Search Results (91)

Background/Objectives: Although numerous prognostic biomarkers have been proposed for colorectal cancer (CRC), their longitudinal evaluation remains limited. The aim of this study was to investigate longitudinal changes in biomarkers calculated from routinely used laboratory markers and their relationships to common chronic diseases (comorbidities). Methods: A retrospective longitudinal observational study was completed with the inclusion of 817 CRC patients and a total of 4542 measurement points. Pan-immune inflammation value (PIV), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated based on complete blood count and albumin measurement data. Results: Longitudinal data analyses confirmed the different values and slopes of the parameters tested at the different endpoints. Survivors had the lowest and most constant PIVs and SII values, and the highest and most slowly decreasing PNI values. Those patients with non-cancerous death had similar values to the previous cohort, but an increase/decrease occurred towards the death event. Patients with CRC-related death had significantly higher PIVs and SII values and significantly lower PNI values (p < 0.0001), and a significant increase/decrease was observed at the early observational periods. The presence of lymph node and/or distant metastases, adjuvant chemotherapy, and hypertension significantly affected PIVs and SII and/or PNI values. The changes in PIVs and SII and PNI values toward pathological values are poor prognostic signs (p < 0.0001). Conclusions: Each of the three calculated markers demonstrates suitability for longitudinal patient follow-up, and their pathological alterations over time serve as valuable prognostic indicators. They may also be useful to detect certain clinicopathological parameters early. Full article

Background/Objectives: Colorectal cancer (CRC) is one of the major epidemiological oncological confronts with established risk factors, including male sex. Still, CRC is reported among the leading malignancies in the female population. The necessity for possible, easily accessible prognostic factors is required to improve patient outcomes. This study aimed to assess sex-related differences in nine-month four-stage CRC results of palliative systemic therapy. Methods: A total of 67 patients (39 males) with a median age of 70 (64–76) years were referred for first-line palliative chemotherapy due to end-stage colorectal cancer diagnosis. The CRC advancement was evaluated by computed tomography (CT) before and 9 months after chemotherapy. The demographical and clinical characteristics were evaluated for nine-month therapy outcomes, including mortality risk and CT scan results. Results: The nine-month mortality risk in female and male groups was indifferent, reaching 21% (6 patients) and 21% (8 patients), respectively (p = 0.935). Among survivors, therapy response was observed in 6 (21%) female and 20 (51%) male patients (p = 0.056). In multivariable analysis, the male sex (OR: 3.91, 95% CI: 1.09–14.05, p = 0.037) and RDW (OR: 0.61, 95% CI: 0.42–0.88, p = 0.008) were found to be significant for disease response to systemic therapy based on CT scan results. The ROC curve for predictive role yields a sensitivity of 71.1%, specificity of 57.8%, and an area under the curve (AUC) of 0.726. Conclusions: Our analysis points out the possible favorable role of the male sex on nine-month systemic therapy response in palliative CRC. The RDW-CV can be regarded as a possible indicator of chemotherapy response in colorectal cancer. The mortality risk within 9 months of systemic therapy is comparable between males and females. Full article

Background: COVID-19 has been linked to prolonged immune dysfunction and long-term health complications. Herpes zoster (HZ), a marker of impaired cell-mediated immunity, may signal increased vulnerability to infections, cardiovascular disease, and potentially cancer. However, its association with colorectal cancer (CRC) after COVID-19 has not been fully explored. Objective: To investigate the long-term risks of cardiovascular events, acute respiratory failure, sepsis, and CRC in COVID-19 survivors who developed HZ compared to those who did not. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults diagnosed with COVID-19 between January 2020 and January 2022 were included. Among the full cohort (aged ≥18 years), 27,664 patients with post-COVID HZ were identified. Due to platform limitations, propensity score matching (PSM) was applied to a restricted subgroup of patients aged 55–60 years, yielding a 1:1 matched cohort for controlled comparisons. Outcomes were assessed over a three-year follow-up. Results: In the matched age-restricted cohort, patients with post-COVID HZ had significantly higher risks of cardiovascular events, acute respiratory failure, sepsis, and CRC compared to matched controls. Subgroup analyses identified age ≥ 50, chronic kidney disease, diabetes, and hypertension as strong independent risk factors across outcomes. Despite the low absolute CRC incidence, cancer-free survival significantly favored the non-HZ group. Conclusion: Herpes zoster reactivation after COVID-19 is associated with increased risk of colorectal cancer. Enhanced surveillance and early CRC screening may benefit this high-risk population. Full article

Background/Objectives: Health behavior management plays a critical role in improving outcomes for cancer survivors. This study aims to examine differences in health behaviors based on survival status and time since diagnosis among individuals with gastric or colorectal cancer. Methods: Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES, 2014–2021). Among adults aged ≥40 years, 478 individuals diagnosed with gastric or colorectal cancer within the past 10 years were included. Participants were classified as current patients or survivors based on current disease status, and time since diagnosis was categorized as ≤3 years or >3 years. All analyses accounted for complex sample weights. Differences in health behaviors were evaluated using weighted t-tests and Rao–Scott chi-square tests, and weighted logistic regression was used to assess the association between time since diagnosis and current alcohol use. Results: Current alcohol consumption was significantly more prevalent in survivors (49.2%) than in current patients (29.9%) (p = 0.0002). Among current patients, those diagnosed more than three years earlier showed a higher drinking rate (40.9%) compared with those diagnosed within three years (25.4%) (p = 0.0411). In logistic regression analysis, time since diagnosis >3 years was associated with higher odds of alcohol consumption (OR = 2.32, 95% CI: 1.04–5.20), even after adjusting for age and sex. No significant differences were observed in smoking, aerobic activity, strength exercise, or walking. Conclusions: A longer time since diagnosis was associated with increased alcohol consumption in gastric and colorectal cancer patients, highlighting the need for sustained behavioral interventions during survivorship. Full article

Background: Colorectal cancer (CRC) is the most common cancer and the leading cause of cancer-related death globally. While survival improved, CRC patients face the risk of subsequent multiple primary cancers (MPCs). This study aimed to determine the incidence and identify risk factors associated with metachronous MPCs among CRC survivors. Methods: A retrospective analysis was performed on adults diagnosed with invasive colorectal adenocarcinoma at Flinders Medical Centre from 2011 to 2024, who had at least 6 months of post-CRC follow-up. Sociodemographic factors, clinical information, tumour characteristics, and treatment types were collected. Cumulative incidence function and sub-distribution hazard models were used to estimate the incidence and identify risk factors of developing MPCs. Results: Of the total 554 eligible study participants, 12% developed MPC, with a median follow-up time of 5 years (interquartile range: 2.8–7.6 years) until the diagnosis of MPC. Gastrointestinal, prostate, and haematological malignancies were the most common types of MPCs identified. The cumulative incidence and standardised incidence ratio (SIR) of an MPC were 20.9% (95% CI: 15.3–25.6) and 1.32 (95% CI: 1.03–1.68), respectively. Male sex, older age (>65 y), early-stage cancer, and loss of mismatch repair (MMR) protein expression were associated with an increased risk of developing MPCs. Conclusions: CRC survivors have a higher risk of developing an MPC compared to the general population. Sex, age, cancer stage, and MMR protein expression are factors associated with MPCs. Therefore, tailored surveillance based on the individual’s risk profile should be considered for timely diagnosis of subsequent cancers to improve long-term outcomes. Full article

Suicide is a major public health problem that has grown at alarming rates in the last two decades. Colorectal cancer (CRC) is one of the most common causes of cancer deaths in the United States in both males and females. However, the influence of suicidal ideation (SI) on the association between CRC and risk of mortality has not been well examined. Methods: For this study, the 2005–2018 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of United States adults aged 20 years or older, was utilized. CRC survivorship was determined from self-reported data on CRC, and mortality was ascertained by linking the NHANES data with death files from the National Death Index up to December 2019. Suicidal ideation (SI) confirmation was based on a response to a survey question. Results: People with SI had a significantly higher rate (12.3% vs. 7.5%, p < 0.01) of mortality than those without SI. Also, individuals with CRC (2.4%) had a statistically significant higher rate of frequent SI (almost daily) than individuals without CRC (0.6%). Upon a mean follow-up of 7.5 years, more CRC survivors (34.6%) died than non-CRC survivors (7.6%). The adjusted HR was elevated HR = 5.4 among individuals who had CRC and SI but close to 1.0 among individuals who had a history of CRC alone after adjusting for demographic and health variables. Conclusions: In this first national study in the U.S., we found that SI and CRC combined had worse mortality outcomes than CRC alone. Additionally, people with CRC were more likely to experience frequent SI. Our findings underscore the importance of mental healthcare and psychological well-being promotion among individuals with chronic diseases and the high need for integrated care approaches that address both physical and mental health needs. Full article

The decline in colorectal cancer (CRC) due to screening success in the U.S. is inconsistent across populations and age groups. CHamorus (Chamorros) and Filipinos constitute minorities in the U.S. but comprise over 70% of the population in Guam where steep increases in CRC incidence occur before the age of 50, and only 53.9% of persons have met national screening standards. This preliminary study explored knowledge, cultural beliefs, and age-specific recommendations associated with CRC and screening. Five focus groups segregated by age and gender were conducted with persons aged 40 and above. Data were collected on knowledge, attitudes, beliefs, and screening education recommendations. Focus group participants (n = 25) were predominantly CHamoru (60%), Filipino (32%), and female (56%). The mean age was 55. Participants preferred interventions that integrated storytelling from CRC survivors with emphasis on family education rather than limiting to screening-age adults. Multicoders performed an iterative collaborative analysis for the main themes: knowledge of CRC/screening primarily derives from family experiences; increased outreach is needed for men; use of personal narratives; and screening is motivated by family values and intergenerational consciousness. Findings can inform future studies on age- and culturally-tailored early detection strategies to improve CRC screening participation in Pacific populations. Full article

Cancer survivors face numerous challenges, and digital health interventions can empower them by enhancing self-efficacy and patient activation. This prospective study aimed to assess the impact of a mHealth app on self-efficacy and patient activation in 166 breast and colorectal cancer survivors. Participants received a smart bracelet and used the app to access personalized care plans. Data were collected at baseline and follow-ups, including patient-reported outcomes and clinician feedback. The study demonstrated positive impacts on self-efficacy and patient activation. The overall trial retention rate was 75.3%. Participants reported high levels of activation (PAM levels 1–3: P = 1.0; level 4: P = 0.65) and expressed a willingness to stay informed about their disease (CASE-Cancer factor 1: P = 0.98; factor 2: P = 0.66; factor 3: P = 0.25). Usability of the app improved, with an increase in participants rating the system as having excellent usability (from 14.82% to 22.22%). Additional qualitative analysis revealed positive experiences from both patients and clinicians. This paper contributes significantly to cancer survivorship care by providing personalized care plans tailored to individual needs. The PERSIST platform shows promise in improving patient outcomes and enhancing self-management abilities in cancer survivors. Further research with larger and more diverse populations is needed to establish its effectiveness. Full article

Background/Objectives: Psychological distress, including anxiety and depression, significantly impacts quality of life (QoL) in colorectal cancer patients. This study explores the relationship between psychological distress and QoL, identifies risk factors (e.g., advanced disease stage, socioeconomic status, and social support levels), and evaluates the influence of emotional and social functioning on patient well-being. Additionally, this study examines workplace reintegration challenges faced by cancer survivors. Methods: A longitudinal study was conducted with 50 patients diagnosed with colorectal cancer undergoing chemotherapy. QoL was assessed using the EORTC QLQ-C30 and EQ-5D scales, while anxiety and depression were measured using the Hospital Anxiety and De-pression Scale (HADS). Assessments were conducted at baseline and at the end of a six-month treatment period. Data were analyzed using correlation and multivariate regression analyses to explore associations between psychological distress and QoL, adjusting for disease stage, social support, and demographic factors. Results: Emotional functioning showed a statistically significant improvement by the sixth chemotherapy cycle (p < 0.05), while physical and role functions remained stable. However, psychological health, as assessed through HADS, showed no significant improvement, highlighting the need for targeted psychological support. Negative correlations were observed between QoL scores and anxiety and depression levels, with stronger associations detected in the later stages of treatment. Patients with advanced disease stages and poor social support were identified as high-risk groups for psychological distress. Effect sizes (Cohen’s d) and confidence intervals were calculated to assess the practical significance of findings. Conclusions: This study highlights the critical impact of psychological distress on the QoL of colorectal cancer patients, emphasizing the importance of integrating systematic psychological assessments and tailored interventions in oncology care. Future research should incorporate larger sample sizes, extended follow-up periods, and an exploration of mediating factors to enhance understanding and improve patient-centered interventions. Full article

The population of cancer survivors is increasing rapidly in the UK. Little is known about the variation in comorbidity and mortality by ethnicity and socio-economic condition in this population. This study explores these variations using primary care data from the Clinical Practice Research Datalink (CPRD) and linked secondary care data. The prevalence of multimorbidity and risk of mortality were calculated for Asian, Black, and Other ethnic and socio-economic groups in England, consisting of 333,226 cancer survivors across 28 cancer types. Odds ratios and hazard ratios were calculated using the White and most affluent groups as references and adjusted for age, sex, BMI, and smoking status. Stratified mortality analysis was conducted for survivors of the six common cancers in the UK: breast, prostate, colorectal, bladder, cervical, and lung. Compared to White cancer survivors, survivors of all other ethnic groups had a statistically significant higher prevalence of type 2 diabetes (Asian adjusted odds ratio (OR) 4.61 (4.02–5.28), Black OR 1.87 (1.52–2.30), and Other OR 2.06 (1.64–2.59)). However, they had lower prevalences of depression and anxiety. Asian survivors exhibited the highest overall prevalence of comorbidity. Black survivors had the worst survival (adjusted hazard ratio (HR) 1.48 (1.38–1.59)) for all cancers combined, as well as for breast, prostate, colorectal, and cervical cancers. Black breast cancer survivors face a particularly high mortality risk (HR 1.78 (1.52–2.10)) compared to Whites. Asian survivors had higher mortality for all cancers combined (HR 1.31 (1.23–1.39)) and specifically for lung cancer (HR 1.81 (1.44–2.28)). The Other ethnic group had a significantly increased risk of mortality in cervical cancer (HR 1.90 (1.19–3.03)). The risk of mortality increased with worse socio-economic conditions, regardless of ethnic group. Cancer survivors of non-White ethnicity and poorer socio-economic background in the UK have worse outcomes in terms of increased prevalence of multimorbidity and mortality compared to White survivors. These findings indicate the need to comprehend the underlying reasons for these disparities and to assess the implications for cancer services, patient experience, and overall outcomes. Full article

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. This study examined the prevalence of screening colonoscopy among individuals who reported ever having had a stroke (stroke survivors). Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for the weighted prevalence and odds of screening colonoscopy uptake among adults aged 45 years and older, based on having had a stroke and socioeconomic status. Results: Almost 6% (n = 16,371) of the adults included in the analysis (N = 285,329) reported having had a stroke, and the weighted prevalence of screening colonoscopy for this group was 73.3% compared to 67.8% for those without stroke. Stroke survivors were 1.3 times more likely to have had a screening colonoscopy compared to those without a history of stroke. Higher odds of screening colonoscopy uptake were observed among stroke survivors that were older than 45–49 years old, with high school or greater than high school education. Stroke survivors that were multiracial and without health insurance coverage had lower odds of screening colonoscopy uptake compared to those that were white and had health insurance coverage, respectively. Conclusions: Though adult stroke survivors, compared to those without a stroke, are more likely to report having had a screening colonoscopy, differences in screening colonoscopy uptake were observed among subgroups of this population based on sociodemographic status. Tailored interventions are needed for increasing screening colonoscopy uptake among disadvantaged subgroups. Full article

Little is known about the impacts of fatigue after cancer treatment, including whether cancer-related fatigue impacts people’s use of healthcare. This study sought to examine how cancer-related fatigue impacts healthcare use after completing cancer treatment. A population-based survey was administered in Nova Scotia, Canada, to examine survivors’ experiences and needs after completing cancer treatment. Respondents included survivors of breast, melanoma, colorectal, prostate, hematologic, and young adult cancers who were 1–3 years post-treatment. Survey responses were linked to cancer registry, physicians’ claims, hospitalization, and ambulatory care data. Data were analyzed descriptively and using regression models. The final study cohort included 823 respondents. Younger respondents reported higher levels of cancer-related fatigue compared to older respondents. More females than males reported cancer-related fatigue. Upon adjusted analyses, those with cancer-related fatigue had lower odds of being discharged to primary care for their cancer-related follow-up (odds ratio = 0.71, p = 0.029). Moreover, those with cancer-related fatigue had 19% higher primary care use (incidence rate ratio = 1.19, p < 0.0001) and 37% higher oncology use (incidence rate ratio = 1.37, p < 0.016) during the follow-up period compared to those without cancer-related fatigue. Providers (oncology and primary care) may require additional support to identify clinically relevant fatigue and refer patients to appropriate resources and services. Full article

Purpose: To characterize dietary patterns and examine associations with cross-sectional and longitudinal changes in quality of life (QOL) over approximately one year after colorectal cancer (CRC) diagnosis. Methods: The ColoCare Study is an international, multi-center, prospective cohort study of newly diagnosed CRC survivors of any stage. A subset of participants with CRC in the United States completed patient-reported outcome measures at 6- and 12-months post-enrollment, including the Food Frequency Questionnaire (FFQ) and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Dietary patterns at 6 months (around the time of treatment completion) were identified using Principal Component Analysis (PCA) with varimax rotation. Adherence scores were calculated for participants within each dietary pattern, with higher scores indicating higher adherence. Mixed models were used to examine the effect of each dietary pattern on changes in QOL at 6- and 12-month follow-ups, controlling for cancer stage, biological sex, body mass index (BMI), smoking status, and age. Results: Participants (N = 174) were, on average, 56 ± 14 years old and were mostly female (51.5%), stage III or IV (51.7%), never smokers (60.2%), non-Hispanic (97.1%), and White (83.3%) with a BMI of 27.9 ± 6.1 kg/m². PCA revealed two emerging dietary patterns: “Western diet”, characterized by processed meats, refined grains, and sugars, and “Prudent diet” characterized by lean proteins, fruits, and vegetables. Higher adherence to a Western diet was associated with worse social functioning at 6-month follow-up (FE = −12.6, p = 0.010). Loss of appetite from 6 to 12 months was associated with higher adherence to both the Western and Prudent dietary patterns (FE = 1.5, p = 0.044; FE = 1.3, p = 0.046, respectively). Neither dietary pattern was associated with global QOL score at 6- or 12-month follow-up (p’s > 0.05). Conclusions: Among CRC survivors in the United States, the Western diet was concurrently associated with worse social functioning. Loss of appetite was reported by CRC survivors following both dietary patterns, suggesting that loss of appetite may be a global experience for CRC survivors during this timeframe. Further research is needed to understand specific social challenges experienced by CRC survivors and develop supportive care interventions to address appetite and nutritional concerns. Full article

The aim of our study is to evaluate the relationship between sociodemographic and clinical characteristics of individuals with Colorectal Cancer (CRC), tumour-intrinsic characteristics and treatment received with health-related quality of life (HRQoL). Methods: Cross-sectional analysis of data from 805 survivors from the MCC study was conducted. HRQoL was assessed through a general and specific questionnaire, SF-12 and FCSI (Colorectal Symptom Index). Statistical analyses were performed with linear regression with adjustment for sociodemographic variables, stage at diagnosis and histological grade. Results: Participants had survived a median of 7.9 years from diagnosis (IQR 7.1–8.5 years). Age at diagnosis, sex and area showed a clear association with HRQoL in both physical and mental dimensions of the SF-12 questionnaire. A direct association between CRC recurrence was also found in the PCS-12 and MCS-12 dimensions and radical surgery in the PCS-12. Regarding the scores in FCSI questionnaire, statistically significant differences were observed by sex, age and area, with older women being the most impaired (p < 0.001). Conclusions: Age, sex and area was associated with lower scores of HRQoL among CRC survivors. Knowing the determinants related to HRQoL would allow us to lay the groundwork to develop strategies that help reduce morbidity and mortality, relapses and increase HRQoL. Full article

Background: Understanding the specific needs of cancer survivors is essential for healthcare policy. In Italy, dedicated studies are lacking, so we aimed to investigate the physical, mental, social, and health difficulties encountered by these patients. Methods: We conducted a cross-sectional study on breast or colorectal cancer survivors (people 5+ years free from it and its treatments) using an ad hoc survey including validated questionnaires (Grauer–Palombi, SF-36, PREDIMED). Participants were recruited within the Oncology Unit of the “Policlinico Tor Vergata”, Italy. Results: A total of 62 patients (80.6% females; years range: 37–87) agreed to be interviewed. A profile of cancer survivors was drafted: an overaged person with multiple co-morbidities, not well-nourished, adhering to the Mediterranean diet, reporting critical conditions as for physical and functional status. The mean number of co-morbidities was 3.6 ± 2.4 SD, with a statistically significant difference between age groups (under and over 65). Compared to the general population, the sample showed more frailties, especially when >65. The risk of having multimorbidity (four or more co-morbidities) significantly increased in those over 65 (OR: 4.72; CI: 1.43–15.59). Conclusion: There is an urgent need for survivorship care planning for the patient-centered continuum of care. Assessing and monitoring their specific needs will help propose appropriate and tailored responses. Full article