The population of colorectal cancer (CRC) survivors is growing and many survivors experience deteriorated health-related quality of life (HRQoL) in both early and late post-treatment phases. Identification of CRC survivors at risk for HRQoL deterioration can be improved by using prediction models. However, such models are currently not available for oncology practice. As a starting point for developing prediction models of HRQoL for CRC survivors, a comprehensive overview of potential candidate HRQoL predictors is necessary. Therefore, a systematic literature review was conducted to identify candidate predictors of HRQoL of CRC survivors. Original research articles on associations of biopsychosocial factors with HRQoL of CRC survivors were searched in PubMed, Embase, and Google Scholar. Two independent reviewers assessed eligibility and selected articles for inclusion (N = 53). Strength of evidence for candidate HRQoL predictors was graded according to predefined methodological criteria. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) was used to develop a biopsychosocial framework in which identified candidate HRQoL predictors were mapped across the main domains of the ICF: health condition, body structures and functions, activities, participation, and personal and environmental factors. The developed biopsychosocial ICF framework serves as a basis for selecting candidate HRQoL predictors, thereby providing conceptual guidance for developing comprehensive, evidence-based prediction models of HRQoL for CRC survivors. Such models are useful in clinical oncology practice to aid in identifying individual CRC survivors at risk for HRQoL deterioration and could also provide potential targets for a biopsychosocial intervention aimed at safeguarding the HRQoL of at-risk individuals.
Implications for practice: More and more people now survive a diagnosis of colorectal cancer. The quality of life of these cancer survivors is threatened by health problems persisting for years after diagnosis and treatment. Early identification of survivors at risk of experiencing low quality of life in the future is thus important for taking preventive measures. Clinical prediction models are tools that can help oncologists identify at-risk individuals. However, such models are currently not available for clinical oncology practice. This systematic review outlines candidate predictors of low quality of life of colorectal cancer survivors, providing a firm conceptual basis for developing prediction models.
摘要
结直肠癌 （CRC） 幸存者人群正在日益增加, 许多幸存者在治疗后早期和远期发生了健康相关生活质量 （HRQoL） 恶化。使用预测模型有可能改善对有 HRQoL 恶化风险的 CRC 幸存者的鉴别。但是目前肿瘤学临床实践中还没有这类模型。对可能的备选 HRQoL 预测因素进行全面综述是开发 CRC 幸存者 HRQoL 模型所必要的第一步。因此, 我们对鉴别 CRC 幸存者的备选 HRQoL 预测因素进行了系统性文献综述。我们在 PubMed、Embase 和 Google Scholar 对与 CRC 幸存者 HRQoL 相关的生物心理社会学因素的原创研究文献进行了检索。由 2 名独立评审员对文章的合格性进行评估, 并且选择入选文献 （N=53）。根据预先定义的方法学标准对备选 HRQoL 预测因素的证据强度进行评级。使用世界卫生组织颁布的国际功能、残疾和健康分类 （ICF） 建立生物心理社会学框架, 鉴别出来的备选 HRQoL 预测因素分布在 ICF 的主要领域中: 健康状况、身体结构和功能、活动程度、参与性, 以及个人和环境因素。建立的生物心理社会学 ICF 框架可作为选择备选 HRQoL 预测因素的基础, 从而为建立 CRC 幸存者 HRQoL 的综合循证预测模型提供概念性指导。这类模型对肿瘤学临床实践十分有用, 可有助于鉴别出存在 HRQoL 恶化危险因素的 CRC 幸存者个体, 同时, 就为 HRQoL 在险个体提供保护措施而言, 该模型也能给出实施生物心理社会学干预的可能靶点。The Oncologist 2016;21:433–452
对临床实践的提示: 如今, 越来越多的确诊结直肠癌患者能够存活下来。而诊断和治疗后持续存在的健康问题年复一年地威胁着这些癌症幸存者的生活质量。因此, 在未来早期鉴别出存在生活质量降低风险的幸存者对于采取预防性措施十分重要。临床预测模型是能够帮助肿瘤科医生鉴别在险个体的工具。然而目前肿瘤学的临床实践中还没有这类模型。本项系统综述概略地给出了结直肠癌幸存者低生活质量的备选危险因素, 为建立预测模型提供了坚实的理论依据。
Keywords: Candidate predictors; Colorectal cancer survivors; Health-related quality of life; International Classification of Functioning, Disability and Health; Systematic review.
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