Quality of Life in Postoperative Colorectal Cancer Survivors: A Structural Equation Model

Chophaka  Suttipong; Siriorn  Sindhu; Ketsarin  Utriyaprasit; Cherdsak  Iramaneerat

doi:10.33192/Smj.2021.75

Authors

Chophaka Suttipong Doctoral candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand
Siriorn Sindhu Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
Ketsarin Utriyaprasit Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
Cherdsak Iramaneerat Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

DOI:

https://doi.org/10.33192/Smj.2021.75

Keywords:

Quality of life, postoperative complications, healthcare delivery, colorectal cancer

Abstract

Objective: The present study has been aimed at constructing a causal model to determine factors affecting healthrelated quality of life (HRQoL) in postoperative patients with colorectal cancer (CRC) following discharge.
Materials and Methods: A cross-sectional study was conducted with 396 postoperative CRC cancer patients from ten tertiary hospitals representing each of the four Regions of Thailand. Data was collected through a standard questionnaire. Structure equation modeling (SEM) was applied to analyze data.
Results: The findings revealed that the majority of patients with CRC surgery had a moderate HRQoL. One hundred and twenty-three patients (31.1%) had complications. SEM showed a good fit with ƛ2=40.347, df=28, p=0.062, GFI=0.980, CFI=0.959 and RMSEA=0.033. The final model showed that age, stage of cancer and healthcare service being received following CRC surgery had direct effects on HRQoL. Nutritional status and follow-up outpatient clinic had indirect effects on HRQoL during postoperative complications. Moreover, social support and primary family caregiver support had indirect effects on HRQoL through self-management capacity.
Conclusion: The findings of this study emphasized the importance of implementing effective strategies to improve quality of life among postoperative patients with CRC after discharge and indicated these strategies should focus on quality of healthcare service following CRC surgery, self-management capacity and prevention of postoperative complications. Postoperative complications can be reduced by providing effective follow-up in outpatient clinics and nutritional status management, consequently improving quality of life among this population.

References

Lithner M, Jakobsson U, Andersson E, Klefsgård R, Palmquist I, Johansson J. Patients’ perception of information and healthrelated quality of life 1 month after discharge for colorectal cancer surgery. J Cancer Educ 2015;30(3):514-21.

Cummings A, Grimmett C, Calman L, Patel M, Permyakova NV, Winter J, et al. Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study. Psychooncology 2018; 27(10):2427-35.

van Heinsbergen M, den Haan N, Maaskant-Braat AJ, Melenhorst J, Belgers EH, Leijtens JW, et al. Functional bowel complaints and quality of life after surgery for colon cancer: prevalence and predictive factors. Colorectal Dis 2020;22(2):136-45.

Orosz E, Ember I, Gombos K, Tóth L, Tarpay Á, Pap Á, et al. Alternatives for the intensive follow-up after curative resection of colorectal cancer. Potential novel biomarkers for the recommendations. Pathol Oncol Res 2013;19(4):619-29.

Jones D, Musselman R, Pearsall E, McKenzie M, Huang H, McLeod RS. Ready to go home? Patients’ experiences of the discharge process in an Enhanced Recovery After Surgery (ERAS) program for colorectal surgery. J Gastrointest Surg 2017;21(11): 1865-78.

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. Support Care Cancer 2017;25(7):2063-73.

Malmstrom M, Ivarsson B, Klefsgard R, Persson K, Jakobsson U, Johansson J. The effect of a nurse led telephone supportive care programme on patients’ quality of life, received information and health care contacts after oesophageal cancer surgery-A six month RCT-follow-up study. Int J Nurs Stud 2016;64:86-95.

Slankamenac K, Slankamenac M, Schlegel A, Nocito A, Rickenbacher A, Clavien PA, et al. Impact of postoperative complications on readmission and long-term survival in patients following surgery for colorectal cancer. Int J Colorectal Dis 2017;32(6):805-11.

Qaderi SM, Swartjes H, Custers JAE, de Wilt JHW. Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review. Eur J Surg Oncol 2020;46(10 Pt A):1779-88.

van Heinsbergen M, Maas H, Bessems S, Vogelaar J, Nijhuis P, Keijzer-Bors L, et al. Follow-up after surgical treatment in older patients with colorectal cancer: The evaluation of emerging health problems and quality of life after implementation of a standardized shared-care model. J Geriatr Oncol 2019;10(1):126-31.

Wiltink LM, White K, King MT, Rutherford C. Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term symptoms and functional impairments. Support Care Cancer 2020;28(6): 2523-32.

Wang SY, Chang TH, Han CY. Effectiveness of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer after enterostomy surgery: A pilot study. Adv Skin Wound Care 2021;34(2):1-6.

Matsui T, Hirai K, Gondo Y, Sato S. Understanding help-seeking behaviour in relation to psychosocial support services among Japanese cancer patients. Jpn J Clin Oncol 2020;50(10):1175-81.

Walming S, Block M, Bock D, Angenete E. Timely access to care in the treatment of rectal cancer and the effect on quality of life. Colorectal Dis 2018;20(2):126-33.

Dunne S, Coffey L, Sharp L, Desmond D, Cullen C, O’Connor J, et al. Investigating the impact of self-management behaviours on quality of life and fear of recurrence in head and neck cancer survivors: A population-based survey. Psychooncology 2019; 28(4):742-9.

Williamson S, Chalmers K, Beaver K. Patient experiences of 578 Volume 73, No.9: 2021 Siriraj Medical Journal https://he02.tci-thaijo.org/index.php/sirirajmedj/indexnurse-led telephone follow-up following treatment for colorectal cancer. Eur J Oncol Nurs 2015;19(3):237-43.

Mazanec SR, Sattar A, Delaney CP, Daly BJ. Activation for health management in colorectal cancer survivors and their family caregivers. West J Nurs Res 2016;38(3):325-44.

Wong-Cornall C, Parsons J, Sheridan N, Kenealy T, Peckham A. Extending “continuity of care” to include the contribution of family carers. Int J Integr Care 2017;17(2):11.

Dong X, Li G, Liu C, Kong L, Fang Y, Kang X, et al. The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: A structural equation model analysis. Eur J Oncol Nurs 2017;29:47-52.

Reyes ME, Ye Y, Zhou Y, Liang A, Kopetz S, Rodriquez MA, et al. Predictors of health-related quality of life and association with survival may identify colorectal cancer patients at high risk of poor prognosis. Qual Life Res 2017;26(2):319-30.

Adams SV, Ceballos R, Newcomb PA. Quality of life and mortality of long-term colorectal cancer survivors in the seattle colorectal cancer family registry. PLoS One 2016;11(6):e0156534.

Baguley BJ, Skinner TL, Wright ORL. Nutrition therapy for the management of cancer-related fatigue and quality of life: a systematic review and meta-analysis. Br J Nutr 2019;122(5):527-41.

Couwenberg AM, de Beer FSA, Intven MPW, Burbach JPM, Smits AB, Consten ECJ, et al. The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study. J Geriatr Oncol 2018;9(2):102-9.

Koplin G, Müller V, Heise G, Pratschke J, Schwenk W, Haase O. Effects of psychological interventions and patients’ affect on short-term quality of life in patients undergoing colorectal surgery. Cancer Med 2016;5(7):1502-9.

Byrne BM. Structural equation modeling with AMOS: basic concepts, applications, and programming (multivariate applications series), 3rded. New York: Routledge,2010.

Bierrenbach A. Steps in applying Probability Proportional to Size (PPS) and calculating Basic Probability Weights, 2008.p.1-5.

Silpakit C, Sirilerttrakul S, Jirajarus M, Sirisinha T, Sirachainan E, Ratanatharathorn V. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): validation study of the Thai version. Qual Life Res 2006;15(1):167-72.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187-96.

Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013;258(1):1-7.

Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res 2005;40(6 Pt 1):1918-30.

Utriyaprasit K, Moore S. Recovery symptoms and mood states in Thai CABG patients. J Transcult Nurs 2005;16(2):97-106.

Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22(4):415-21.

Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. Journal of personality assessment 1988;52(1):30-41.

Wongpakaran T, Wongpakaran N, Ruktrakul R. Reliability andvalidity of the Multidimensional Scale of Perceived Social Support (MSPSS): Thai version. Clin Pract Epidemiol Ment Health 2011;7:161-6.

Steffens D, Beckenkamp PR, Hancock M, Solomon M, Young J. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med 2018;52(5):344.

Kwag SJ, Kim JG, Kang WK, Lee JK, Oh ST. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res 2014;86(4):206-11.

Ye T, Sun X, Tang W, Miao Y, Zhang Y, Zhang L. Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China. BMC Health Serv Res 2016;16(1):674-8.

Valdivieso B, García-Sempere A, Sanfélix-Gimeno G, Faubel R, Librero J, Soriano E, et al. The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study. Med Clin (Barc) 2018;151(8):308-14.

Sier MF, Oostenbroek RJ, Dijkgraaf MGW, Veldink GJ, Bemelman WA, Pronk A, et al. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial. Colorectal Dis 2017;19(8):739-49.

Acher AW, Campbell-Flohr SA, Brenny-Fitzpatrick M, Leahy-Gross KM, Fernandes-Taylor S, Fisher AV, et al. Improving patient-centered transitional care after complex abdominal surgery. J Am Coll Surg 2017;225(2):259-65.

Lin CC, Bruinooge SS, Kirkwood MK, Olsen C, Jemal A, Bajorin D, et al. Association between geographic access to cancer care, insurance, and receipt of chemotherapy: geographic distribution of oncologists and travel distance. J Clin Oncol 2015;33(28):3177-85.

Gleason KT, Tanner EK, Boyd CM, Saczynski JS, Szanton SL. Factors associated with patient activation in an older adult population with functional difficulties. Patient Educ Couns 2016;99(8):1421-6.

Dumrongpanapakorn P, Liamputtong P. Social support and coping means: the lived experiences of Northeastern Thai women with breast cancer. Health Promot Int 2017;32(5):768-77.

Witt D, Benson G, Campbell S, Sillah A, Berra K. Measures of patient activation and social support in a peer-led support network for women with cardiovascular disease. J Cardiopulm Rehabil Prev 2016;36(6):430-7.

Mosher CE, Adams RN, Helft PR, O’Neil BH, Shahda S, Rattray NA, et al. Family caregiving challenges in advanced colorectal cancer: patient and caregiver perspectives. Support Care Cancer 2016;24(5):2017-24.