OBJECTIVE: The purpose of this systematic review and meta-analysis is to determine the long-term effect of combined physical activity (PA) and behaviour change techniques (BCT) interventions in PA maintenance of colorectal cancer survivors (CRCS) and identify the most frequent BCT implemented in them.
METHODS: PRISMA recommendations were followed. Databases were searched for randomized controlled trials up to October 2023. Studies in which CRCS completed a PA intervention based on any Theoretical Model of Behaviour Change (TMBC) and a subsequent follow-up period were included. Between-group differences at baseline and after follow-up were pooled for meta-analysis. BCT codification was performed using the BCT taxonomy v1. Methodological quality and evidence certainty were also assessed.
RESULTS: Five studies involving 906 CRCS met the inclusion criteria. PA interventions applying BCT showed a significant change with a small positive effect (pooled SMD = 0.22 (0.09, 0.35)) on the PA after a follow-up period between 3 and 12 months. Twenty-two different BCTs were identified (mean 17.2, range 15-19) of which 12 were common across all interventions.
CONCLUSIONS: PA and BCT interventions have been found to be effective in improving the long-term maintenance of PA in CRCS. Further studies with higher methodological quality are needed to confirm these findings.
CONCLUSIONS: Aerobic exercise, pedometers, PA diaries and educational materials seem to be important aspects to achieve sustainable adherence to an active lifestyle over time. Supervision, access to fitness areas and applying some BCT appear to be differentiating features to obtain more successful PA maintenance.

Quality of life (QoL) assessments are integral to cancer care, yet their effectiveness in providing essential information for supporting survivors varies. This study aimed to elucidate key indicators of QoL among colorectal cancer survivors from the perspective of healthcare professionals, and to evaluate existing QoL questionnaires in relation to these indicators. Two studies were conducted: a Delphi study to identify key QoL indicators and a scoping review of questionnaires suitable for colorectal cancer survivors. Fifty-four healthcare professionals participated in the Delphi study\'s first round, with 25 in the second. The study identified two primary QoL domains (physical and psychological) and 17 subdomains deemed most critical. Additionally, a review of 12 questionnaires revealed two instruments assessing the most important general domains. The findings underscored a misalignment between existing assessment tools and healthcare professionals\' clinical priorities in working with colorectal cancer survivors. To enhance support for survivors\' QoL, efforts are needed to develop instruments that better align with the demands of routine QoL assessment in clinical practice.

OBJECTIVE: Colorectal cancer (CRC) survivors with permanent stomas might be at higher risk of social isolation, and stigma can play an important role in the development of social isolation. However, the underlying psychological mechanisms are understudied. The current study examined how stoma acceptance and valuable actions mediated the relationships between stigma and social isolation among CRC survivors with permanent stomas.
METHODS: A cross-sectional survey was conducted with a sample of 303 CRC survivors with permanent stomas. The chain mediation models were conducted using the PROCESS macro for SPSS to explore the pathways through which stigma can be associated with CRC survivors\' social isolation, mediated by stoma acceptance and valuable actions.
RESULTS: The results indicated that higher stigma was related to lower stoma acceptance, less personal values enactment, and higher social isolation, as well as lower objective social connectedness and subjective social belongingness among CRC survivors with permanent stomas. Additionally, the mediational analyses revealed that stoma acceptance and valuable actions jointly mediated the relationships between stigma and social isolation.
CONCLUSIONS: Social isolation among CRC survivors during the adjustment to both stoma and stigma may be alleviated through tailored interventions that improve stoma acceptance and valuable actions.
CONCLUSIONS: The chain mediating roles of stoma acceptance and valuable actions highlight that tailored interventions, such as acceptance and commitment therapy, can be targeted for this population, considering this population\'s unique needs.

BACKGROUND: Early diagnostic and treatment advances have resulted in prolonged cancer survivorship. Therefore, exercise intervention in survivorship management is essential for enhancing cancer survivors\' health-related quality of life (HRQoL).
OBJECTIVE: The systematic review and meta-analysis in this study aimed to explore the effect of exercise intervention on health-related quality of life of colorectal cancer survivors.
METHODS: The current study followed guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) to identify relevant literature. Comprehensive searches were conducted using EBSCOhost, Web of Science (WOS), Scopus, Science Direct, and PubMed. The inclusion criteria included are randomised control trials studies written in English, with no restrictions for the time of publication that reported the effects of exercise intervention on health-related quality of live among colorectal cancer survivors. Meta-analysis was conducted by pooling the mean and standard deviation of post-intervention scores across randomised control trial studies using a random effects model.
RESULTS: A total of 467 articles were identified but only seven articles were randomised control trials (RCT) (n = 7) with PEDro scores ranging from 6 to 9 showing good internal validity were included in the review. The results of the meta-analysis of pooled data from six RCTs studies on HRQoL showed no significant effect of exercise intervention on HRQoL in the intervention group compared to control group [SMD = 0.25; 95% CI; -0.0, 0.51; Z = 1.88; p = 0.06; I2 = 30.8%].
CONCLUSIONS: This meta-analysis provides key insights into the effect of exercise on the health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Therefore, more experimental studies should be carried out with rigorous methodology to evaluate the effectiveness of exercise interventions before it is recommended as a routine activity in post-treatment management for CRC survivors.

OBJECTIVE: The purpose of this qualitative study was to use semi-structured interviews and thematic analysis to elicit key influencing factors (i.e., behavioral, normative, and control beliefs) related to physical activity and exercise in colorectal cancer survivors.
METHODS: Colorectal cancer survivors (N = 17) were recruited from exercise programs designed for colorectal cancer survivors at the Yonsei Cancer Center, Seoul, South Korea. A purposive sampling method was used. Interview questions were informed by the theory of planned behavior (TPB). Semi-structured face-to-face interviews were conducted, and open-ended questions addressed the research question. Interviews were transcribed verbatim and analyzed using thematic analysis.
RESULTS: Participants were on average 2.2 years post-treatment. The mean age of the sample was 55.9 years. Key behavioral, normative, and control beliefs emerged in the data. For behavioral beliefs, colorectal cancer survivors believed that exercise would result in physical and psychological improvements, and improve their bowel problems. For normative beliefs, most colorectal cancer survivors wanted their oncologists\' approval for participation of exercise. Family members, more specifically the spouse, were also influencing factors for colorectal cancer survivors adopting physical activity. The most frequently mentioned control belief was that supervised exercise with an exercise specialist made exercise participation easier.
CONCLUSIONS: Beliefs identified in this study can inform TPB-based physical activity interventions tailored for colorectal cancer survivors. While information alone may not lead to behavior change, integrating these beliefs with other influential factors can potentially enhance intervention efficacy and promote physical activity in this population.

OBJECTIVE: The recent trend of Internet-based digital health interventions has driven researchers to implement them to promote physical activity (PA) and improve patients\' health outcomes. This systematic review and meta-analysis aim to evaluate the effects of Internet-based digital health interventions on PA and quality of life (QoL) in colorectal cancer (CRC) survivors.
METHODS: We searched for relevant studies investigating the effects of internet-based digital health interventions published until Dec. 2022 in electronic databases (PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and CEPS) according to PRISMA guidelines. The Joanna Briggs Institute critical appraisal checklist was used to examine the quality of the included studies. We performed the fixed and random effects model for meta-analysis.
RESULTS: Among 746 identified studies, eight published between 2018 and 2022 were included. These covered 991 internet-based digital health interventions and 875 controls. After 6 months of internet-based digital health interventions, CRC survivors\' performance in PA (standardized mean difference (SMD) = 0.23, 95% confidence interval [CI] = 0.09-0.38) and QoL (SMD = 0.11, 95% CI = 0.01-0.22) indicators improved significantly.
CONCLUSIONS: Internet-based digital health improved the PA behaviour and QoL of patients with CRC. Because of differences in intervention outcomes, additional randomized controlled trials are warranted to provide suggestions for clinical practice. Internet-based digital health interventions are promising for promoting PA in CRC survivors.

OBJECTIVE: This study aimed to investigate the current situation and factors influencing physical activity, self-efficacy, and quality of life in Chinese colorectal cancer survivors. Additionally, this study explored the associations between physical activity, self-efficacy, and quality of life.
METHODS: A multicenter, cross-sectional study was conducted, involving 173 colorectal cancer survivors with a mean age of 59 years. Self-reported data on basic demographic characteristics, physical activity, self-efficacy, and quality of life were collected.
RESULTS: Among 173 colorectal cancer survivors, 90 (52.0%) were engaged in manual work. The self-efficacy score was found to be 25.99 ± 7.10, while the global health status score was 54.96 ± 21.56. Global health status was associated with sex, residence, chemoradiotherapy, and monthly income (p < 0.01). The self-efficacy score exhibited a significant positive correlation with quality of life, while demonstrating a negative correlation with symptom scores (p < 0.01). Recreational PA scores were positively associated with global health status (P < 0.05). Self-efficacy, recreational physical activity during winter, and whether the participants underwent chemoradiotherapy explained 29.3% of the variance in quality of life among colorectal cancer survivors.
CONCLUSIONS: Colorectal cancer survivors exhibited low levels of physical activity, self-efficacy, and quality of life. Their health is influenced by self-efficacy, recreational physical activity, and chemoradiotherapy. When developing intervention plans for colorectal cancer survivorship, it is crucial to consider survivors\' self-efficacy and the type of physical activity in which they engage.

Fatigue and insomnia, potentially induced by inflammation, are distressing symptoms experienced by colorectal cancer (CRC) survivors. Emerging evidence suggests that besides the nutritional quality and quantity, also the timing, frequency and regularity of dietary intake (chrono-nutrition) could be important for alleviating these symptoms. We investigated longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in CRC survivors. In a prospective cohort of 459 stage I-III CRC survivors, four repeated measurements were performed between 6 weeks and 24 months post-treatment. Chrono-nutrition variables included meal energy contribution, frequency (a maximum of six meals could be reported each day), irregularity and time window (TW) of energetic intake, operationalised based on 7-d dietary records. Outcomes included sleep quality, fatigue and plasma concentrations of inflammatory markers. Longitudinal associations of chrono-nutrition variables with outcomes from 6 weeks until 24 months post-treatment were analysed by confounder-adjusted linear mixed models, including hybrid models to disentangle intra-individual changes from inter-individual differences over time. An hour longer TW of energetic intake between individuals was associated with less fatigue (β: -6·1; 95 % CI (-8·8, -3·3)) and insomnia (β: -4·8; 95 % CI (-7·4, -2·1)). A higher meal frequency of on average 0·6 meals/d between individuals was associated with less fatigue (β: -3·7; 95 % CI (-6·6, -0·8)). An hour increase in TW of energetic intake within individuals was associated with less insomnia (β: -3·0; 95 % CI (-5·2, -0·8)) and inflammation (β: -0·1; 95 % CI (-0·1, 0·0)). Our results suggest that longer TWs of energetic intake and higher meal frequencies may be associated with less fatigue, insomnia and inflammation among CRC survivors. Future studies with larger contrasts in chrono-nutrition variables are needed to confirm these findings.

OBJECTIVE: To develop and evaluate the effects of an interactive coaching intervention, using a self-management mobile application, on quality of life and physical and psychological factors for colorectal cancer survivors.
METHODS: We developed a self-management mobile application providing social support services for post-treatment CRC survivors and evaluated its effects through baseline and post-intervention surveys. Using the biopsychosocial holistic model as the theoretical framework, automated interactive coaching technology was applied for six weeks to provide supportive services tailored for each user. To evaluate the effects of the application, self-efficacy, health practice index, depression, fear of cancer recurrence, and quality of life measures were administered to participants. A total of 34 men and 5 women were included in the analysis.
RESULTS: Participants\' mean age were 54.10 years and 78% of them had been diagnosed within the last five years. There were significant increases in self-efficacy (z = 2.09, p = .04), health practice index (t = 2.35, p = .02), and quality of life (t = 2.03, p = .05). More specifically, the emotional functional score increased (z = 2.23, p = .03) while both of the total symptom score (t = 2.10, p = .04) and the fatigue symptom score (z = 2.54, p = .01) decreased after six weeks of using the mobile application.
CONCLUSIONS: Interventions supporting colorectal cancer survivors\' self-management are critical for addressing the challenges they face after treatment and improving their quality of life. Providing social support through mobile applications could be a good strategy in terms of usability and effectiveness.

OBJECTIVE: The purpose of the study was to compare the individual and total number of symptoms and explore symptom clusters by hyperglycemia status in colorectal cancer survivors (CRCS) with diabetes (type 2).
METHODS: A retrospective cohort study was conducted, whereby symptom data were extracted from clinical notes in electronic health records. CRCS (stage II or III) diagnosed between 2007 and 2017 who had diabetes and at least one HbA1c within 8 months of initial chemotherapy were included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by hyperglycemia status (hyperglycemia versus no hyperglycemia). Exploratory factor analysis was conducted to identify symptom clusters.
RESULTS: Two hundred forty-three CRCS met inclusion criteria. CRCS with hyperglycemia (HbA1c ≥ 6.5%) had greater individual symptoms (fatigue and depression) and total number of symptoms than those with no hyperglycemia. Two distinct symptom clusters, with five (nausea, vomiting, constipation, fatigue, and peripheral neuropathy) and two symptoms (anxiety and depression), were identified among CRCS with hyperglycemia.
CONCLUSIONS: These findings indicate that CRCS with diabetes and hyperglycemia had more symptoms and two distinct symptom clusters compared to those with no hyperglycemia. Prospective research studies are needed to examine the role of hyperglycemia in symptoms among CRCS with diabetes. Understanding hyperglycemia\'s influence is important as it is a modifiable risk factor towards which prevention and intervention can be directed, potentially mitigating symptoms and symptom clusters and improving outcomes for CRCS with diabetes.