title: Participation in Activities Associated With Quality of Life for Long-Term Survivors of Rectal Cancer.
abstract: Cancer patients' participation in social, recreational, and civic activities is strongly associated with quality of life (QOL), but these activities are not well integrated into cancer survivorship research or interventions.
  
  
  
  Test the hypothesis that for long-term (≥ 5 years) survivors of rectal cancer, clinical factors (type of surgery and bowel function) are associated with long-term participation in activities and that participation in activities is associated with long-term QOL.
  
  
  
  Observational study with longitudinal and cross-sectional components.
  
  
  
  Participation in activities and QOL. Tumor registry records were used to identify patients and obtain clinical data; surveys assessed participation and QOL. Using general linear models, we analyzed participation in activities in relation to type of surgery and bowel function after adjustment for potential confounders. We analyzed overall QOL relative to participation in activities after adjustment.
  
  
  
  A total of 567 rectal cancer survivors completed a mailed questionnaire. Overall response rate was 61%. The type of operation (p < 0.0001), receipt of radiation therapy (p = 0.002), and bowel function (p < 0.0001) were associated with participation in activities. Participation in activities was the strongest predictor of QOL (p < 0.0001), explaining 20% of the variance (R2) in QOL, with all other variables together accounting for another 18% of the variance.
  
  
  
  The importance of participation in activities on rectal cancer survivors' QOL is underappreciated. We recommend revising QOL instruments used in cancer care and research to include questions about participation in activities. Interventions should address maintenance of preferred activities and adoption of new, fulfilling activities.
authors.affiliation: Medical Anthropologist and Investigator in the Science Programs Department at The Center for Health Research in Portland, OR. carmit.mcmullen@kpchr.org.
authors.forename: Carmit
authors.initials: C
authors.lastname: Mcmullen
authors.affiliation: Senior Data Consultant for the Division of Research in Oakland, CA. liyan.liu@kp.org.
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.affiliation: Research Associate at The Center for Health Research in Portland, OR. joanna.e.bulkley@kpchr.org.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Bulkley
authors.affiliation: Chief Scientist at The Center for Health Research in Portland, OR. mark.c.hornbrook@kpchr.org.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.affiliation: Instructor at the University of Arizona College of Medicine and Arizona Center on Aging in Tucson. cwendel@aging.arizona.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wendel
authors.affiliation: Distinguished Professor in the Department of Nursing Research and Education at the City of Hope National Medical Center in Duarte, CA. mgrant@coh.org.
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.affiliation: Research Project Manager for the Division of Research in Oakland, CA. andrea.altschuler@kp.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.affiliation: Surgical Oncologist at the Memorial Sloan-Kettering Cancer Center in New York, NY. templel@mskcc.org.
authors.forename: Larissa Kf
authors.initials: LK
authors.lastname: Temple
authors.affiliation: Instructor of Surgery at the University of Pennslvania School of Medicine and Chief of Surgery for the CMC Veterans Affairs Medical Center in Philadelphia. robert.krouse@uphs.upenn.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Krouse
authors.affiliation: Research Scientist for the Division of Research in Oakland, CA. lisa.herrinton@kp.org.
authors.forename: Lisa
authors.initials: L
authors.lastname: Herrinton
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery; D003430:Cross-Sectional Studies; D003672:Defecation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010030:Ostomy; D011788:Quality of Life; D011998:Recreation; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D058992:Social Participation; D011795:Surveys and Questionnaires; D017741:Survivors