The Longitudinal Trends of Care Needs, Psychological Distress, and Quality of Life and Related Predictors in Taiwanese Colorectal Cancer Survivors

Colorectal cancer (CRC) is the third most diagnosed cancer worldwide and it is estimated that there will be 220 million new cases and 110 million CRC-related deaths by 2030, resulting in 60% increase in medical expenditures.1 In Taiwan, CRC has been ranked as the most commonly diagnosed cancer since 2006, with an increased prevalence rate of 4.7% and 17,302 new cases in 2019.2 Due to early cancer detection and advancements in medicine, the 5-year survivor rate for CRC, which was 20% to 30%3 has more recently increased to 63.5%.4,5 Despite these improvements, a cohesive body of scientific evidence has documented that, following completion of treatment, CRC survivors still experience acute (≤3–6 months) and chronic (≥6 months) physical (ie, fatigue, gastrointestinal disorders, peripheral neuropathy, and sexual disorder)6, 7, 8 and psychosocial distress (ie, fear of recurrence, alterations in their body image, relationships with family members, as well as financial burdens).9, 10, 11 Additionally, this patient population reports notable unmet survivorship care needs,12,13 thereby compromising their quality of life (QOL).14, 15, 16 To address the enumerated, the Institute of Medicine (IOM)17 proposed that healthcare providers need to assess the late and long-term physio-psychosocial impacts of cancer as a foundational aspect of survivorship care plans (SCPs).18

In terms of survivorship care needs, 30% to 50% of cancer survivors reported having at least one or more of the following unmet care needs,13,19 including lack of relevant information pertaining to physical care and healthcare services20, 21, 22; psychological distress,23 and/or fear of cancer recurrence.24,25 Considering that 40% of CRC survivors might develop recurrent cancer and 15% will be diagnosed with an additional cancer,12 fears of recurrent or second cancer were prevalent for CRC survivors.25 Such increased risks of future cancers might be related to survivors’ anxiety and/or depressed mood.26 Even though survivors’ mood fluctuations might not meet all of the criteria for a clinical diagnosis for either anxiety and/or major depression distorted, these subclinical symptoms could erode their QOL.27 However, less than one-third of survivors actually requested relevant assistance, leading to negative impacts on overall health and, eventually, more multifaceted unmet care needs.28 Existing studies have identified factors linked to the degree of their unmet care needs, such as age, type(s) of cancer, symptom distress,21 and level of anxiety or depression.28, 29, 30 Similarly, other studies on CRC survivors’ QOL found that factors such as age,31,32 gender,33 cancer stage,34 progression of disease,35,36 presence of ostomies,37 and social support38 were linked to QOL. To ensure quality survivorship care, it is crucial for healthcare professionals to concurrently consider the relationship between care needs, survivorship emotional status, and QOL and its related influential factors.

To date, studies on CRC survivors primarily focused on care needs13,39,40 and the correlation between QOL and care needs23 as well as anxiety40,41 and depression.30 However, longitudinal studies specifically examining highly correlated variables, such as care needs, psychological distress, and QOL and its related predictors for CRC survivors, are still lacking. By considering the nature of the disease and prognosis of CRC (slow growth at the early stage but easily recurrent or having second cancer), the findings from existing studies may not fully reflect how CRC survivors respond to the physical and psychological impact of their cancer, what their unmet care needs might be, and what factors influence their unmet care needs. More importantly, the major survivor-related findings from Western countries may not be fully generalizable to CRC patients in non-Western culture and health systems, such as in Taiwan, from the perspective of transcultural care. Notably, CRC patients in the Asia Pacific region engage with disparate healthcare systems, hold various and culturally specific beliefs surrounding illness, and engage in distinct patient-physician communication patterns. Therefore, there is a need for further Asian-related (non-Western) research. For example, the results from internationally collaborative studies10,42 showed that Asia cancer patients in China, Korea, or Myanmar (not including Taiwan) seemed to have higher strength of care needs on information and lower strength of psychological needs compared to other patients in Western countries (ie, Australia or the US).

The purposes of this prospective study were to longitudinally examine the status of unmet care needs, psychological distress, and QOL in CRC survivors after completion of treatment; identify the differences in personal information in care needs, psychological distress, and QOL; and identify trend changes (at 3 months, 6 months, and 12 months) and predictors of the designed outcome measures.

留言 (0)

沒有登入
gif