Identifying Social Distress: A Cross-Sectional Survey of Social Outcomes 12 to 36 Months After Colorectal Cancer Diagnosis.
OBJECTIVE
To establish the prevalence and determinants of poor social outcomes after a diagnosis of colorectal cancer (CRC).


METHODS
All 12- to 36-month survivors of CRC (International Classification of Diseases [10th revision] codes C18 to C20) diagnosed in 2010 or 2011 and treated in the English National Health Service were identified and sent a questionnaire from their treating cancer hospital. This included the Social Difficulties Inventory, a 16-item scale of social distress (SD) comprising everyday living, money matters, and self and others subscales, plus five single items. Sociodemographic and clinical data were also collected. Analyses using descriptive statistics, χ(2) tests, and logistic regression models were conducted.


RESULTS
Response rate was 63.3% (21,802 of 34,467). Of the 21,802 participants, 17,830 (81.8%) completed all SD items; 2,688 (15.1%) of these 17,830 respondents were classified as experiencing SD (everyday living, 19.5%; money matters, 15.6%; self and others, 18.1%). Multivariable analysis demonstrated having ≥ three long-term conditions was the strongest predictor of SD (odds ratio [OR], 6.64; 95% CI, 5.67 to 7.77 compared with no long-term conditions), followed by unemployment (OR, 5.11; 95% CI, 4.21 to 6.20 compared with being employed), having recurrent or nontreatable disease (OR, 2.75; 95% CI, 2.49 to 3.04 compared with being in remission), and having a stoma (OR, 2.10; 95% CI, 1.86 to 2.36 compared with no stoma). Additional predictors of SD were young age (< 55 years), living in a more deprived area, nonwhite ethnicity, having advanced-stage disease, having undergone radiotherapy, and being a carer.


CONCLUSIONS
Although it is reassuring a majority do not experience social difficulties, a minority reported significant SD 12 to 36 months after diagnosis of CRC. The identified clinical and social risk factors are easy to establish and should be used to target support.
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom. e.p.wright@leeds.ac.uk.
Penny
P
Wright
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
Amy
A
Downing
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
Eva J A
EJ
Morris
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
Jessica L
JL
Corner
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
Mike A
MA
Richards
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
David
D
Sebag-Montefiore
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
Paul
P
Finan
Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.
Adam W
AW
Glaser
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology