Risk factors for cancer-related distress in colorectal cancer survivors: one year post surgery

J Cancer Surviv. 2020 Jun;14(3):305-315. doi: 10.1007/s11764-019-00845-y. Epub 2020 Mar 12.


Purposes: Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (CRC) survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery.

Methods: We included 212 CRC patients with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support, and health-related quality of life (HrQOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress.

Results: Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months.

Conclusion: Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies.

Implications for cancer survivors: Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.

Keywords: Cancer; Clinical management; Colorectal neoplasms; Distress; Quality of life; Surgical oncology.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cancer Survivors
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / psychology*
  • Colorectal Neoplasms / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Period
  • Prospective Studies
  • Quality of Life / psychology*
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors