric effect of resilience.

CONCLUSION

Resilience is an intermediary variable between FoP and sleep quality in patients with hematological malignancies. Medical staff should evaluate and follow-up FoP and resilience to implement measures to improve sleep quality.

Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review

AIM

To systematically review the types of spiritual interventions available for colorectal cancer survivors and determine if they improve their lives.

DESIGN

Systematic review.

DATA SOURCE

A thorough literature search was conducted in July 2023 using PRIMO, PubMed/Medline, Cochrane, CINAHL, Scopus, and EMBASE.

REVIEW METHODS

As an extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, the Synthesis Without Meta-Analysis reporting guideline was employed. A narrative synthesis was used to analyse the data.

RESULTS

Thirty-five articles were analysed for this study. The findings suggest that psychoeducational intervention, cognitive behavioural therapy intervention, mindfulness intervention, social intervention, and spiritual counselling improved CRC survivor's coping skills, boosted self-esteem, lessened anxiety, instilled hope, enhanced daily functioning, improved survival rates, improved neurological functional status and quality of life (QoL).

CONCLUSION

There is proof that spiritual interventions help CRC patients and improve their QoL. It has been discovered that spiritual intervention is helpful in the diagnosis, management, and treatment of CRC conditions.

IMPACT

CRC survivors may have impairments in their physical ability and daily functioning as a result of many symptoms, such as pain, bowel dysfunction, and exhaustion. Furthermore, individuals may encounter difficulties in several aspects of their psychological, emotional, social, and role functioning due to the presence of dread symptoms. Therefore, these study will help CRC survivors To implement spiritual interventions in the management of their long-term care. To cultivate problem-solving abilities, foster self-assurance, and enhance self-awareness. To alleviate symptoms, enhance everyday functioning, and improve QoL.

NO INDUCEMENT

No financial incentives were used to compensate patients or members of the public for this review.

Comparative Study of the Quality of Life and Coping Strategies in Oncology Patients

BACKGROUND

Despite the current data on morbidity and mortality, a growing number of patients with a diagnosis of cancer survive due to an early diagnosis and advances in treatment modalities. This study aimed to compare the quality of life and coping strategies in three groups of patients with cancer and identify associated clinical and sociodemographic characteristics.

METHODS

A comparative study was conducted with outpatients at a public hospital in the state of São Paulo, Brazil. The 300 participants were assigned to three groups: patients in palliative care (Group A), patients in post-treatment follow-up with no evidence of disease (Group B), and patients undergoing treatment for cancer (Group C). Data collection involved the use of the McGill Quality of Life Questionnaire and the Ways of Coping Questionnaire. No generic quality-of-life assessment tool was utilized, as it would not be able to appropriately evaluate the impact of the disease on the specific group of patients receiving palliative care.

RESULTS

Coping strategies were underused. Participants in the palliative care group had poorer quality of life, particularly in the psychological well-being and physical symptom domains. Age, currently undergoing treatment, and level of education were significantly associated with coping scores. Age, gender, income, and the absence of pharmacological pain control were independently associated with quality-of-life scores. Moreover, a positive association was found between coping and quality of life.

CONCLUSION

Cancer patients in palliative care generally report a lower quality of life. However, male patients, those who did not rely on pharmacological pain control, and those with higher coping scores reported a better perception of their quality of life. This perception tended to decrease with age and income level. Patients currently undergoing treatment for the disease were more likely to use coping strategies. Patients with higher education and quality-of-life scores also had better coping scores. However, the use of coping strategies decreased with age.

Changes and predictors of social support in adolescent and young adult cancer survivors-Results of a 7-year longitudinal study

OBJECTIVE

As social support has been shown to have beneficial effects on coping with cancer, our study aims to close the research gap on perceived social support in adolescent and young adult (AYA) cancer survivors.

METHODS

AYAs evaluated their perceived positive social support (PS) and detrimental interactions (DI) by completing the Illness-Specific Social Support Scale (ISSS-8) upon completion of acute treatment (t1) as well as 1 year (t2) and 7 years (t6) later. Temporal changes of social support were examined. Sociodemographic, psychological and medical factors were investigated as predictors for PS and DI by using mixed effects models.

RESULTS

We analyzed data from 319 cancer survivors (74.9% women). At baseline, survivors reported an average score of 13.73 (SD = 2.52) for PS and 3.92 (SD = 2.85) for DI. Average perceived PS changed over time, while DI remained stable. Males, AYAs without a partner and AYAs with clinically meaningful anxiety or depression levels reported fewer PS. Higher effort to cope with the disease and clinically significant anxiety and depression levels were associated with more perceived DI.

CONCLUSIONS

Existing social networks and perceived social support should be evaluated regularly in AYA-cancer survivorship. The identification and discussion of mental health of AYAs should also be a standard component in survivor consultations both during treatment and follow-up care, as elevated depression and anxiety levels were associated with fewer PS and more perceived DI.

Patient-reported unmet supportive care needs in long-term colorectal cancer survivors after curative treatment in an Asian population

OBJECTIVES

Despite an increase in colorectal cancer (CRC) survival, less is known about CRC-specific long-term unmet supportive needs in Asian patients. This study aimed to examine the prevalence of long-term unmet needs and identify clinical and socio-demographic factors associated with increased unmet needs in Asian CRC survivors.

DESIGN AND SETTING

We conducted a cross-sectional study that assessed unmet needs using the Cancer Survivors' Unmet Needs scale. CRC survivors of at least two years after undergoing curative surgery were recruited from an outpatient clinic of a large public hospital in Singapore.

RESULTS

In total, 400 CRC survivors with a mean age of 64 and a median survival time post-surgery of 78 months participated in the study. Approximately half of patients (52%) reported at least one unmet need. Male gender (RR 1.19, p = 0.01), age greater than 65 years (RR 0.63, p < 0.0001), longer follow up of more than 5 years (RR 0.80, p = 0.009), presence of a permanent stoma (RR 1.78, p < 0.0001), prior radiotherapy in treatment course (RR 1.99, p < 0.0001), higher educational status (RR 1.30, p = 0.0002), currently employed (RR 0.84, p = 0.014), currently married (RR 0.84, p = 0.01) were significant predictors for increased unmet needs.

CONCLUSION

There is a high prevalence of unmet needs in long-term Asian CRC survivors, which underscores the importance of screening patients to allow for early detection of unmet needs. Our findings on sociodemographic and clinical predictors can inform the development of targeted interventions tailored to the need domains and improvement of survivorship programmes.

Inequalities in treatment among patients with colon and rectal cancer: a multistate survival model using data from England national cancer registry 2012-2016

BACKGROUND

Individual and tumour factors only explain part of observed inequalities in colorectal cancer survival in England. This study aims to investigate inequalities in treatment in patients with colorectal cancer.

METHODS

All patients diagnosed with colorectal cancer in England between 2012 and 2016 were followed up from the date of diagnosis (state 1), to treatment (state 2), death (state 3) or censored at 1 year after the diagnosis. A multistate approach with flexible parametric model was used to investigate the effect of income deprivation on the probability of remaining alive and treated in colorectal cancer.

RESULTS

Compared to the least deprived quintile, the most deprived with stage I-IV colorectal cancer had a lower probability of being alive and treated at all the time during follow-up, and a higher probability of being untreated and of dying. The probability differences (most vs. least deprived) of being alive and treated at 6 months ranged between -2.4% (95% CI: -4.3, -1.1) and -7.4% (-9.4, -5.3) for colon; between -2.0% (-3.5, -0.4) and -6.2% (-8.9, -3.5) for rectal cancer.

CONCLUSION

Persistent inequalities in treatment were observed in patients with colorectal cancer at every stage, due to delayed access to treatment and premature death.

Is Social Support Associated with Colorectal Cancer Care Utilization? A Multilevel Mixed-Effects Model of a Cross-Sectional Cohort Study in Vietnam

OBJECTIVE

To investigate the relationship between the social support (SS) and colorectal cancer (CRC) care utilization of patients in the central region of Vietnam.

METHODS

This was a cross-sectional cohort study in which the cohort was defined as all residential patients diagnosed with CRC in a tertiary hospital, Hue Central Hospital (HCH), in central Vietnam from 2013 to 2019. Social support was considered the main independent variable and was evaluated using the Medical Outcomes Study Social Support Survey (MOS-SSS), a self-administered 19-item SS survey. MOS-SSS is a widely used scale for assessing social support in CRC patients because it is brief, easy to use, reliable, and valid. In this study, we considered a data framework with a multilevel structure that included the patient level and duration of diagnosis as the second level. We estimated the magnitude of SS and CRC-specific treatment modalities using multilevel mixed-effects (MM) models under a hierarchical approach.

RESULTS

The findings indicated that CRC care utilization rates were 89.9%, 48.5%, and 30.6% for surgical resection, chemotherapy, and radiation therapy, respectively. The overall trend of SS decreased significantly and affected the CRC care utilization. We found a positive effects of overall SS, as well as emotional and tangible support, on the number of hospitalization admissions and chemotherapy utilization.

CONCLUSION

This study suggests that the use of the MOS-SSS should be continued in the long term for CRC patients to enhance medical accessibility and care utilization.

Perceived negative consequences of cancer and psychological distress in survivors: the moderating role of social support

PURPOSE

Many cancer survivors experience psychological distress at some point during their care. The degree to which individuals perceive negative consequences of cancer has been associated with psychological distress, including anxiety and depression. Identifying psychosocial factors that buffer the effects of illness perceptions on distress may provide a target for intervention to improve the psychological health of cancer survivors. As such, the present study aimed to examine whether social support moderates the relationship between perceived negative consequences of cancer and psychological distress.

METHODS

The current longitudinal study of 413 cancer survivors (64% female, 58% breast cancer, Mage = 59.68, SD = 11.41) examined social support as a potential moderator of the relationship, hypothesizing that greater overall perceived social support would buffer the relationship between perceived negative consequences of cancer and subsequent symptoms of anxiety and depression.

RESULTS

Perceived negative consequences of cancer predicted anxiety and depression over time (p < .05), but social support had a buffering effect on the perceived negative consequences of cancer-anxiety relationship (β =  - .20, p < .001) as well as the perceived negative consequences of cancer-depression relationship (β =  - .11, p < .05).

CONCLUSION

Results suggest that social support is a protective factor over time against the pathway of illness perceptions leading to psychological distress among cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Interventions that improve social support in cancer survivors may attenuate psychological distress and help support these individuals in their survivorship journey.

Mediating role of resilience between family functioning and quality of life in patients with advanced colorectal cancer

To better understand the relationship between family functioning, resilience, and quality of life (including physical and mental component score, PCS and MCS) in patients with advanced colorectal cancer (CRC) to predict and improve their quality of life.

A cross-sectional study was conducted in which a total of 165 patients with advanced colorectal cancer participated in a one-time survey. Measures included the Family Functioning Assessment Device, the 10-item Connor-Davidson Resilience Scale, and the SF-12 Health Survey Assessment Scale. The data analysis methods included descriptive analysis, pearson's correlation analysis, t-tests, and nonparametric tests.

Of the patients with advanced CRC, 47.27% and 72.73% had moderate or low mental and physical health components, respectively. The results indicated that in patients with advanced CRC, family function was negatively correlated with resilience (p < 0.01), family functioning was negatively correlated with MCS (p < 0.01), and resilience was positively correlated with PCS (p < 0.05) and MCS (p < 0.01). The mediating analysis revealed that family functioning regulated MCS through resilience (effect value = 13.17%).

Our findings suggest that the MCS of patients with advanced CRC is influenced by both family functioning and resilience. PCS in patients with advanced CRC appears to be influenced by resilience but not by family functioning.

The role of social networks in the self-management support for young women recently diagnosed with breast cancer

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016-2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes.

Coping strategies and considerations regarding low anterior resection syndrome and quality of life among patients with rectal cancer; a qualitative interview study

Introduction

Low anterior resection syndrome (LARS) is defined as disordered bowel function following rectal resection, which is detrimental to quality of life (QoL). A recent international consensus definition of LARS stresses the importance of focusing on both the symptoms and the consequences that the symptoms have for the individual patient as studies indicate that LARS has a negative impact on patients’ QoL. However, an ongoing PROM study investigating late sequelae after rectal cancer finds that a minor proportion of patients scoring major LARS experience none or only little impact on quality of life

Aim

The aim of this study was to identify patients’ considerations and coping strategies to establish why the burden caused by major LARS had little or no influence on their QoL.

Materials and methods

This was a qualitative interview study based on 21 semi-structured individual telephone interviews with patients treated for rectal cancer. Data were analysed using a hermeneutic inspired thematic analysis.

Results and conclusion

Three themes emerged from the analysis; Adapting new life situation, Altering life perception and the Importance of relationships. Major LARS and its consequences following rectal cancer may be managed or altered by adopting problem-focused and emotion-focused coping strategies. Maintaining a positive attitude and having a good network of family and friends constitute a surplus, allowing patients to cope with the need for changed behaviour and appreciate the life that they have been given. Accepting that major LARS and its consequences cause limitations in life allowed patients to change their normality threshold over time.

The Use of Natural Language Processing to Assess Social Support in Patients With Advanced Cancer

BACKGROUND

Data examining associations among social support, survival, and healthcare utilization are lacking in patients with advanced cancer.

METHODS

We conducted a cross-sectional secondary analysis using data from a prospective longitudinal cohort study of 966 hospitalized patients with advanced cancer at Massachusetts General Hospital from 2014 through 2017. We used NLP to identify extent of patients' social support (limited versus adequate as defined by NLP-aided review of the Electronic Health Record (EHR)). Two independent coders achieved a Kappa of 0.90 (95% CI: 0.84-1.00) using NLP. Using multivariable regression models, we examined associations of social support with: 1) OS; 2) death or readmission within 90 days of hospital discharge; 3) time to readmission within 90 days; and 4) hospital length of stay (LOS).

RESULTS

Patients' median age was 65 (range: 21-92) years, and a plurality had gastrointestinal (GI) cancer (34.3%) followed by lung cancer (19.5%). 6.2% (60/966) of patients had limited social support. In multivariable analyses, limited social support was not significantly associated with OS (HR = 1.13, P = 0.390), death or readmission (OR = 1.18, P = 0.578), time to readmission (HR = 0.92, P = 0.698), or LOS (β = -0.22, P = 0.726). We identified a potential interaction suggesting cancer type (GI cancer versus other) may be an effect modifier of the relationship between social support and OS (interaction term P = 0.053). In separate unadjusted analyses, limited social support was associated with lower OS (HR = 2.10, P = 0.008) in patients with GI cancer but not other cancer types (HR = 1.00, P = 0.991).

CONCLUSION

We used NLP to assess the extent of social support in patients with advanced cancer. We did not identify significant associations of social support with OS or healthcare utilization but found cancer type may be an effect modifier of the relationship between social support and OS. These findings underscore the potential utility of NLP for evaluating social support in patients with advanced cancer.

Assessment of socio-relational self-efficacy in breast cancer patients: Italian validation of the social relationship coping efficacy scale (SRCE-I)

BACKGROUND

Social relationship coping efficacy (SRCE) represents the ability to maintain or enhance social relationships in the context of serious illness. The purpose of the current study was to confirm the factor structure, psychometric properties, and utility of the Italian version of the SRCE scale.

METHODS

181 breast cancer patients completed the SRCE-Italian (SRCE-I), the Cancer Behavior Inventory-Brief/Italian (CBI-B/I), quality of life (QOL) measures (EORTC QLQ-C30; EORTC QLQ-BR23), and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The SRCE-I was internally consistent (Cronbach alpha = .95) and factor analysis confirmed that the SRCE-I was a unidimensional construct. In terms of validity, the SRCE-I was correlated with QOL (EORTC QLQ-30, Social Functioning, r = .33, Emotional Functioning, r = .57, and Global Health/Quality of Life; r = .54) and scales of the EORTC QLQ-BR23 (e.g., Future Perspective, r = .38; Breast Symptoms, -.31). SRCE-I was also correlated negatively with the HADS (r = -.72) and positively with the CBI-B/I (r = .79), a measure of coping efficacy (all ps < .001). Mediation analyses confirmed the utility of the SRCE-I scale as a mediating mechanism in enhancing social functioning and QOL.

CONCLUSIONS

The SRCE-I is a structurally sound, reliable, and valid measure that assesses the ability to maintain or enhance social support and mitigate the loss of social support. The SRCE-I can be used as a screening measure to assess low efficacy for maintaining social support or as a measure to detect the change in efficacy for enhancing social support in interventions to improve the QOL of patients.

A Model of Social Support for a Patient–Informal Caregiver Dyad

Background

Close persons (informal caregivers) are the most important providers of support indicated by cancer patients. Cancer affects couples as a codependent system. The aim of this study was to investigate the factors influencing the multidimensional aspect of social support in a cancer patient–informal caregiver dyad.

Methods

The research project was cross-sectional. The diagnostic survey method and the survey technique were used. The study was conducted using standardised research tools: BSSS, POS, SSCS, TIPI, ET, SPT, and the authors' own tool for sociodemographic assessment.

Results

Patients and caregivers experienced injustice, exclusion, and a sense of loss with a similar intensity. Statistically significant differences between the examined patients and their caregivers were obtained for the support currently received (p < 0.01), emotional support (p < 0.05), and the general level of protective buffering support (p < 0.001). A higher level of information support for caregivers increases the need for support and a sense of support for patients.

Conclusion

The quality of functioning and mental well-being of patients is directly influenced by the way their caregivers experience the situation of caring for them; negative or positive states of caregivers, affecting the condition of patients, may affect the course of treatment and contribute to or delay the improvement of the state of health. The subjective sense of support in patients during treatment depends on the need for help that is shown to their caregivers. The sense of support variable is subjective and sometimes disproportionate to the support received and given. Therefore, both the patient and their loved one should be provided with care during the treatment process. In the treatment process, both patients and their caregivers need more protective buffering support that allows them to overcome difficulties related to stress, anxiety, and insecurity, thus weakening their negative effects rather than functional support: emotional, information, instrumental, or material.

Exploring variables affecting sense of coherence and social support in recovery after colorectal cancer surgery among the oldest old

OBJECTIVE

To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer.

METHODS

This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables.

RESULTS

Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support.

CONCLUSION

The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery.

Sexual Functioning in Female Patients Undergoing Surgical Treatment for Colorectal Cancer-A Single-Center, Prospective Triple Timepoint Yearly Follow-Up

The study was aimed at assessing the quality of sexual functioning in female patients having undergone surgical treatment for cancer depending on the type of surgery. The prospective cohort consisted of 48 female patients (23 patients with stoma [A2] and 25 patients with maintained continuity of the GI tract [A1]). Study methods included a diagnostic survey and the analysis of medical records of patients. Research tools consisted of a standardized FSFI questionnaire and a proprietary form for evaluation of sociodemographic data. Measurements were performed at threetimepoints: On the day before the surgery (Measurement I) as well as six and 12 months after the surgery (Measurements II and III, respectively). Statistically significant differences in results were observed in Measurements II and III in the subscales of arousal (II:p = 0.0068, III:p = 0.0018), lubrication (II:p = 0.0221, III:p = 0.0134), orgasm (II:p = 0.0044, III:p = 0.0021), satisfaction (II:p = 0.0021, III:p = 0.0433), and pain/discomfort (II:p = 0.0343, III:p = 0.0473). In all cases, lower scores corresponding to lower quality of sexual functioning were observed in patients in whom stoma had been performed. Statistically significant differences in sexual functioning were observed at Measurements II and III in each group, with the results being significantly (p > 0.05) worse in patients having undergone Hartmann’s procedure or abdominoperineal resection). Variables significantly affecting self-assessed sexual satisfaction included marital status, age, and modality of neoadjuvant treatment. Restoration of the continuity of the gastrointestinal tract is a chance for better self-assessment of the patient’s quality of life as regards sexual functioning.

A Structural Model of Quality of Life in Patients after Colorectal Cancer Surgery

BACKGROUND

This study was conducted to determine a hypothetical model for the factors affecting the quality of life of postoperative colorectal cancer patients.

METHODS

We collected data from 209 patients that was analyzed using SPSS 22.0 and AMOS 25.

RESULTS

Predictive variables of the hypothesis model included an exogenous variable, social support, as well as endogenous variables self-efficacy, symptoms, health promotion behavior, and quality of life. Testing of the correction model showed that significant paths directly affecting quality of life of patients after colorectal cancer surgery included health promotion behavior, symptoms, and self-efficacy and also showed an explanation power of 58.7%. Social support was found to have a significant impact on the quality of life indirectly through self-efficiency.

CONCLUSIONS

To improve the quality of life of colorectal cancer patients, it is necessary to develop a nursing intervention program that strengthens patients' health promotion behaviors to alleviate their symptoms and improve their social support and self-efficacy.

Understanding the psychosocial impact of colorectal cancer on young-onset patients: A scoping review

Objective

The incidence of young‐onset (<50 years) colorectal cancer (CRC) has been increasing internationally. The psychosocial experience of younger cancer patients is vastly different from older patients, especially in domains such as financial toxicity, body image, and sexual dysfunction. What is unknown is the cancer type‐specific experience. The aim of the current scoping review was to examine (1) the psychosocial factors and/or outcomes associated with young‐onset CRC and (2) other determinants that influences these outcomes.

Methods

A systematic search was conducted on four databases (PubMed, CINAHL, Scopus and PsycINFO) from inception to December 2020 using key terms and combinations. Primary literature that examined the psychosocial (e.g., quality‐of‐life, emotional, social, sexual) impact of young‐onset CRC were included.

Results

A total of 1389 records were assessed by four reviewers, with a total of seven studies meeting inclusion criteria (n = 5 quantitative, n = 1 qualitative and n = 1 case series). All studies indicated there was significant psychosocial impact in younger CRC patients, including emotional impact, social impact, physical burden, sexual impact, work impact, unmet needs, financial impact and global quality of life. Three studies explored other determinants that influenced the psychosocial experience and found that socioeconomic background (e.g., being female, lower education), CRC treatment (e.g., chemotherapy) and health status were associated with worse psychosocial impact.

Conclusions

Young‐onset CRC patients face severe psychosocial impact unique to this age group, such as self‐image and sexual impact. Social support services and resources needs to be uniquely tailored. More empirical investigations are required to understand its long‐term impact and influence of other psychosocial domains.

This scoping review of psychosocial impact in young‐onset colorectal cancer patients uncovered significant psychosocial impact which are in‐line with previous studies on young cancer (e.g., emotional impact, social impact, physical burden) as well as impact unique to colorectal cancer (e.g., self‐image, embarrassment with bowel movements and the impact of stoma). More empirical investigations are required to understand its long‐term impact and influence of other psychosocial domains.

Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study

AIM

Depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition of depression at key points in the pathway enables timely referral to support. This study aimed to examine depression before and 5 years after surgery to examine its prevalence and identify determinants.

METHOD

The ColoREctal Wellbeing (CREW) study is a prospective UK cohort study involving 872 adults with nonmetastatic CRC recruited before surgery with curative intent. Questionnaires completed before surgery and 3, 9, 15, 24, 36, 48 and 60 months after surgery captured socio-demographics and assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present the prevalence of clinically significant depression (CES-D ≥ 20) over time and its predictors assessed before and 2 years after surgery.

RESULTS

Before surgery, 21.0% of the cohort reported CES-D ≥ 20 reducing to 14.7% 5 years after surgery. Presurgery risk factors predicting subsequent depression were clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Postsurgery risk factors at 2 years predicting subsequent depression were clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health.

CONCLUSION

Depression is highly pervasive in people with CRC, exceeding prevalence in the general population across follow-up. Our findings emphasize the need to screen and treat depression across the pathway. Our novel data highlight key risk factors of later depression at important and opportune time points: before surgery and at the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.

Breast cancer and social relationship coping efficacy: validation of the Greek version

The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.

Association of Social Support With Overall Survival and Healthcare Utilization in Patients With Aggressive Hematologic Malignancies

BACKGROUND

Social support plays a crucial role for patients with aggressive hematologic malignancies as they navigate their illness course. The aim of this study was to examine associations of social support with overall survival (OS) and healthcare utilization in this population.

METHODS

A cross-sectional secondary analysis was conducted using data from a prospective longitudinal cohort study of 251 hospitalized patients with aggressive hematologic malignancies at Massachusetts General Hospital from 2014 through 2017. Natural Language Processing (NLP) was used to identify the extent of patients' social support (limited vs adequate as defined by NLP-aided chart review of the electronic health record). Multivariable regression models were used to examine associations of social support with (1) OS, (2) death or readmission within 90 days of discharge from index hospitalization, (3) time to readmission within 90 days, and (4) index hospitalization length of stay.

RESULTS

Patients had a median age of 64 years (range, 19-93 years), and most were White (89.6%), male (68.9%), and married (65.3%). A plurality of patients had leukemia (42.2%) followed by lymphoma (37.9%) and myelodysplastic syndrome/myeloproliferative neoplasm (19.9%). Using NLP, we identified that 8.8% (n=22) of patients had limited social support. In multivariable analyses, limited social support was associated with worse OS (hazard ratio, 2.00; P=.042) and a higher likelihood of death or readmission within 90 days of discharge (odds ratio, 3.11; P=.043), but not with time to readmission within 90 days or with index hospitalization length of stay.

CONCLUSIONS

In this cohort of hospitalized patients with aggressive hematologic malignancies, we found associations of limited social support with lower OS and a higher likelihood of death or readmission within 90 days of hospital discharge. These findings underscore the utility of NLP for evaluating the extent of social support and the need for larger studies evaluating social support in patients with aggressive hematologic malignancies.

Model of Social Support for Patients Treated for Cancer

Social support can be one of the main factors in better assessing the quality of life at any stage of the recovery process. It should meet the patient's needs so that they can develop constructive methods of coping with the disease. In order to explain the factors influencing social support for cancer patients, a theoretical research model was formulated. It is presented in a graphic form in this article. In order to verify the model, the authors' questionnaire and other standardised questionnaires were used. The experimental group consisted of 170 hospitalised oncological patients being treated for cancer. Personality structure, through its relationship with state of health (0.40) and attitude developed to the disease (0.64), influenced the support experienced by the treated patients (0.40). The surveyed patients, who were characterised by positive self-esteem and experience of life satisfaction despite various difficult situations, perceived to a greater degree the emotional and instrumental support provided to them. During cancer treatment, those patients who showed a need for help and did not experience negative emotions were characterised by an increased need for support. The research results can be introduced into evidence-based medical practice, which could significantly improve the quality of nursing and medical care for patients.

Long-term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort

AIM

As populations age and cancer management improves, long-term survivorship and quality-of-life (QOL) outcomes are becoming equally important as oncological results. Data from Asian populations are scarce. We aimed to evaluate the sexual health, gastrointestinal function and QOL amongst colorectal cancer survivors in a tertiary referral centre in Singapore.

METHOD

Adults who had undergone elective curative surgery for non-metastatic colorectal cancer at least 2 years prior were included. Exclusion criteria were cognitive disease, serious postoperative complications or recurrent cancer. Participants were invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires EORTC-QLQ-C30 and QLQ-CR29. Using multiple bivariate analysis, r scores were used to examine relationship trends between QOL domains and survivor sociodemographic and disease-specific characteristics.

RESULTS

From February 2017 to July 2019, 400 responses were recorded. Median age and follow-up duration were 64 years (range 32-90) and 78 months (interquartile range 49-113) respectively. Patients who had Stage III cancer had better overall QOL scores compared to Stage I/II. Rectal (vs. colon) cancer negatively influenced sexual health and gastrointestinal function, but did not appear to affect overall QOL. Amongst our cohort, 57% (n = 129) of men and 43% (n = 75) of women were sexually active. Markers of socioeconomic status, including employment, education and housing type, were found to significantly impact perception of various aspects of QOL.

CONCLUSION

Knowledge of factors which influence well-being can identify individuals who may benefit from tailored management strategies. Regular patient-doctor contact may play a role in building and maintaining positive perspectives of cancer survivors. Normative data should be obtained from local populations to facilitate future comparative research.

Depression: Screening, Assessment, and Interventions in Oncology Nursing

BACKGROUND

A high prevalence of depression exists among individuals with cancer, which negatively affects their health outcomes, quality of life, and adherence to cancer treatment.

OBJECTIVES

This article provides an overview and synthesis of depression screening, assessment, and nonpharmacologic treatments to help oncology nurses in their practices.

METHODS

Key insights are presented from a synthesized literature review regarding patients with cancer with depression. Resources for patient treatment and nurse training are also provided.

FINDINGS

To improve patient outcomes, nurses need to understand and follow a process that addresses the screening, assessment, and nonpharmacologic treatment of depression in patients with cancer.

Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication.

A systematic review and qualitative synthesis of the experience of living with colorectal cancer as a chronic illness

OBJECTIVE

Advances in detection and treatment mean that over 50% of people diagnosed with colorectal cancer can expect to live for more than ten years following treatment. Studies show that colorectal cancer patients can experience numerous physical and psychological late effects. The aim of this study was to conduct a systematic review and qualitative synthesis on the experiences of living with colorectal cancer as a chronic illness.

METHODS

Electronic searches of online databases were undertaken of peer reviewed and grey literature. Forty-seven papers were eligible for inclusion in the review, capturing the experiences of over 700 participants, the findings from which were analysed using thematic synthesis.

RESULTS

Three higher order concepts were identified which were prevalent across studies and countries and which related to the supportive care needs of patients; common physical and psychological late effects of cancer; and methods of psychosocial adjustment to living with and beyond colorectal cancer.

CONCLUSION

The results are considered in the context of existing theoretical approaches to chronic illness and the need to develop a theoretical approach which fully encapsulates the experience of living with colorectal cancer as a chronic illness in order to inform interventions to support patient adjustment.

Correlation between social support and psychological resilience levels in patients undergoing colorectal cancer surgery: a descriptive study

Psychological resilience is considered to be promising especially for patients with CRC, which is among the most frequent types of cancer and is known to have serious physical and psycho-social impacts on individuals. Thus, it is stated that psychosocial interventions need to be done in order to overcome emotional stress. This study was conducted to determine the correlation between social support and resilience in patients undergoing surgical therapy due to colorectal cancer. The study is descriptive and cross sectional. A patient information form, Connor-Davidson Resilience Scale, and Multidimensional Scale of Perceived Social Support were used to interview 103 patients undergoing colorectal cancer surgery. It was determined that family support and significant other support were positively correlated with subscale and total scores of the Resilience Scale (p < 0.05). İt was determined that the model was highly significant (R² = 0.113; p < 0001). An increase of 1 unit in healthcare professionals support triggered an increase of one-unit (0.976) in psychological resilience (p:0.014). It was determined that social support provided to patients, undergoing surgical therapy due to colorectal cancer, by family and healthcare professionals, played an essential role in increasing resilience.

Unmet Emotional Support Needs Among Diverse Patients with Colorectal Cancer

BACKGROUND

Social support, which is partly emotional support, is associated with adherence to colorectal cancer (CRC) treatment, quality of life, and survival. We hypothesized that the needs, sources, and availability of emotional support would vary by race and income among CRC patients and sought to quantify the emotional support and the perceived adequacy of support reported by patients.

METHODS

We surveyed CRC patients from Detroit and Georgia Surveillance, Epidemiology and End Results registries about the quantity and quality of emotional support received from different sources. We tested differences using the chi-square test, t-tests, and logistic regression.

RESULTS

There were 1909 patients who met inclusion criteria and 1301 (68%) completed surveys. Among respondents, 68% were white, 25% black, and 7% other. Black patients were more likely to be female and younger and reported lower annual income and education. Patients reported high support from several sources. Among those with a spouse/partner (58%), 95% reported high levels of support; however, older, black, female, or lower income patients were less likely to have spouses/partners (P < .001). Patients also endorsed high support from family (88.6%), important others (82.9%), and clinicians (71.3%). Black patients were less likely than white patients to report support that was "just right" (P < .001).

DISCUSSION

Most patients reported high emotional support from at least 1 source. Black patients were most at risk for low support or unmet support needs. Spouse/partner support was important but only available to 58% of respondents. Patients at risk for unmet emotional support needs may benefit from additional support resources.

Greater Well-Being in More Physically Active Cancer Patients Who Are Enrolled in Supportive Care Services

Background: Cancers are one of the leading causes of mortality worldwide. Cancer patients are increasingly seeking integrative care clinics to promote their health and well-being during and after treatment. Aim: To examine relationships between physical activity (PA) and quality of life (QoL) in a sample of cancer patients enrolling in integrative care in a supportive care clinic. Also, to explore circulating inflammatory biomarkers and heart rate variability (HRV) in relationship to PA and QoL. Methods: A cross-sectional design of adult patients who sought care in the InspireHealth clinic, Vancouver, British Columbia, Canada. Patients with complete PA data (n = 118) answered psychosocial questionnaires, provided blood samples, and received HRV recordings before enrollment. Patients were stratified into “less” versus “more” active groups according to PA guidelines (150 minutes of moderate or 75 minutes of vigorous PA or an equivalent combination). Results: Breast (33.1%) and prostate (10.2%) cancers were the most prevalent primary diagnoses. Patients engaging in more PA reported better physical (U = 1265.5, P = .013), functional (U = 1306.5, P = .024), and general QoL (U = 1341, P = .039), less fatigue (U = 1268, P = .014), fewer physical cancer-related symptoms (U = 2.338, P = .021), and less general distress (U = 2.061, P = .021). Between PA groups, type of primary cancer diagnosis differed (χ² = 41.79, P = .014), while stages of cancer did not (χ² = 3.95, P = .412). Fewer patients reported depressed mood within the more active group (χ² = 6.131, P = .047). More active patients were also less likely to have ever used tobacco (χ² = 7.41, P = .025) and used fewer nutritional supplements (χ² = 39.74, P ≤ .001). An inflammatory biomarker index was negatively correlated with vigorous PA (r_s = −0.215, P = .022). Multivariable linear regression (R² = 0.71) revealed that age (β = 0.22; P = .001), fatigue (β = −0.43; P ≤ .001), anxiety (β = −0.14; P = .048), and social support (β = 0.38; P = .001) were significant correlates of QoL.

Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study

Background

The ColoREctal Wellbeing (CREW) study is the first study to prospectively recruit colorectal cancer (CRC) patients, carry out the baseline assessment pre-treatment and follow patients up over five years to delineate the impact of treatment on health and wellbeing.

Methods

CRC patients received questionnaires at baseline (pre-surgery), 3, 9, 15, 24, 36, 48 and 60 months. The primary outcome was Quality of Life in Adult Cancer Survivors (QLACS); self-efficacy, mental health, social support, affect, socio-demographics, clinical and treatment characteristics were also assessed. Representativeness was evaluated. Predictors at baseline and at 24 months of subsequent worsened quality of life (QOL) were identified using multivariable regression models.

Results

A representative cohort of 1017 non-metastatic CRC patients were recruited from 29 UK cancer centres. Around one third did not return to pre-surgery levels of QOL five years after treatment. Baseline factors associated with worsened QOL included >2 comorbidities, neoadjuvant treatment, high negative affect and low levels of self-efficacy, social support and positive affect. Predictors at 24 months included older age, low positive affect, high negative affect, fatigue and poor cognitive functioning.

Conclusions

Some risk factors for poor outcome up to five years following CRC surgery, such as self-efficacy, social support and comorbidity management, are amenable to change. Assessment of these factors from diagnosis to identify those most likely to need support in their recovery is warranted. Early intervention has the potential to improve outcomes.

Prediagnosis social support, social integration, living status, and colorectal cancer mortality in postmenopausal women from the women's health initiative

BACKGROUND

We evaluated associations between perceived social support, social integration, living alone, and colorectal cancer (CRC) outcomes in postmenopausal women.

METHODS

The study included 1431 women from the Women's Health Initiative who were diagnosed from 1993 through 2017 with stage I through IV CRC and who responded to the Medical Outcomes Study Social Support survey before their CRC diagnosis. We used proportional hazards regression to evaluate associations of social support (tertiles) and types of support, assessed up to 6 years before diagnosis, with overall and CRC-specific mortality. We also assessed associations of social integration and living alone with outcomes also in a subset of 1141 women who had information available on social ties (marital/partner status, community and religious participation) and living situation.

RESULTS

In multivariable analyses, women with low (hazard ratio [HR], 1.52; 95% CI, 1.23-1.88) and moderate (HR, 1.21; 95% CI, 0.98-1.50) perceived social support had significantly higher overall mortality than those with high support (P [continuous] < .001). Similarly, women with low (HR, 1.42; 95% CI, 1.07-1.88) and moderate (HR, 1.28; 95% CI, 0.96-1.70) perceived social support had higher CRC mortality than those with high social support (P [continuous] = .007). Emotional, informational, and tangible support and positive interaction were all significantly associated with outcomes, whereas affection was not. In main-effects analyses, the level of social integration was related to overall mortality (P for trend = .02), but not CRC mortality (P for trend = .25), and living alone was not associated with mortality outcomes. However, both the level of social integration and living alone were related to outcomes in patients with rectal cancer.

CONCLUSIONS

Women with low perceived social support before diagnosis have higher overall and CRC-specific mortality.

Investigating relationships among cancer survivors' engagement in an online support community, social support perceptions, well-being, and moderating effects of existing (offline) social support

PURPOSE

Socially supportive relationships help cancer survivors cope with their diagnosis and may improve quality of life; however, many survivors report unmet support and information needs. Online communities of survivors may address these needs, but research on their benefits have been equivocal. This cross-sectional, self-report study investigated relationships among cancer survivors' level of engagement in an online survivor community (The American Cancer Society Cancer Survivors Network®; CSN), perceptions of emotional/informational support available from online communities ("online social support"), well-being, and moderating effects of "offline social support."

METHODS

Participants were 1255 registered users of the CSN who completed surveys between 2013 and 2014. Three types of engagement with the CSN-social/communal, interpersonal communication, and informational/search engagement-were identified through principal components analysis. Regression analyses examined hypotheses.

RESULTS

More frequent social/communal and interpersonal communication engagement were associated with increased online social support (p < .0001), and the relationship between interpersonal communication engagement and online social support was strongest for survivors reporting lower offline social support (interaction β = - .35, p < .001). Greater online social support was associated with increased well-being, but only among survivors reporting low offline social support (interaction β = - .35, p < .0001).

CONCLUSIONS

Engagement in online survivor communities may increase support perceptions that promote well-being, but benefits may accrue more to survivors reporting low offline social support.

IMPLICATIONS FOR CANCER SURVIVORS

Newly diagnosed cancer survivors, particularly those with unmet emotional/informational support needs, should be given the opportunity to communicate with other survivors through online survivor support networks.

Impact of social support on psychosocial symptoms and quality of life in cancer patients: results of a multilevel model approach from a longitudinal multicenter study

Background: This prospective multicenter study aimed to investigate the courses of positive support (PS) and detrimental interaction (DI), two different aspects of social support, and the relation between social support and psychosocial distress and/or health-related quality of life (HRQOL) in a large sample of patients with different cancers. Methods: For this observational study, we enrolled adult patients with cancer from 13 comprehensive cancer centers (CCCs) in Germany. We included a total of 1087 patients in our analysis. We assessed the outcomes via standardized self-report questionnaires at three measurement points: at admission for acute care (T1), 6 (T2) and 12 months (T3) thereafter. Our outcome variables included PS and DI, depression and anxiety symptoms, distress, mental quality of life (MQoL) and physical QoL (PQoL). Data were analyzed using three-level hierarchical linear modeling (HLM) and group-based trajectory modeling. Results: During the first year after the cancer diagnosis, both PS and DI decreased in our sample. Baseline depression symptom severity was a significant predictor of PS and DI. Further analyses revealed significant associations between PS, DI and the course of depression and anxiety symptoms, and MQoL. PS buffered the negative effects of DI with regards to these variables. Low DI was associated with better PQoL, whereas PS was not. In general, the impact of social support on psychosocial outcomes was weak to moderate. Conclusions: Our findings provide evidence for the influence of PS and DI on psychosocial symptoms and HRQOL, and emphasize the importance of psycho-oncological interventions that strengthen PS and prevent or reduce DI for patients with cancer and their relatives.

Application of discharge planning in rectal cancer patients with a stoma

BACKGROUND

Rectal cancer is a common malignant tumor of the digestive system. Surgery is the main method of treatment for rectal cancer. Enterostomy affects the patient's body structure, lifestyle, psychological adjustment, and social adaptability. Exploring ways to improve the stoma adaptability and quality of life in patients with rectal cancer can help patients return to their families and society smoothly.

AIM

To evaluate the effects of discharge planning in rectal cancer patients with a stoma.

METHODS

Using the convenience sampling method, 100 rectal cancer patients with a stoma were selected and randomly divided into a control group and an observation group, with 50 cases in each group. The control group received routine nursing intervention and telephone follow-up, while the observation group received planned nursing intervention at discharge and routine nursing intervention. The adaptation level to stoma, quality of life, and incidence of colostomy complications were compared between the two groups.

RESULTS

Three and six mo after discharge, the ostomy adjustment inventory (OAI) scores in the observation group were significantly higher than those of the control group (t = 2.136 and 6.713, P < 0.05). The scores of quality of life in the observation group were significantly higher than those in the control group (t = 22.52 and 24.87, P < 0.05). The incidence of colostomy complications in the observation group was significantly lower than that of the control group (χ² = 15.072, P < 0.05).

CONCLUSION

The application of discharge planning in rectal cancer patients with a stoma can help improve the adaptation level to stoma, effectively improve the quality of life, and reduce the incidence rate of colostomy complications.

Sexual Function in Women with Colorectal/Anal Cancer

BACKGROUND

Treatments for colorectal and anal cancers can have a detrimental impact on sexual function. Type of treatment, which may include surgery, radiation, and/or chemotherapy, varies by disease site and severity. Treatment and long-term side effects can impact sexual function and intimacy for patients and their partners.

AIM

To review the literature regarding treatment for colorectal/anal cancer and its impact on female sexual function, and to provide an assessment of medical outcomes and patient-reported outcomes (PROs) of women with a history of colon, rectal, or anal cancer seeking sexual health treatment.

METHODS

We performed a PubMed search to identify peer-reviewed, English-language articles published between 2008 to 2018, using the following search terms: "colorectal cancer," or "rectal cancer," or "anal cancer" and "sexual function," or "sexual dysfunction." We also assessed the medical outcomes and PROs from our recent cross-sectional cohort study of 99 women with a history of colon, rectal, or anal cancer seeking sexual health treatment.

MAIN OUTCOME MEASURES

Sexual function, quality of life, and PROs after colorectal/anal cancer.

RESULTS

A total of 23 studies were identified. Study designs included 15 cross-sectional survey studies, 5 longitudinal studies, 2 psychoeducational interventions, and 1 pilot study. 10 studies included only women, and 13 included both men and women. The literature and our cohort confirmed that women with colorectal/anal cancer experience changes in sexual function after diagnosis and throughout the continuum of care; however, the scarcity of data in this area indicates a need for additional intervention trials and longitudinal studies.

CONCLUSIONS

Research studies with large sample sizes and long study durations are needed to help us better understand the needs of female survivors of colorectal/anal cancer. Women with colorectal/anal cancer need simple strategies and resources to address concerns of sexual function after cancer treatment. Such interventions have been shown to enhance survivorship and quality of life. Canty J, Stabile C, Milli L, et al. Sexual Function in Women with Colorectal/Anal Cancer. Sex Med Rev 2019;7:202-222.

Resilience Mediates the Relationship Between Social Support and Quality of Life in Patients With Primary Glaucoma

Objective: Glaucoma is a serious disease causing blindness, which seriously affects the quality of life of patients. Previous studies have reported that both resilience and social support play important roles in enhancing the quality of life of patients with some diseases. The purpose of this study is to investigate if resilience mediates the relationship between social support and quality of life in patients with primary glaucoma. Methods: We conducted a cross-sectional study with 120 patients with primary glaucoma in China. The Connor-Davidson Resilience Scale was used to measure resilience, and social support was measured by the Perceived Social Support Scale. The Glaucoma Quality of Life-15 questionnaire was used to measure quality of life. Results: There were significant positive correlations between all dimensions and total scores on the resilience, social support, and quality of life scales (p < 0.01). Both resilience and social support could predict these patients' quality of life. A bootstrap test showed that resilience had a partial mediating effect on the relationship between social support and quality of life (p < 0.05). Conclusion: Resilience mediates the relationship between social support and quality of life in primary glaucoma patients. This finding suggests that increasing resilience and social support can improve the quality of life of primary glaucoma patients in clinical practice.

The "sphere of care": A qualitative study of colorectal cancer patient and caregiver experiences of support within the cancer treatment setting

Introduction

Colorectal cancer is associated with considerable physical and psychosocial burden. Whilst social support is known to facilitate psychological adjustment to cancer, patients’ and caregivers’ experiences of social support within a treatment setting and their perceptions of the role of the treating team in providing this support is unknown. Specifically, there is a gap in the research that explores in detail who people affected by colorectal cancer consider to be supportive, and the function, timing and nature of this support, whilst receiving treatment. This study explored both patients’ and caregivers’ a) experiences of social support and how this relates to their experience of treatment; and b) what facilitates support in the treatment setting.

Methods

Individual interviews (N = 20) were conducted with patients diagnosed with colorectal cancer and caregivers of such patients. Audiotaped interviews were transcribed verbatim and analysed using the framework method.

Results

Three major themes emerged from the data: a) treating team as a source of support, highlighting the importance of connection with the treating team; b) changes in existing social supports, encompassing issues regarding distance in interpersonal relationships as a consequence of cancer; and c) differing dimensions of support, exploring the significance of shared experience, practical, financial, and emotional support.

Conclusions

Patients and caregivers perceived the treating team as a major source of support. Support from the treating team was particularly important in the context of the changes that occur as a result of a diagnosis of colorectal cancer and the effects of subsequent treatment. Incidental support from others encountered in the treatment setting was also experienced and was equally important to both patients and caregivers. This has implications for the way health care professionals respond to both patients and caregivers in the treatment setting in terms of communication, interventions and environment.

Social relationship coping efficacy: A new construct in understanding social support and close personal relationships in persons with cancer

OBJECTIVE

Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL).

METHOD

A mixed diagnosis sample (N = 151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL.

RESULTS

The SRCE scale is a 10-item, one-factor, internally reliable (α = 0.965) measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support.

CONCLUSIONS

The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

Long non-coding RNA DILC suppresses cell proliferation and metastasis in colorectal cancer

Colorectal cancer (CRC) is one of the most common malignant tumors and one of the leading causes of cancer-related death in both men and women. The prognosis of CRC remains poor due to the advanced stage and cancer metastasis at the time of diagnosis. However, the exact mechanism of tumorigenesis in CRC remains unclear. Long non-coding RNAs (lncRNAs), which refer to transcripts longer than 200 nucleotides that are not translated into protein, are known to play important roles in multiple human cancers. Lnc-DILC is reported to be an important tumor suppressor gene and its inactivation is closely associated with liver cancer stem cells. However, the role of lnc-DILC in CRC remains to be elucidated. In the present study, we observed that lnc-DILC overexpression inhibited the growth and metastasis of CRC cells. Consistently, lnc-DILC knockdown facilitated the proliferation and metastasis of CRC cells. Mechanically, lnc-DILC suppressed CRC cell progression via IL-6/STAT3 signaling inactivation. More importantly, the specific STAT3 inhibitor S3I-201 and IL-6R inhibitor tocilizumab abolished the discrepancy of growth and metastasis capacity between lnc-DILC-interference CRC cells and control cells, which further confirmed that IL-6/STAT3 signaling was required in lnc-DILC-disrupted CRC cell growth and metastasis. Taken together, our results suggest that lnc-DILC is a novel CRC suppressor and may prove to be an inhibitor of CRC progression by inactivating IL-6/STAT3 signaling.

Social support following diagnosis and treatment for colorectal cancer and associations with health-related quality of life: Results from the UK ColoREctal Wellbeing (CREW) cohort study

Objective

Social support is acknowledged as important in cancer survivorship, but little is known about change in support after cancer diagnosis and factors associated with this, particularly in colorectal cancer. The CREW cohort study investigated social support up to 2 years following curative intent surgery for colorectal cancer.

Methods

A total of 871 adults recruited pre‐treatment from 29 UK centres 2010 to 2012 consented to follow‐up. Questionnaires at baseline, 3, 9, 15, and 24 months post‐surgery included assessments of social support (Medical Outcomes Study‐Social Support Survey, MOS‐SSS) and health‐related quality of life (HRQoL). Socio‐demographic, clinical and treatment details were collected. Longitudinal analyses assessed social support over follow‐up, associations with participant characteristics, and HRQoL.

Results

Around 20% were living alone and 30% without a partner. Perceived social support declined in around 29% of participants, with 8% of these reporting very low levels overall from baseline to 2 years (mean MOS‐SSS overall score < 40 on a scale from 0 to 100). Older age, female gender, greater neighbourhood deprivation, presence of co‐morbidities, and rectal cancer site were significantly associated with reductions in perceived support. Poorer HRQoL outcomes (generic health/QoL, reduced wellbeing, anxiety, and depression) were significantly associated with lower levels of social support.

Conclusions

Levels of social support decline following colorectal cancer diagnosis and treatment in nearly a third of patients and are an important risk factor for recovery of HRQoL. Assessment of support early on and throughout follow‐up would enable targeted interventions to improve recovery, particularly in the more vulnerable patient groups at risk of poorer social support.