A study to find out about the experiences of people after surgery for bowel cancer (CREW)

The study team found that people who have depression and little confidence to manage problems don’t recover well from bowel surgery. 

857 people took part in the study. Everyone filled in questionnaires:

• before surgery
• and after surgery at:
  ​
  • 3 months
  • 9 months
  • 15 months
  • 2 years

The questionnaires asked about:

• how people had been feeling (quality of life )
• their health status
• wellbeing
• how confident they felt in managing health problems
• social support
• other health problems
• where they lived, worked and their age (socio-demographics)
•  any other treatment they might have had
• how long it took to get better
• how long symptoms such as tiredness lasted
• any problems with anxiety or depression
• what sort of things helped them to feel better 

Using the above information, the study team made some predictions about how people might recover. The predictions they made took into account:

• the cancer type, stage  and grade
• how much treatment people had 
• how much support was available 
• what kind of coping skills they had 

They grouped the information into the 3 following areas:

• quality of life 
• health status
• wellbeing

The study team used the information in the questionnaires to track how people were getting on in each of the 3 above areas. They looked at all the results and divided people into 4 groups depending on how they rated the above in the first two years following their surgery. 

Quality of life

• people in group 1 had a good quality of life
• people in group 2 had an average quality of life
• people in group 3 had a worse quality of life in the short term but this improved after 15 months
• people in group 4 had a poor quality of life

Health status

• people in group 1 had some mild health problems but they improved after 15 months
• people in group 2 had good health but this declined after 15 months
• people in group 3 had constant health problems over the 2 years
• people in group 4 had poor health 

Wellbeing

• people in group 1 had good wellbeing throughout the study
• people in group 2 had average wellbeing
• people in group 3 had declining levels of wellbeing
• group 4 had the poorest levels of wellbeing

From this, they identified 4 possible routes of recovery. Of the 4 groups:

• groups 1 and 2 managed well
• group 3 had some problems
• group 4 did poorly in all 3 areas

The study team found that having depression and lacking the confidence to manage problems before surgery were significantly linked to having poorer quality of life, health status and wellbeing after surgery. This is independent of treatment or the type and stage of the cancer. 

Other predictors of poor recovery were:

• higher levels of anxiety before surgery
• not having much social support
• having a colostomy (stoma)

The study team concluded that this study helped to identify the people who were most in need of intensive support. They say this is an important finding as appropriate support before surgery and soon after could result in a more positive experience.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.