Colorectal cancer patients who are more confident at self-managing illness (self-efficacy) are more likely to have better quality of life, according to new research by Macmillan Cancer Support and the Macmillan Survivorship Research Group at the University of Southampton.

The major new study, published yesterday in the journal PLOS ONE, reveals factors that could determine how well colorectal cancer patients will recover.

The research showed that people who are depressed or had low self-efficacy at the time of diagnosis were more likely to have poorer quality of life in the two years following surgery.

Professor Jane Maher, Joint Chief Medical Officer of Macmillan Cancer Support, says “All too often we only focus on the disease and treatment rather than the person having to cope with their illness. Every cancer patient is different and as healthcare professionals we need to consider each person’s individual needs to ensure they get the best support possible. And we know, it’s not just while they’re going through treatment. This research shows us the need for ongoing long term support.

“Good, honest conversations can go a long way to helping achieve this. A holistic needs assessment is one practical way to ensure any areas of concern are identified and addressed from the beginning, directing the person to the right support, in order to help them manage their condition and live well.”

Both self-efficacy and depression had more of an impact on a person’s health and wellbeing than the type of treatment received or stage at diagnosis.

Participants were asked to score their quality of life (based on physical and emotional concerns) as well as their levels of self-efficacy (defined as confidence to manage illness-related problems) and other factors that may influence recovery.

The findings showed that people can be categorised into one of four groups depending on how well they recover from colorectal cancer and its treatment.

Professor Dame Jessica Corner, DBE, a co-author, says “This study shows for the first time the different journeys that people face while recovering from colorectal cancer and how important factors such as feeling able to manage your condition and depression can have a bearing on recovery. It underlines the importance of preparing people for cancer treatment and providing support and expert intervention for psychological problems. It also shows the value of undertaking long-term studies of this kind.”

More than one in four (30%) people were in the bottom two groups who reported consistently below average quality of life.

A 10% improvement in the score for self-efficacy[iii] reduced the risk of being in the bottom group (compared with top group) for quality of life by 68%.

For depression, each 1.7% increase in the score for depression increased the risk of being in the bottom group for quality of life by 20%.

The groundbreaking research, the largest of its kind, is following the lives of more than a thousand colorectal cancer patients from before surgery until several years after treatment, assessing the impact of the treatment and disease on their everyday lives.

Macmillan is using the findings to highlight the importance of individual assessment of colorectal cancer patients to ensure that needs are identified and support offered.

Claire Foster, Professor of Psychosocial Oncology and Director of the Macmillan Survivorship Research Group at the University of Southampton, says "Our study has highlighted the importance of taking into account psychological factors as well as aspects of diagnosis and treatment when thinking about how best to support patients recently diagnosed with colorectal cancer. We have shown that a person’s confidence to manage illness related problems and self-reported depression before they start their cancer treatment predicts their quality of life and health status during treatment and up to two years later.

“Identification of those most at risk of poorer quality of life through assessment of depression and confidence to manage illness-related problems soon after diagnosis will help identify those patients most in need of support to manage the consequences of cancer and its treatment. These results have the potential to revolutionise patient assessment and care-planning to enhance patient care and improve recovery experiences after cancer. However these results are just the beginning, we now need to assess whether they can be applied to patients with different types of cancer, develop supportive interventions to enhance confidence to manage cancer and its treatment and improve access to psychological resources and services for those experiencing depression.”
 

Source: PLOS ONE