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Purpose: Continuing employment or returning to work (RTW) as a cancer survivor can be meaningful and financially necessary, yet challenging. However, there is a lack of qualitative research on RTW experiences and financial wellbeing of people with advanced colorectal cancer (CRC-A). This study aimed to fill this gap.Methods: Adults treated for CRC-A were recruited 0.5-2 years post-surgery (or post-diagnosis of CRC-A for palliative chemotherapy participants). Semi-structured telephone interviews, exploring RTW and finances, were subjected to framework analysis. Demographic, clinical, and quality of life data (FACT-C, Distress Thermometer, COST measure) were collected to characterise the sample and inform the framework analysis.Results: Analysis of 38 interviews revealed five overarching themes: work as a struggle, work as my identity, work as my saviour, work as a financial necessity, and employer and colleague response. Many survivors with CRC-A desired to, and had the capacity to, continue work or RTW, yet faced unique challenges from compounded stigma of both cancer and toileting issues. Inability to RTW negatively impacted financial and psychosocial wellbeing. Workplace support was an important facilitator of RTW.Conclusion: For survivors with CRC-A, continuing or RTW is fraught with challenges, including physical functioning challenges, financial anxiety, and unsupportive workplace environments. Survivors require psychosocial, financial, and employer support to manage these difficulties. This paper recommends a multiprong approach, including education programmes (facilitated through workers' union groups, human resource institutions, and/or large consumer CRC groups) and policies, to support workers and for employers to understand the unique challenges of employees with CRC-A. [ABSTRACT FROM AUTHOR]

Introduction: With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early‐stage and advanced CRC survivors. Methods: CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis. Results: Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early‐stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas. Conclusion: CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment‐specific impacts on QoL and long‐term (>5 years) impacts on CRC survivors. [ABSTRACT FROM AUTHOR]

Background: Improving care coordination is a key priority for health services. The aims of this study were to identify patient- and health service-related predictors of poorly coordinated care and to explore patient preferences to assist care coordination.Methods: Patients with incident colorectal cancer, identified from a state-wide cancer registry, completed a self-report questionnaire 6 to 8 months after their diagnosis. Care coordination was assessed with the Cancer Care Coordination Questionnaire for Patients. Multiple linear regression models were used to predict factors associated with a poor experience with cancer care coordination.Results: Among 560 patients (56% response rate), care coordination experiences were normally distributed (mean score, 76.1; standard deviation, 10.9). Patients who had 3 or more comorbid conditions (β, -4.56; standard error [SE], 1.46; P = .006), little or no understanding of the health system (β, -4.34; SE, 0.94; P < .001), and no regular general practitioner (GP; β, -4.09; SE, 2.07; P = .049) experienced poorer care coordination. At the health service level, patients who did not receive a written pretreatment plan (β, -4.15; SE, 0.95; P < .001) or did not see a cancer care coordinator (β, -3.29; SE, 1.03; P = .001) had lower scores. The most preferred resources included information packs (92%), written care plans (88%), and improved access to their own personal medical records (electronic, 86; paper, 84%), with most patients preferring a shared GP and surgeon care model.Conclusions: There was wide variation in experiences across the state. The factors associated with lower scores provide a focus for targeted strategies for improving patients' experience with colorectal cancer care coordination. Cancer 2017;123:319-326. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Introduction. Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls. Methods. At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care. Results. Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOLat FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items). Conclusion. The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but patients in the SC group were more satisfied with care. [ABSTRACT FROM AUTHOR]

Modern treatments, including surgery and palliative chemotherapy without surgery, enable longer survival for people with advanced/recurrent colorectal cancer (CRC). Qualitative research comparing the physical and psychosocial outcomes of these different treatments is lacking. This study therefore aimed to explore and compare the physical and psychosocial challenges and survivorship experiences of people who receive different treatments for advanced CRC, through a qualitative study. Adults with CRC who have undergone treatment for advanced/recurrent CRC were recruited 0.5–2 years post-surgery or, for palliative chemotherapy participants, 0.5–2 years post-diagnosis of advanced CRC. Qualitative semi-structured telephone interviews, analysed via framework analysis, explored quality of life (QoL) experiences. Demographic, clinical, and QoL data (Functional Assessment of Cancer Therapy – Colorectal (FACT-C), Distress Thermometer) were collected to characterise the sample and inform the framework analysis. A diverse sample of 38 participants (22 female) participated, with ages ranging 27–84 (Median = 59), FACT-C 56–132 (Median = 102), and distress 0–10 (median = 3). Analysis of interviews revealed three overarching themes: 1) the overwhelming impact of protracted, complex illness ; 2) compounding and interacting effects of multiple treatments, impacts, and multimorbidity ; and 3) the long haul is unpredictable, bumpy, and wearing. These themes reveal that people with advanced CRC experience many challenges due to the complex nature of the illness, its treatment, and side effects. Survivors require continued multi-disciplinary supportive care throughout follow-up to manage survivorship challenges. Guideline-led survivorship care and routine monitoring of physical and psychosocial wellbeing throughout follow up is imperative to manage patient expectations and support advanced CRC survivors. • Survivors of advanced colorectal cancer experience many challenges in survivorship. • Pelvic exenteration survivors may require tailored care for their unique challenges. • Treatment complexity makes survival an unpredictable, bumpy, and wearing long haul. • We need tailored services to meet the needs of advanced colorectal cancer survivors. [ABSTRACT FROM AUTHOR]

Issue addressed: To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. Methods: This study used data from the International Cancer Benchmarking Partnership Module 2, a representative populationbased telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n = 2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. Results: Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). Conclusions: Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effect of patient age on receipt of stage-appropriate adjuvant therapy for colorectal cancer in New South Wales, Australia. Materials and Methods A linked population-based dataset was used to examine the records of 580 people with lymph node-positive colon cancer and 498 people with high-risk rectal cancer who underwent surgery following diagnosis in 2007/2008. Multilevel logistic regression models were used to determine whether age remained an independent predictor of adjuvant therapy utilisation after accounting for significant patient, surgeon and hospital characteristics. Results Overall, 65–73% of eligible patients received chemotherapy and 42–53% received radiotherapy. Increasing age was strongly associated with decreasing likelihood of receiving chemotherapy for lymph node-positive colon cancer ( p < 0.001) and radiotherapy for high-risk rectal cancer ( p = 0.003), even after adjusting for confounders such as Charlson comorbidity score and ASA health status. People aged over 70 years for chemotherapy and over 75 years for radiotherapy were significantly less likely to receive treatment than those aged less than 65. Emergency resection, intensive care admission, and not having a current partner also independently predicted chemotherapy nonreceipt. Other predictors of radiotherapy nonreceipt included being female, not being discussed at multidisciplinary meeting, and lower T stage. Adjuvant therapy rates varied widely between hospitals where surgery was performed. Conclusion There are continuing age disparities in adjuvant therapy utilisation in NSW that are not explained by patients' comorbidities or health status. Further exploration of these complex treatment decisions is needed. Variation by hospital and patient characteristics indicates opportunities to improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

Aim Telephone-delivered supportive care interventions hold potential as a sustainable, low-resource option to improve patients' outcomes. Such interventions may be delivered centrally or locally. There is limited information about clinicians' preferences for these alternative models of service delivery. This study investigated the views of cancer clinicians who had experience of a centralized model. Methods Interviews were conducted with 16 surgeons and nurses across New South Wales, Australia, who had participated in a trial of a centralized telephone-based supportive care intervention. Content analysis was conducted. Data were analyzed inductively and responses organized into categories and then higher order themes. Results All clinicians valued the role of telephone follow ups as they would allow patients to ask questions and receive reassurance. Clinicians believed these services could reduce hospital presentations and provide equity and standardized care, particularly to those outside metropolitan centers. Although clinicians accepted a centralized model of delivery would be cheaper, most ( n = 15) indicated a preference for local delivery. This preference was based on the perception that local nurses would have superior knowledge of the local context. Despite the improved feasibility of a telephone-only service, clinicians felt some face-to-face contact with patients was essential. Key at-risk groups to target were identified. Clinicians acknowledged there could be overlap with cancer nurses locally requiring local decisions about implementation. Conclusion There was clear endorsement of additional telephone support with a preference for a local model of service delivery. The limited acceptability of centralized telephone-based supportive care interventions may restrict their uptake. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational and relationship functioning for many years after the end of treatment or, in fact, lifelong. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. We previously developed a nurse-led supportive care program (SurvivorCare) and tested it in a pilot study involving 10 CRC survivors. The intervention was found to be highly acceptable, appropriate, relevant and useful.Methods/design: This study is a multisite, randomised controlled trial, designed to assess the impact of the addition of the SurvivorCare intervention to usual post-treatment care, for people with potentially cured CRC. SurvivorCare comprises the provision of survivorship educational materials, a tailored survivorship care plan, an individually tailored nurse-led, face-to-face end of treatment consultation and three subsequent telephone calls. Eligible patients have completed treatment for potentially cured CRC. Other eligibility criteria include stage I to III disease, age greater than 18 years and adequate understanding of English. All consenting patients complete questionnaires at three time points over a six-month period (baseline, two and six months). Measures assess psychological distress, unmet needs and quality of life.Discussion: This supportive care package has the potential to significantly reduce individual suffering, whilst reducing the burden of follow-up on acute cancer services through enhanced engagement with and utilisation of general practitioners and community based services. If the intervention is successful in achieving the expected health benefits, it could be disseminated readily. All training and supporting materials have been developed and standardised. Furthermore, the intervention could easily be adapted to other cancer or chronic disease settings.Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12610000207011. [ABSTRACT FROM AUTHOR]

Laparoscopic resection remains to be established as the procedure of first choice for operable colorectal cancer. The aim of the study was to conduct a systematic review of non-randomized comparative studies of laparoscopic resection for colorectal cancer. Published work in English was searched for relevant articles published by the end of 2003. The MOOSE statement was used to conduct the meta-analysis. Study quality was assessed by two investigators using the MINORS tool and the analysis was conducted using Comprehensive Meta-analysis software (Biostat, Englewood, NJ, USA) and Microsoft Excel (Microsoft, Redmond, WA, USA). One thousand two hundred and twenty abstracts were reviewed and 398 articles examined in detail. Out of 108 articles reporting the results of relevant studies, 75 were reports of 64 non-randomized comparative studies. Fifteen studies were excluded. Analysis of the outcomes of 6438 resections showed that the conversion rate was 13.3% with a statistically significant difference between studies with more than 50 versus those with 50 or less attempted resections (11.7 vs 16.5%; P < 0.001). Laparoscopic resection took 27.6% (41 min) longer to carry out than open resection. There was no significant difference between the two groups in early mortality rates (1.2 vs 1.1%; P = 0.787) or likelihood of re-operation (2.3 vs 1.5%; P = 0.319). Laparoscopic resection was associated with a lower morbidity rate (24.05 vs 30.80%, odds ratio (95% confidence interval) = 0.77 (0.63–0.95); P = 0.014, n = 4111, random-effects model). Time until passage of first flatus, passage of a bowel motion, tolerating oral fluids and a solid diet was 1.2–1.6 days (26 to 37%) shorter, measurements of pain and narcotic analgesic requirements were 16–35% lower and hospital stay was 3.5 days (18.8%) shorter following laparoscopic resection compared with open resection. The two approaches were 99% similar in terms of adequacy of oncological clearance. Meta-analysis of non-randomized comparative studies favours laparoscopic over open resection for colorectal cancer. The results were remarkably similar to those of a contemporaneous meta-analysis of randomized controlled trials published by the end of 2002. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the results of meta-analysis of nonrandomized comparative studies (NRCSs) of a surgical procedure with that of randomized controlled trials (RCTs), and to assess the effect of design and conduct issues in NRCSs on measured outcomes. Study Design and Setting: Two meta-analyses of RCTs and NRCSs (2,512 and 6,438 procedures, respectively) of laparoscopic resection for colorectal cancer were performed according to accepted protocols, and 13 outcomes common between them were compared. Odds ratios (ORs) and 95% confidence intervals (CI) for dichotomous outcomes were assessed for the degree of overlap. Continuous outcomes were compared using cumulative weighted ratios (CWRs) and percentages for which a mean and standard deviation (SD) were calculated. The effects of design and conduct issues in the meta-analysis of NRCSs on measured morbidity rates were assessed using subgroup analysis. Results: The ORs of the three dichotomous outcomes overlapped widely. For the 10 continuous variables, the mean difference (SD) in the results of the two meta-analyses was only 5.6% (4.9%). Fulfillment of certain quality and conduct issues in the NRCSs determined the statistical homogeneity of the results of meta-analysis and their comparability with the “gold standard.” Conclusion: Meta-analysis of well-designed NRCSs of surgical procedures is probably as accurate as that of RCTs. [Copyright &y& Elsevier]