Factors Predicting Health–Related Quality of Life among Colorectal Cancer Survivors during 6 Months to 5 Years after Treatment Completion

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Aphantree Janthathai
Kanaungnit Pongthavornkamol
Doungrut Wattanakitkrileart
Nopadol Soparattanapaisarn


Purpose: To investigate health–related quality of life and the predictive power of symptom distress, stage of cancer, fear of cancer recurrence, and unmet supportive care needs on health–related quality of life in colorectal cancer survivors during 6 months to 5 years after treatment completion.

Design: Correlational predictive research.

Methods: The sample included 108 colorectal cancer survivors meeting the inclusion criteria who came for post-treatment follow up service at one tertiary, university hospital in Bangkok. Questionnaires consisted of demographic data, symptom distress, fear of cancer recurrence, unmet needs, and health-related quality of life. Data were analyzed by descriptive statistics, and predictive power was tested by enter multiple regression analysis.

Mains finding: The findings revealed that colorectal cancer survivors had a quite high healthrelated quality of life (gif.latex?\bar{X} = 109.14, SD = 10.32). Together four predicting study variables explained 20.4% of the variance in health – related quality of life in colorectal cancer survivors with statistical significance (R2 = .204, F(4, 103) = 6.586, p < .01). Symptom distress was the factor that best predicted health – related quality of life (β = -.295, p < .01), followed by unmet needs (β = -.261, p < .01). Stage of cancer and fear of cancer recurrence were not able to explain health – related quality of life.

Conclusion and recommendations: Symptom distress and unmet needs have been found as significant predictors of health-related quality of life in colorectal cancer survivors after completion of primary treatment, Nurses should be aware of cancer survivorship care by focusing on managing distressing symptoms and developing individualized cancer survivorship care plan that resolves unmet needs.

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How to Cite
Janthathai, A., Pongthavornkamol, K., Wattanakitkrileart, D., & Soparattanapaisarn, N. (2018). Factors Predicting Health–Related Quality of Life among Colorectal Cancer Survivors during 6 Months to 5 Years after Treatment Completion. Nursing Science Journal of Thailand, 36(4), 52–65. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/176896
Research Papers


1. American Cancer Society. Colorectal cancer facts & figures 2014-2016. Atlanta: American Cancer Society; 2014.
2. National Cancer Institute. National cancer control programmes 2013-2017. Bangkok: The Agricultural Co-operative Federation of Thailand; 2013. (in Thai).
3. Mullan F. Seasons of survival: reflections of a physician with cancer. N Engl J Med. 1985;313(4):270-3.
4. Gray NM, Hall SJ, Browne S, Macleod U, Mitchell E, Lee AJ, et al. Modifiable and fixed factors predicting quality of life in people with colorectal cancer. Br J Cancer. 2011;104(11):1697-703.
5. Mehnert A, Koch U, Sundermann C, Dinkel A. Predictors of fear of recurrence in patients one year after cancer rehabilitation: a prospective study. Acta Oncol. 2013;52(6):1102-9.
6 Santin O, Murray L, Prue G, Gavin A, Gormley G, Donnelly M. Self-reported psychosocial needs and health-related quality of life of colorectal cancer survivors. Eur J Oncol Nurs. 2015;19(4):336-42.
7. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570-9.
8. Hung HC, Chien TW, Tsay SL, Hang HM, Liang SY. Patient and clinical variables account for changes in health-related quality of life and symptom burden as treatment outcomes in colorectal cancer: a longitudinal study. Asian Pac J Cancer Prev. 2013;14(3):1905-9.
9. Teerathongdee K, Ronnarithivichai C, Thongchareon V, Pongthavornkamol K. Factors predicting quality of life in older adult patients with colorectal cancer post stomal surgery. Thai Cancer Journal. 2014;34(2):68-78. (in Thai).
10. Batehup L, Porter K, Gage H, Williams P, Simmonds P, Lowson, E, et al. Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months. Supportive Care Cancer. 2017;25(7):2063-73.
11. Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR. Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol. 2002;97(5):1228-34.
12. Tung HY, Chao TB, Lin YH, Wu SF, Lee HY, Ching CY, et al. Depression, fatigue, and QoL in colorectal cancer patients during and after treatment. West J Nurs Res. 2016;38(7):893-908.
13. Cho D, Lu Q. The association between fear of cancer recurrence and quality of life among Chinese cancer survivors: main effect hypothesis and buffering hypothesis. Qual Life Res. 2017;26(9):2375-85.
14. Cheng KKF, Wong WH, Koh C. Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors. Supportive Care Cancer. 2016;24(5):2025-33.
15. Mishel MH. Reconceptualization of the uncertainty in illness theory. Image J Nurs Sch. 1990;22(4):256-62.
16. Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins; 2008.
17. Brodaty H, Pond D, Kemp NM, Luscombe G, Harding L, Berman K, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50(3):530-4.
18. Griffiths J, Putthioi S, Pongsuksri M. The General Practitioner Assessment of Cognition; GP-COG (Thai version): validity and reliability. Poster session presented at: Rewinding the aging clock. 9th Pan-Pacific Conference on Rehabilitation cum, 21st Annual Congress of Gerontology; 2014 Nov 29-30; Jockey Club Auditorium, The Hong Kong Polytechnic University. Hong Kong, China.
19. Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler HT. The Memorial Symptom Assessment Scale Short Form (MSAS-SF). Cancer. 2000;89(5):1162–71.
20. Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv. 2015;9(3):481-91.
21. Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Lo SK, et al. The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the CaSUN (Cancer Survivors’ Unmet Needs measure). Psychooncology. 2007;16(9):796–804.
22. Molassiotis A, Yates P, Li Q, So WKW, Pongthavornkamol K, Pittayapan P, et al. Mapping unmet supportive care needs, quality-of-life perceptions and current symptoms in cancer survivors across the Asia-Pacific region: results from the International STEP Study. Ann Oncol. 2017;28(10):2552-8.
23. Sirilerttrakul S, Jirajarus M, Rattanatharathorn W, Hanucharoenkul S, Sirachaiyanan A, Nilchaigowit T. Reliability of Functional Assessment of Cancer Therapy (FACT) Thai version in breast cancer patients, colorectal cancer patients and lung cancer patient. Thai Journal of Nursing Research. 2000;4(1):61-77. (in Thai).
24. Willems RA, Bolman CAW, Mesters I, Kanera IM, Beaulen AA, Lechner L. Cancer survivors in the first year after treatment: the prevalence and correlates of unmet needs in different domains. Psychooncology. 2016;25(1):51-7.
25. Mellon S, Northouse LL, Weiss LK. A population-based study of the quality of life of cancer survivors and their family caregivers. Cancer Nurs. 2006;29(2):120-31.