The cost of survival: A mixed-method exploration of healthcare-related factors predicting colorectal cancer survivors’ quality of life

Abstract

Background: Follow-up care is a central component of cancer survivorship. Declining frequency of contact with healthcare professionals after treatment is linked to psychological distress and perceived insufficiencies in information and support among cancer survivors. However, evidence on the relationship between healthcare-related factors and quality of life (QOL) outcomes is sparse within this population. This study aims to explore the healthcare-related predictors of QOL outcomes among colorectal cancer (CRC) survivors undergoing routine follow-up care up to five years after diagnosis. Methods: A sequential explanatory mixed-methods study was conducted with CRC survivors 6-60 months after diagnosis. A cross-sectional survey (n=304) assessed survivors' QOL (EuroQOL; FACT-C), continuity of care (PCCQ), and unmet information and supportive care needs. Semi-structured interviews were subsequently conducted with a subsample of survey participants (n=22), eliciting more in-depth information about survivors' experiences of cancer-related healthcare and QOL outcomes. The findings of the thematic qualitative analysis were integrated with the results of statistical analysis to explain, enhance and extend the quantitative findings. Results: Overall, CRC survivors reported positive QOL and continuity of care. However, logistic regression models indicate positive QOL outcomes were predicted by health insurance status, remission of disease, greater continuity of care, non-use of cancer support and low levels of social difficulty (all p ≤0.05; 24-32% of variance). Interview data corroborated these results, suggesting healthcare factors which negatively influenced QOL outcomes had individual, organisational, and political origins, and contributed to unmet information and supportive care needs. Conclusions: The results suggest that survivors' perceptions of continuity of care is predictive of QOL outcomes and may be influenced by unmet information and supportive care needs arising from perceived shortcomings in healthcare provision. Strategies to address such unmet needs are necessary and should consider survivors' preferences for cancer support and social difficulties.