Predictors of health-related quality of life of colorectal cancer survivors: a systematic literature review

Background. The population of colorectal cancer survivors is growing. A colorectal cancer diagnosis and its treatment can bring along adverse long- and short term effects that influence the health-related quality of life (HRQOL) of survivors. In order to prevent these adverse effects and deteriorating HRQOL, the right care needs to be offered to the right individual at the right time. For early identification of survivors at risk for deteriorating HRQOL, it is important to know which factors are predictive of HRQOL. Therefore, the aim of this study was to identify possible predictors of HRQOL of colorectal cancer survivors. Methods. A systematic literature review was conducted using the search engines MEDLINE/PubMed, EMBASE, and Google Scholar to find available literature on the relation between lifestyle, clinical, and socio-demographic variables and HRQOL in colorectal cancer survivors. Additional articles were found by citation tracking. Results. In total, 29 studies met the inclusion criteria. The most relevant lifestyle predictors of lower HRQOL that were identified were low levels of physical activity and higher BMI. Higher stage, presence of a stoma, having comorbidities, having fecal incontinence, and having rectal cancer were the most relevant clinical predictors of lower HRQOL. The most relevant socio-demographic predictors of lower HRQOL were low income, no private health insurance, negative cancer threat appraisal, low levels of social support, and pessimism. Discussion and conclusion. Evidence suggests that the predictors, found in the studies included in this systematic review, could help in identifying colorectal cancer survivors at increased risk of deteriorating HRQOL. For some predictors the evidence appeared inconclusive or contradictory, and therefore, more research is needed with special focus on these associations. Especially lifestyle predictors are an important area for future research, since these factors are mostly related to modifiable behavior and changing them thus could help in improving HRQOL. The predictors identified in this systematic review can be used for developing, validating, and testing prediction models for HRQOL of colorectal cancer survivors

Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2–10 years post-diagnosis:A cross-sectional analysis

The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I–III CRC survivors, 2–10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (β 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (−4·5; −7·6, −1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (−4·2; −7·1, −1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations

Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2–10 years post-diagnosis: A cross-sectional analysis

The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I–III CRC survivors, 2–10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (β 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (−4·5; −7·6, −1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (−4·2; −7·1, −1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations

DNA-based communication in populations of synthetic protocells

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Supplementary Material for: The Role of Leisure Activities in Mediating the Relationship between Physical Health and Well-Being: Differential Patterns in Old and Very Old Age

<p><b><i>Background:</i></b> Recently, Paggi et al. [Gerontology 2016;62:450-458] for the very first time showed in a cross-sectional sample of 259 adults aged 18-81 years that the relation of physical health to psychological well-being was mediated via frequency of leisure activity participation. <b><i>Objective:</i></b> To extend this framework, we followed theories on successful aging and vulnerability to propose to add a differential perspective predicting that certain individuals may be more vulnerable than others and therefore may show differences in the mediation pattern. Specifically, we examined whether mediation patterns were differential in certain populations, such as in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. <b><i>Methods:</i></b> We analyzed data from 3,080 individuals on physical health (number of chronic diseases, subjective health status, and subjective evaluation of change in health over the last 10 years), frequency of participation in 18 leisure activities, and physical and psychological well-being using moderated mediation models with a path model approach that allowed the simultaneous estimation of all model paths, including their significance. <b><i>Results:</i></b> We found that the relation of physical health to physical and psychological well-being was mediated via frequency of activity participation. For physical (but not for psychological) well-being, this mediation was more pronounced in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. These moderated mediations were attributable to differential relations of physical health to frequency of activity participation and to differential relations of frequency of activity participation to physical well-being between the investigated moderator levels. <b><i>Conclusion:</i></b> Present data suggest that participation in leisure activities may play a key role in mediating the relationship between physical health and well-being, particularly in very old age. Findings are discussed with respect to theories of successful aging and differences between physical and psychological well-being.</p