Identifying associations between quality of life outcomes and healthcare-related variables among colorectal cancer survivors: A cross-sectional survey study
Section snippets
What is already known about the topic?
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Fragmentation of follow-up care may exacerbate cancer survivors’ unmet needs and psychological distress.
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Insufficient continuity of care, informational insecurity and difficulties accessing cancer-related support contribute to survivors’ difficulties with healthcare navigation and may lead to survivors experiencing isolation and a loss of confidence in healthcare providers.
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While quality of life has been identified as a predictor of continuity of care in primary care-led models of cancer
What this paper adds
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Healthcare variables are significantly associated with colorectal cancer survivors’ quality of life in multiple domains.
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Poorer continuity of care, difficulties accessing information and support and greater social difficulty were associated with lower quality of life in several domains.
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Hospital-based professionals were the most common source of information and support for colorectal cancer survivors.
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Fewer participants expressed satisfaction with support from primary care and community care
Design and participants
This cross-sectional survey study forms part of The Cost of Survival Study, a sequential explanatory mixed methods study. The point at which one becomes a cancer survivor has been widely debated and varies internationally (Doyle, 2008; Drury et al., 2017; Khan et al., 2012; Leigh, 2007; Mullen, 1985; Reuben, 2004; Rowland et al., 2013). The most consistent and accepted definition of cancer survivorship begins at the point of diagnosis, as the challenges of survivorship persist for the duration
Sample characteristics
Of 404 colorectal cancer survivors invited to participate in the study, 304 questionnaires were returned (response rate=75.6%). Participants were predominantly White Irish, ranging in age from 25 to 96 years (=67.2 years, SD=11.4) and diagnosed on average, 3.1 years prior to participation in the study (SD=1.4) (Table 2). Most were diagnosed with colon cancer (64.1%, n = 191) and had no active disease at the time of the survey (82.9%, n = 228). Almost half held private health insurance (48.3%,
Discussion
This paper suggests that healthcare-related variables are consistently associated with colorectal cancer survivors’ quality of life in all domains of the FACT-C, aligning with the Ashing-Giwa (2005) Contextual Model of Health-Related Quality of Life. The finding that greater social difficulty and absence of private health insurance are associated with poorer quality of life in multiple domains adds to the body of evidence highlighting the relationship between healthcare disparities, greater
Conclusions
This study advances the utility of the Ashing-Giwa (2005) Contextual Model of Health-Related Quality of Life with heterogeneous populations of cancer survivors. This study highlights the potential importance of healthcare experiences for colorectal cancer survivors’ quality of life outcomes. Greater social difficulty, lower satisfaction with continuity of care and health insurance status were the factors most consistently associated with poorer quality of life. While colorectal cancer survivors
Funding
This research was funded by the Health Research Board Research Training Fellowship 2014 (grant number HPF.2014.715). The Health Research Board had no role in the design of the study, the collection, analysis or interpretation of data, nor the writing of this paper.
Conflict of interest
SP and AMB report no conflict of interest. AD's time was funded by the Health Research Board Research Training Fellowship at the School of Nursing and Midwifery Trinity College Dublin. The authors alone are responsible for the content and writing of this paper.
Acknowledgements
The authors would like to thank the physicians, nurses and staff at the colorectal cancer Surgery and Medical Oncology Departments of the participating hospitals, and the voluntary cancer support services who facilitated data collection.
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