Identifying associations between quality of life outcomes and healthcare-related variables among colorectal cancer survivors: A cross-sectional survey study

Background: Follow-up care and surveillance are essential components of colorectal cancer survivorship. However, the relative contribution of healthcare experiences to quality of life in cancer survivorship is poorly understood. Objectives: This study explores associations between colorectal cancer survivors' healthcare experiences and quality of life. Design: Cross-sectional survey study. Settings: Participants were recruited from medical oncology and colorectal cancer surgery departments in three hospitals, and twenty-one cancer support centres providing psycho-social care to cancer patients and survivors in Ireland. Participants: 304 colorectal cancer survivors between 6 and 60 months post-diagnosis. Methods: Participants completed a cross-sectional questionnaire, including the Functional Assessment of Therapy-Colorectal Cancer Survey and the Patient Continuity of Care Questionnaire. Multivariate logistic regression analysis was undertaken to identify associations between quality of life outcomes and healthcare-related variables including continuity of care, access to care, information needs and perceptions of support from health and advocacy services. Results: Most participants (80%) had access to a named healthcare professional and were more frequently satisfied with support received in hospital (95%) compared to primary care (76%) or community (61%) settings. More than two-thirds of participants reported unmet information needs (68%) or social difficulties (66%). 40% reported some dissatisfaction with continuity of care. Greater social difficulty was consistently associated with poorer quality of life in all domains (OR range: 2.9-9.7). Lower satisfaction with continuity of care predicted poorer physical (OR=2.6), social (OR=2.1), functional (OR=2.9) and overall quality of life (OR=2.0). Unmet information needs (OR=2.9) and absence of access to a named nurse (OR=3.8) were associated with lower levels of emotional well-being. Survivors who were living with active malignant disease (OR=3.8), had undergone reversal of a temporary ostomy (OR=4.0) or had accessed advocacy-led cancer support were more likely to experience lower quality of life overall (OR=2.6). Conclusions: Colorectal cancer survivors relied on oncology professionals for cancer-related support and experienced quality of life issues and unmet needs, which were not addressed by oncology, primary care or advocacy professionals. This study suggests there is scope to optimise the contribution of primary care, community care and advocacy services to cancer survivorship care; these services were often overlooked or provided insufficient support when accessed by survivors. The recurring associations between quality of life outcomes and continuity of care and social difficulties suggest these may be meaningful variables to target in the development of interventions to improve survivors' quality of life in the context of healthcare. (C) 2019 Elsevier Ltd. All rights reserved.