Aims
People living with and beyond colorectal cancer (CRC) form the largest group of cancer survivors that includes men and women but knowledge about recovery from CRC in terms of health and well-being is limited. The ColoREctal Well-being (CREW) study is the first study to prospectively recruit a representative sample of CRC patients, carry out the first comprehensive assessment pre-treatment and follow up longitudinally over five years to explore the impact of treatment on health and wellbeing.
Methods
CRC patients from 29 UK cancer centres received questionnaires at baseline (pre-surgery), 3, 9, 15, 24, 36, 48 and 60 months. Quality of life (QOL), self-efficacy, mental health, social support, affect, socio-demographics, clinical and treatment characteristics were assessed. Data were analysed using trajectory analysis and multivariable regressions (linear, logistic).
Results
A representative cohort of 872 non metastatic CRC patients participated. Around 30% had poor psychosocial outcomes and this persisted to 5 years. Baseline psychosocial factors (particularly self-efficacy and depression) were more important than disease stage and location of tumour in determining those most likely to have health and wellbeing problems over the next 5 years. Risk factors for poor outcomes throughout follow up were depression, low self-efficacy, a lack of perceived social support, comorbidities that limit an individual’s typical daily activities and unmet needs.
Conclusions
CREW provides robust evidence that psychosocial factors, such as self-efficacy, are important predictors for longer term wellbeing and health outcomes of CRC patients. We call for early assessment and intervention, including assessment of depression and confidence to manage illness related problems and limiting co-morbidities, from diagnosis onwards. Early assessment would identify those most likely to need support and has the potential to reduce need and improve outcomes throughout treatment and beyond.