title: Illness perceptions are associated with mortality among 1552 colorectal cancer survivors: a study from the population-based PROFILES registry.
abstract: Cancer survivors construct perceptions of illness as a (mal)adaptive mechanism. These perceptions motivate/drive subsequent self-management behaviors toward symptoms and treatment that influence health outcomes. Negative illness perceptions have been associated with increased mortality in other chronically ill groups. However, this association is under-researched in cancer survivors. We aimed to explore the association between illness perceptions and mortality in stage I-III progression-free colorectal cancer (CRC) survivors.
  
  
  
  We used data from the population-based Patient Reported Outcomes Following Initial treatment and Long Term Evaluation of Survivorship (PROFILES) registry of two CRC survivorship studies conducted in 2009 and 2010. We accessed clinical data from the Netherlands Cancer Registry, and mortality data from municipal personal records database. Follow-up was until 31 December 2014. Survivors (n = 1552) completed the Brief Illness Perception Questionnaire. Cox proportional hazard models estimated the association between illness perceptions and mortality.
  
  
  
  Negative illness perceptions on consequences (adjusted hazard ratio (HRadj) 1.60, 95 % confidence interval (CI) 1.14-2.25) and emotion (HRadj 1.65, 95 % CI 1.18-2.31) were associated with higher mortality, after adjusting for demographic, clinical, and lifestyle factors. Smoking and inadequate physical activity were independently associated with mortality for all Brief Illness Perception Questionnaire (BIPQ) dimensions.
  
  
  
  Survivors' perceptions of their illness are important as these perceptions may influence health outcomes during survivorship period. Clinical practice needs to identify and address maladaptive illness perceptions to support more adaptive self-management behaviors and enhance survivorship.
  
  
  
  Cancer survivors may benefit from interventions that address potentially maladaptive perceptions and encourage more adaptive self-management behaviors.
authors.affiliation: Department of Medical Psychology, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands. s.y.thong@amc.uva.nl.
authors.forename: Melissa S Y
authors.initials: MS
authors.lastname: Thong
authors.affiliation: Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands.
authors.forename: Pauline A J
authors.initials: PA
authors.lastname: Vissers
authors.affiliation: Department of Internal Medicine, Máxima Medical Centre, Veldhoven, Netherlands.|Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Vreugdenhil
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands.|Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Lonneke V
authors.initials: LV
authors.lastname: van de Poll-Franse
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000523:psychology*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010465:Perception; D012042:Registries / Q000706:statistics & numerical data*; D012648:Self Care; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*
keywords: Cancer; Illness perceptions; Mortality; Population-based; Survivors