title: The cost of survival: an exploration of colorectal cancer survivors' experiences of pain.
abstract: BACKGROUND
  The Institute of Medicine report 'From Cancer Patient to Cancer Survivor' has drawn widespread attention to the experiences of cancer survivors. Research examining the symptom experiences of survivors are proliferative within the literature but limited by samples which include multiple tumor groups and varying inclusion criteria. This cross-sectional quantitative study seeks to examine pain and quality of life (QoL) in the context of colorectal cancer (CRC) survivorship, as defined by the Institute of Medicine.
  
  
  METHODS
  A purposive sample of CRC survivors (n = 252) attending hospitals and cancer support centers in the Republic of Ireland were recruited between September 2014 and January 2016. Self-rated health (SRH), QoL and pain were assessed in the sample using the EuroQOL questionnaire, the Functional Assessment of Therapy-Colorectal (FACT-C) questionnaire, and symptom experience items.
  
  
  RESULTS
  One hundred participants (40%) indicated they had pain on the day of the survey or in the past week. Of those with pain, many also experienced a lack of energy (95%), bowel dysfunction (74%), sleep disturbance (76%) or interference with their ability to enjoy life (75%). Pain was associated with younger age, female gender, current chemotherapy treatment, and previous radiotherapy treatment. Although participants reported positive QoL scores, statistical analysis revealed pain was linked to significantly poorer SRH and overall QoL, and poorer physical, emotional, functional, social/family and CRC-specific wellbeing, compared to those who did not indicate pain.
  
  
  CONCLUSIONS
  Pain was experienced by almost two fifths of CRC survivors up to five years after treatment and was associated with poorer SRH and QoL. In light of these findings, healthcare professionals must endeavor to manage cancer survivors' needs in a manner which is cognizant of the burden of pain and in the context of other symptoms and morbidities experienced by long-term cancer survivors.
authors.affiliation: a School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin , Dublin , Ireland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Drury
authors.affiliation: b International Observatory on End of Life Care, Division of Health Research, Lancaster University , Lancaster , UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.affiliation: a School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin , Dublin , Ireland.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Brady
mesh_terms: D000328:Adult; D000368:Aged; D000072716:Cancer Pain / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*