Case 10 colorectal cancer survivorship

Question 1

What is a cancer survivor?

Answer 1

• individual considered survivor from time of diagnosis through the balance of their life.
• Remain survivor till end of life.
• Can continue to function during/ after overcoming disease.
• Family members, friends and caregivers are also impacted by the survivorship experience

Question 2

What does surviviorship of colorectal cancer depend on?

Answer 2

• stage of the cancer at diagnosis
• age and overall health of the patient
• type of treatment received.

Question 3

Why is is the population of survivors increasing?

Answer 3

• Demographics: population ageing, Westernised lifestyle. Incidence increasing.
• Improved treatments: better & more targeted cancer treatments. Survival increasing
• Early detection: colorectal cancer screening (in NL since 2014). Survival increasing.

Question 4

What is the incidence of colorectal cancer?

Answer 4

Incidence rates highest in more developed regions & highest in Western Europe

Question 5

What is the mortality of colorectal cancer?

Answer 5

Mortality rates (far) lower than incidence rates & lowest in Western Europe

Question 6

What is the prevalence of CC?

Answer 6

Prevalence highest in more developed regions & highest in Western Europe

Question 7

What is the situation in NL with regards to CC?

Answer 7

In NL: increasing number of new patients & deaths but the # of survivors is also increasing?

Question 8

*What is the patient journey?

Answer 8

See image

Question 9

What are the short term consequences of CC disease/treatment?

Answer 9

• Pain, fatigue, nausea, skin irritation, other side effects of chemo & radiation
• Diarrhea, constipaiton, other gastrointestinal symptoms
• Emotional distress, anxiety and depression
• Surgery related complications: discomfort after surgery, bleeding, infection, blood clots

Question 10

What are the long term consequences of CC disease/treatment?

Answer 10

• Increased risk of developing other types of cancer, such as bladder, kidney, and pancreatic cancer
• Chronic gastrointestinal problems (e.g. stoma)
• Financial/ work related issues
• Psychological effects→ PTSD, fear of recurrence, depression
• Sexual dysfunction and fertility issues

Question 11

**What is the psychosomatic impact of diagnosis & treatment of CC?

is this not same as another fc?

Answer 11

• Emotional functioning problems (anxiey & depression, fatigue)
• physical funcitioning problems (nerve damage after chemo)
• sexual functioning problems
• social functioning problems (work-related issues, financial difficulties)
• bowel functioning problems (pain, constipation, incontinence, etc)
• stoma (incl body image issues)

All of these decrease QoL!

Question 12

What is QoL?

Answer 12

individual’s perception of their position in life in context of culture & value systems in which they live & in relation to their goals, expectations, standards & concerns

Question 13

What are difficulties with QoL?

Answer 13

• Abstract definition (you can’t see someone’s quality of life)
• Related to health but also aspects independent of health (autonomy, freedom, etc)
• Individually, social, culturally determined.

Question 14

What does QoL incorporate?

Answer 14

• Physical ehealth
• Psychological state
• Level of independence
• Social relationships
• Personal beliefs
• Personal environment
  ⇒ when related to health and related domains = health-related quality of life

Question 15

When are theoretical models used?

Answer 15

• To better define construct
• To define relevant concepts
• To identify determinants and outcomes
• To improve healthcare & research

Question 16

***How can you measure QoL with questionnaires?

Question 17

What are potential targets for intervention?

Answer 17

• prevention/reduction of negative consequences of disease & treatment
• To decrease burden on healthcare services & socioeconomic system

=> enhance quantity and quality of life after cancer

Question 18

What is the ICF model?

Answer 18

designed to provide a standardised framework for describing an individual’s functioning, including any impairments, activity limitations, and participation restrictions.

Question 19

What is the purpose of the ICF model?

Answer 19

• To define & classify functioning in multiple dimensions
• To provide a universal language
• To improve compatibility & exchangeability of data
  E.g. between countries, time periods, scientific disciplines, etc.

Question 20

What is meant by the purpose of defining and classifying functioning in multiple dimensions in the ICF model?

Answer 20

• Understanding of functioning in broad health-related context
• Conceptual basis for defining/meausring disability and its determinants
• => paradigm shift from biomedical to biopsychosocial view

Question 21

What is meant by the purpose of providing a universal language in the ICF model?

Answer 21

• Standardized, systematic description & classification
• Facilitates improved (interdisciplinary) communication

Question 22

What is the structure of the ICF model?

Answer 22

2 main parts:
* Functioning & disability
* Contextual factors

Each part has several components or domains
* Part 1: body functions & structures; activities; participation
* Part 2: environmental factors; personal factors

Components are further subdivided
* Subdivision in chapters and items or categories
* Qualifiers used for classification

Look at diagram of this!

Question 23

Who is the ICF model used by?

Answer 23

• healthcare providers & researchers to assess & describe individual’s functioning
• develop treatment plans
• evaluate the effectiveness of interventions
• monitor changes in health status over time
• policymakers to develop policies and programs that
• promote inclusion & participation of individuals with disabilities in society

Question 24

How is functioning defined in the ICF model?

Answer 24

Positive aspects of interaction between individual in certain health state and the individual’s contextual factors

Question 25

What are the 3 domains part of functioning in the ICF model?

Answer 25

**Body functions and structures:** * physio/psychological functions of body systems & anatomical body parts * Biological perspective of functioning **Activities:** * Execution of a task or action by an individual * Individual perspective of functioning **Participation:** * Involvement in a life situation * Societal perspective of functioning

Question 26

How is **disability** defined in the ICF model?

Answer 26

Negative aspects of interaction between individual in certain health state and the individuals contextual factors

Question 27

What are the 3 domains part of functioning problems in the ICF model?

Answer 27

**Impairment in body functions & structures** * Problems in body functions and structures such as a signfication deviation or loss (e.g. loss of limb or impaired functioning of skeletal muscle) **Activity limitations** * Difficulties an individual may have in executing activities (e.g. limited ability to walk or dress) **Participation restrictions** * Problems an individual may experience in involvement in life situations * (e.g. restricted capacity to work or participate in sports)

Question 28

*How are **contextual factors** defined in the ICF model?

Question 29

What are ICF qualifiers?

Answer 29

describe & classify level of functioning or disability, occurring within certain context

Question 30

What is the biopsychosocial framework of the ICF?

Answer 30

Bio-psychosocial view of human functioning: * Framework to characterise functioning & disability in particular context * Functioning in relation to health, environment and person * => broader than traditional biomedical view0 | look at diagram

Question 31

How can the biopsychosocial framework of the ICF be used to study QOL and functioning of colorectal cancer survivors?

Answer 31

* Biological factors, such as the cancer itself, treatments received, and any comorbid conditions, can have a significant impact on the physical functioning of colorectal cancer survivors. By considering these factors, researchers can better understand how the cancer and its treatment may impact the survivor's ability to perform activities and participate in society. * Psychological factors, such as anxiety, depression, and coping strategies, can also impact the QOL and functioning of colorectal cancer survivors. By assessing these factors, researchers can better understand how psychological factors may impact the survivor's ability to adapt to life after cancer and perform daily activities. * Social factors, such as social support, financial resources, and access to healthcare, can also impact the QOL and functioning of colorectal cancer survivors. By considering these factors, researchers can better understand how social factors may influence the survivor's ability to participate in society and access the resources they need to support their recovery. * Overall, biopsychosocial framework of the ICF can provide a comprehensive and holistic understanding of the factors that impact the QOL and functioning of colorectal cancer survivors. By considering all of these factors together, researchers can develop interventions that address the unique needs of each individual survivor and improve their health and well-being over the long term

Question 32

What is cancer survivorship research?

Answer 32

* Encompasses the physical, psychosocial and economic consequences of cancer diagnosis and its treatment among survivors of cancer. * Includes issues related to healthcare delivery, access and follow up care * Focuses on the health and life of a person with a history of cancer beyond the acute diagnosis and treatment phase.

Question 33

What does ICF based research approach facilitate?

Answer 33

* Development of conceptual models * Definition of outcome measures * Selection of measurement tools * Identification of variables for analysis * Interpretation of study findings

Question 34

What is acute survivorship?

Answer 34

* Focus is on cancer diagnosis & cancer treatment * usually from diagnosis till end of treatment

Question 35

what is extended survivorship?

Answer 35

* focus is on short term effects of cancer & treatment * early post-treatment phase (up to 2-5 yrs)

Question 36

What is permanent survivorship?

Answer 36

* focus is on long-term effects of cancer & treatment * late post treatment phase (>2-5 yrs)

Question 37

What are the dimensions of functioning?

Answer 37

1. physical functioning 2. cognitive functioning 3. emotional funcitoning 4. social functioning 5. occupational functioning 6. self-care functioning 7. communication functioning

Question 38

What are the dimensions of functioning?

Answer 38

1. physical functioning 2. cognitive functioning 3. emotional funcitoning 4. social functioning 5. occupational functioning 6. self-care functioning 7. communication functioning

Question 39

What are the dimensions of quality of life?

Answer 39

QoL after cancer diagnoses encopasses several important domains: * physical fufnctioning * emotional functioning * cognitive functioning * social funxtioning * role functioning * overall quality of life - global assessment of functioning in all domains of life