The psychological impact of surviving colorectal cancer

March 2023 –A German study published in BMC Cancer explored the emotional impact of colorectal cancer (CRC) on long-term survivors. With an increasing number of patients surviving the disease due to advances in treatment, understanding the emotional aftermath of the disease is an important step to improving aftercare and minimizing the negative impact of the disease on patients.

The study

Previous  studies have demonstrated that cancer patients may suffer from long-term impairments to their quality of life, with some considering their cancer experience to be a profound or traumatic event, and others continuing to suffer from long-term symptoms such as bowel problems.

In this study, 220 patients with CRC who were involved in a previous randomized controlled trial were asked to complete a questionnaire regarding the emotional experience of the disease. Patients received the questionnaire 5-7 years after their CRC diagnosis.

33% of the respondents indicated that the worst experience during their illness was “psychological distress”, referring specifically to the anxiety they experienced regarding the uncertainty of their prognosis. Typical answers in this category were “fear of recurrence” or “the feeling of uncertainty”. It has been shown in previous research that fear of recurrence is associated with reduced emotional and social QoL[1].

Around 17% of patients cited “indigestion and discomfort during defecation”, and 16% cited receiving the initial cancer diagnosis as the worst experiences. Among patients who had an ostomy, 36% said that having one was the worst part.

45% of patients reported that the “change in life priorities” that resulted from their cancer diagnosis was the most positive aspect of surviving the disease. 43% of respondents said that having a “fighting spirit” was the most important advice they received, and 21% said that cancer screening was important advice for future patients.

Conclusions

The majority of survivors that participated in the study saw “psychological distress”, more specifically anxiety, as the worst experience in the course of their disease. This supports the results of a large meta-analysis of Mitchell et al. who showed that uncertainty and fear are the biggest issues for cancer survivors and their spouses[2]. These findings highlight the importance of addressing this topic in patient-doctor communication to ensure that patients who may require additional psychological support can be identified early and treated accordingly. This is

[1] Götze H, Taubenheim S, Dietz A, Lordick F, Mehnert-Theuerkauf A. Fear of cancer recurrence across the survivorship trajectory: results from a survey of adult long‐term cancer survivors. Psycho‐Oncology. 2019 Oct;28(10):2033–41.

[2] Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol. 2013 Jul;14(8):721–32.