Restricted accessResearch articleFirst published online 2025-2
Fear of Cancer Progression and Death Anxiety in Survivors of Advanced Colorectal Cancer: A Qualitative Study Exploring Coping Strategies and Quality of Life
This study aimed to examine coping strategies used by advanced colorectal cancer (CRC-A) survivors to manage death anxiety and fear of cancer progression, and links between these strategies and quality of life (QoL), distress, and death acceptance. Qualitative semi-structured interviews of 38 CRC-A survivors (22 female) were analysed via framework analysis. QoL and distress were assessed through the FACT-C and Distress Thermometer. Eleven themes were identified and mapped to active avoidance (keeping busy and distracted), passive avoidance (hoping for a cure), active confrontation (managing negative emotions; reaching out to others; focusing on the present; staying resilient), meaning-making (redefining one’s identity; contributing to society; gaining perspective; remaining spiritual), and acceptance (accepting one’s situation). Active confrontation (specifically utilising informal support networks) and meaning-making appeared beneficial coping strategies; more research is needed to develop and evaluate interventions which increase CRC-A survivors’ use of these strategies to manage and cope with their death anxiety.
AhnS.RomoR. D.CampbellC. L. (2020). A systematic review of interventions for family caregivers who care for patients with advanced cancer at home. Patient Education and Counseling, 103(8), 1518–1530. https://doi.org/10.1016/j.pec.2020.03.012.
2.
Al-BusaidiZ. Q. (2008). Qualitative research and its uses in health care. Sultan Qaboos University Medical Journal, 8(1), 11–19.
Arjona-SánchezA.Medina-FernándezF. J.Muñoz-CasaresF. C.Casado-AdamA.Sánchez-HidalgoJ. M.Rufián-PeñaS. (2014). Peritoneal metastases of colorectal origin treated by cytoreduction and HIPEC: An overview. World Journal of Gastrointestinal Oncology, 6(10), 407–412. https://doi.org/10.4251/wjgo.v6.i10.407.
5.
BarbourR. S. (2000). The role of qualitative research in broadening the ‘evidence base’ for clinical practice. Journal of Evaluation in Clinical Practice, 6(2), 155–163. https://doi.org/10.1046/j.1365-2753.2000.00213.x.
6.
BaschE.DealA. M.KrisM. G.ScherH. I.HudisC. A.SabbatiniP.RogakL.BennettA. V.DueckA. C.AtkinsonT. M.ChouJ. F.DulkoD.SitLBarzA.NovotnyP.FruscioneM.JeffASloanJ. A.SchragD. (2016). Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal of Clinical Oncology, 34(6), 557–565. https://doi.org/10.1200/JCO.2015.63.0830.
7.
BestL.SimmondsP.BaughanC.BuchananR.DavisC.FentimanL.GeorgeS.GosneyM.NorthoverJ.FentimanI.Collaboration Colorectal Meta-analysis (2000). Palliative chemotherapy for advanced or metastatic colorectal cancer. Colorectal Meta-analysis Collaboration. The Cochrane Database of Systematic Reviews, 2000(2), CD001545. https://doi.org/10.1002/14651858.CD001545.
8.
BrayF.FerlayJ.SoerjomataramI.SiegelR. L.TorreL. A.JemalA. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492.
9.
ButowP.PriceM. A.ShawJ. M.TurnerJ.ClaytonJ. M.GrimisonP.RankinN.KirstenL. (2015). Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psycho-Oncology, 24(9), 987–1001. https://doi.org/10.1002/pon.3920.
10.
ButowP.ShepherdH.CuddyJ.HarrisM.HeS.MaysaL.The ADAPT Program GroupShawJ. (2021). Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: A mixed methods study of staff perspectives. Springer Nature.
Clinical Oncology Society of Australia (2016). Model of survivorship care: Critical components of cancer survivorship care in Australia. Clinical Oncology Society of Australia. Retrieved from Clinical Oncology Society of Australia website:https://www.cosa.org.au/groups/survivorship/resources/.
13.
DuineveldL. A. M.van AsseltK. M.BemelmanW. A.SmitsA. B.TanisP. J.van WeertH. C. P. M.WindJ. (2016). Symptomatic and asymptomatic colon cancer recurrence: A multicenter cohort study. Annals of Family Medicine, 14(3), 215–220. https://doi.org/10.1370/afm.1919.
GrossmanC. H.BrookerJ.MichaelN.KissaneD. (2018). Death anxiety interventions in patients with advanced cancer: A systematic review. Palliative Medicine, 32(1), 172–184. https://doi.org/10.1177/0269216317722123.
HayesS. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665. https://doi.org/10.1016/S0005-7894(04)80013-3.
18.
HeS.LimC. Y. S.DhillonH. M.ShawJ. (2022). Australian oncology health professionals’ knowledge, perceptions, and clinical practice related to cancer-related cognitive impairment and utility of a factsheet. Supportive Care in Cancer, 30(6), 4729–4738. https://doi.org/10.1007/s00520-022-06868-z.
19.
HeinemannV.von WeikersthalL. F.DeckerT.KianiA.Vehling-KaiserU.Al-BatranS.-E.HeintgesT.LerchenmüllerC.KahlC.SeipeltG.KullmannF.StauchM.ScheithauerW.HielscherJ.ScholzM.MüllerS.LinkH.NiederleN.RostA.StintzingS. (2014). FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): A randomised, open-label, phase 3 trial. The Lancet Oncology, 15(10), 1065–1075. https://doi.org/10.1016/S1470-2045(14)70330-4.
KarlssonM.FribergF.WallengrenC.ÖhlénJ. (2014). Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: A life-world phenomenological study. BMC Palliative Care, 13(1), 1–9. https://doi.org/10.1186/1472-684X-13-28.
23.
KotronoulasG.PapadopoulouC.Burns-CunninghamK.SimpsonM.MaguireR. (2017). A systematic review of the supportive care needs of people living with and beyond cancer of the colon and/or rectum. European Journal of Oncology Nursing, 29, 60–70. https://doi.org/10.1016/j.ejon.2017.05.004.
24.
LaiP.SudS.ZhangT.AsmisT.Wheatley-PriceP. (2016). Palliative chemotherapy in advanced colorectal cancer patients 80 years of age and older. Current Oncology, 23(3), 144–153. https://doi.org/10.3747/co.23.2996.
25.
Laidsaar-PowellR. C.ButowP. N.BuS.CharlesC.GafniA.LamW. W. T.JansenJ.McCafferyK. J.ShepherdH. L.TattersallM. H. N.JuraskovaI. (2013). Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations. Patient Education and Counseling, 91(1), 3–13. https://doi.org/10.1016/j.pec.2012.11.007.
26.
LebelS.OzakinciG.HumphrisG.MutsaersB.ThewesB.PrinsJ.DinkelA.Phyllis Butow on behalf of the University of Ottawa Fear of Cancer Recurrence Colloquium attendees (2016). University of Ottawa Fear of Cancer Recurrence Colloquium attendeesFrom normal response to clinical problem: Definition and clinical features of fear of cancer recurrence. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 24(8), 3265–3268. https://doi.org/10.1007/s00520-016-3272-5.
27.
LimC. Y. S.Laidsaar-PowellR. C.YoungJ. M.KaoS. C.-H.ZhangY.ButowP. (2021). Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research. European Journal of Cancer Care, 30(4), Article e13421. https://doi.org/10.1111/ecc.13421.
28.
LimC. Y. S.HeS.ShawJ.DhillonH. M. (2022a). Cancer-related cognitive impairment: A mixed methods evaluation of a standard factsheet. Supportive Care in Cancer, 30(3), 2375–2385. https://doi.org/10.1007/s00520-021-06666-z.
29.
LimC. Y. S.Laidsaar-PowellR. C.YoungJ. M.SolomonM.SteffensD.YeoD.BlinmanhPKoczwaraijB. (2022b). The long haul: Lived experiences of survivors following different treatments for advanced colorectal cancer: A qualitative study. European Journal of Oncology Nursing, 58, 102123. https://doi.org/10.1016/j.ejon.2022.102123.
30.
LimC. Y. S.Laidsaar-PowellR. C.YoungJ. M.SteffensD.KoczwaraB.ZhangY.The advanced-CRC survivorship authorship group, & Butow, P. (2022c). Work: Saviour or struggle? A qualitative study examining employment and finances in colorectal cancer survivors living with advanced cancer. Supportive Care in Cancer. https://doi.org/10.1007/s00520-022-07307-9.
31.
LinehanM. M. (2015). DBT skills training manual (2nd ed.). US: The Guilford Press.
MartínezM.ArantzamendiM.BelarA.CarrascoJ. M.CarvajalA.RullánM. (2017). ‘Dignity therapy’, a promising intervention in palliative care: A comprehensive systematic literature review. Palliative Medicine, 31(6), 492–509. https://doi.org/10.1177/0269216316665562.
34.
McHughR. K.ReynoldsE. K.LeyroT. M.OttoM. W. (2013). An examination of the association of distress Intolerance and emotion regulation with avoidance. Cognitive Therapy and Research, 37(2), 363–367. https://doi.org/10.1007/s10608-012-9463-6.
MorseJ. M. (1994). Designing funded qualitative research. In DenzinN. K.LincolnY. S. (Eds.), Handbook of qualitative research (pp. 220–235). Thousand Oaks, CA, USA: Sage Publications.
37.
NilesB. L.WillistonS. K.MoriD. L. (2020). Mindfulness approaches. In FordJ. D.CourtoisC. A. (Eds.), Treating complex traumatic stress disorders in adults: Scientific foundations and therapeutic models (2nd ed., pp. 550–568). New York: Guildford Press.
38.
North American Nursing Diagnosis Association International (2007). Nursing diagnoses: Definitions & classification, 2007-2008 (1st ed.). Oxford, UK: Wiley-Blackwell.
39.
N.S.W. Cancer Council & Cancer Council Australia (2020). Caring for someone with cancer: A guide for family and friends who provide care and support.
40.
PlattE.DovellG.SmolarekS. (2018). Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer. Techniques in Coloproctology, 22(11), 835–845. https://doi.org/10.1007/s10151-018-1883-1.
PortmanD. (2018). Families, Systems & Health: The Journal of Collaborative Family Healthcare. Scanxiety, 36(3), 415. https://doi.org/10.1037/fsh0000353.
43.
QSR International Pty Ltd (2012). NVivo qualitative data analysis software.
Sánchez-HidalgoJ. M.Rodríguez-OrtizL.Arjona-SánchezÁ.Rufián-PeñaS.Casado-AdamÁ.Cosano-ÁlvarezA.Briceño-DelgadoJ. (2019). Colorectal peritoneal metastases: Optimal management review. World Journal of Gastroenterology, 25(27), 3484–3502. https://doi.org/10.3748/wjg.v25.i27.3484.
46.
SchmidtL.ChristensenU.HolsteinB. E. (2005). The social epidemiology of coping with infertility. Human Reproduction, 20(4), 1044–1052. https://doi.org/10.1093/humrep/deh687.
47.
SecintiE.TometichD. B.JohnsS. A.MosherC. E. (2019). The relationship between acceptance of cancer and distress: A meta-analytic review. Clinical Psychology Review, 71, 27–38. https://doi.org/10.1016/j.cpr.2019.05.001.
48.
SteffensD.SolomonM. J.YoungJ. M.KohC.VenchiaruttiR. L.LeeP.AustinK. (2018). Cohort study of long-term survival and quality of life following pelvic exenteration. BJS Open, 2(5), 328–335. https://doi.org/10.1002/bjs5.75.
49.
TomlinsonJ. S.JarnaginW. R.DeMatteoR. P.FongY.KornpratP.GonenM.KemenyN.BrennanM. F.BlumgartL. H.D’AngelicaM. (2016). Actual 10-year survival after resection of colorectal liver metastases defines cure. Journal of Clinical Oncology, 25(29), 4575–4580. https://doi.org/10.1200/JCO.2007.11.0833.
50.
TongA.SainsburyP.CraigJ. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042.
51.
WangT.MolassiotisA.ChungB. P. M.TanJ.-Y. (2018). Unmet care needs of advanced cancer patients and their informal caregivers: A systematic review. BMC Palliative Care, 17(1), 1–29. https://doi.org/10.1186/s12904-018-0346-9.
52.
WardW. L.HahnE. A.MoF.HernandezL.TulskyD. S.CellaD. (1999). Reliability and validity of the functional assessment of cancer therapy-colorectal (FACT-C) quality of life instrument. Quality of Life Research, 8, 181–195. https://doi.org/10.1023/a:1008821826499.
53.
WeinsteinN.BrownK. W.RyanR. M. (2009). A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43(3), 374–385. https://doi.org/10.1016/j.jrp.2008.12.008.
54.
WeismanA. D.WordenJ. W. (1977). The existential plight in cancer: Significance of the first 100 days. The International Journal of Psychiatry in Medicine, 7(1), 1–15. https://doi.org/10.2190/UQ2G-UGV1-3PPC-6387.
55.
Weiss WieselT. R.NelsonC. J.TewW. P.HardtM.MohileS. G.OwusuC.KlepinH. D.GrossC. P.GajraA.LichtmanS. M.RamaniR.KatheriaVZavalaL.HurriaA.On behalf of the Cancer and Aging Research Group (CARG) (2015). The relationship between age, anxiety, and depression in older adults with cancer. Psycho-Oncology, 24(6), 712–717. https://doi.org/10.1002/pon.3638.
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