The effects of age, education, and treatment on physical, sexual and body concern symptoms among multimorbid, colorectal cancer survivors.
OBJECTIVE
Less is known about longitudinal changes in quality of life between treatment completion and early survivorship among multimorbid cancer survivors. The current study describes longitudinal changes in quality of life among a multimorbid cohort of US Veterans diagnosed and treated for colorectal cancer.


METHODS
A sample of 68 multimorbid adults with colon and/or rectal cancer who received one or more treatment options (surgery, chemo or radiation therapy) was recruited. Participants were not excluded by cancer stage unless they reported being in hospice or similar status. Comprehensive assessments of quality of life and treatment side-effects were conducted 6, 12, and 18months after diagnosis. Descriptive statistics characterized treatment side-effects and changes in quality-of-life domains longitudinally. Multivariate Analysis of Variance identified sociodemographic and clinical variables associated with quality of life changes.


RESULTS
Many physical symptoms improved from 6 to 18months following diagnosis, while some remained stable. Sexual symptoms worsened, attributable to increasing rates of dysfunction in older patients. Low education attainment was predictive of worse physical symptoms (F=5.59, p=.023) and associated with body concerns (F=5.7; p=.005) over time. Advanced cancer stage (F=4.94; p<.04) and receipt of chemotherapy (F=4.21; p<.05) independently predicted body concerns in multivariate analyses.


CONCLUSIONS
Endorsement of physical and sexual symptoms and body concerns occurs in different patterns over time among multimorbid colorectal cancer survivors. Low education attainment is consistently associated with physical symptoms and body concerns. Cancer stage and chemotherapy are predictive of body concerns, but not physical or sexual symptoms.
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. Electronic address: anaik@bcm.edu.
Aanand D
AD
Naik
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. Electronic address: Natalie.Uy@bcm.edu.
Natalie
N
Uy
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. Electronic address: Daniel.anaya@va.gov.
Daniel A
DA
Anaya
Geriatric Mental Health, VA Boston Healthcare System, Brockton Division, 940 Belmont St., Brockton, MA 02301, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA. Electronic address: Jennifer.Moye@va.gov.
Jennifer
J
Moye
D000203:Activities of Daily Living / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data
Cancer survivors; Colorectal cancer; Multimorbidity; Quality of life; Symptoms