Effectiveness of survivorship programmes to enhance health-related quality of life of colorectal cancer survivors: a systematic review and meta-analysis of randomised controlled trials
Clinical Snapshot
PICO Framework
| P — Population | Colorectal cancer survivors |
| I — Intervention | Survivorship programmes |
| C — Comparator | Standard care or control interventions |
| O — Outcomes | Health-related quality of life (HRQoL) - physical and mental domains |
Bottom Line
This meta-analysis of 22 RCTs involving nearly 3000 colorectal cancer survivors demonstrates that structured survivorship programmes significantly improve both physical and mental health-related quality of life. However, the evidence quality is limited by substantial heterogeneity between studies and only low-to-moderate certainty ratings. The moderate effect sizes (SMD 0.4-0.52) suggest clinically meaningful benefits, but the high variability between programmes makes it difficult to identify optimal intervention components. While promising for clinical practice, the heterogeneity indicates that survivorship programmes may need tailoring to specific populations and settings. Australian clinicians should consider these findings when developing post-treatment support services, particularly given the potential for nurse-led delivery models that could integrate with existing cancer care pathways.
Key Findings
P Value: Physical: P = 0.002; Mental: P = 0.02
Effect Size: Physical domain SMD = 0.52; Mental domain SMD = 0.4
Primary Outcome: Health-related quality of life improvement in physical and mental domains
Nnt Or Sensitivity: Moderate effect sizes suggesting clinically meaningful improvements
Confidence Interval: Physical: 95% CI [0.18, 0.86]; Mental: 95% CI [0.06, 0.74]
Clinical Application
Nurse-led programmes appear feasible with potential for mobile health integration Relevant to Australian cancer survivorship care under Medicare Benefits Schedule items for allied health and nursing services. Aligns with Cancer Australia survivorship guidelines and potential integration with existing cancer care coordinators Colorectal cancer survivors in post-treatment phase requiring supportive care
Abstract
PURPOSE: This study aimed to assess the effectiveness of the survivorship programmes by synthesising and analysing the available evidence to enhance health-related quality of life (HRQoL) amongst colorectal cancer (CRC) survivors. METHODS: Ten English-language databases were searched from inception to June 2025 in this systematic review and meta-analysis. All randomised controlled trials (RCTs) were included. Available data were pooled in a meta-analysis using RevMan (version 5.4.0). Two independent reviewers performed the database searches, extracted the data, assessed the methodological quality by using the Cochrane Risk-of-Bias tool (version 2) and evaluated the overall quality of findings by using Cochrane GRADE. RESULTS: A total of 22 RCTs involving 2949 CRC survivors were identified. The meta-analysis results (thirteen studies) indicated a significant improvement in the physical (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI, 0.18, 0.86], P = 0.002, I2 = 88%) and mental domains of HRQoL (SMD = 0.4, 95% CI [0.06, 0.74], P = 0.02, I2 = 86%). Sensitivity analysis involved reducing the heterogeneity after removing one study. No publication bias was found. The overall quality of findings was from 'low' to 'moderate'. CONCLUSIONS: The detailed components of the survivorship programme can enhance HRQoL in physical and mental domains, indicating its potential as valuable evidence for health providers to support CRC survivors post-treatment. Future research should focus on expanding the delivery of such programme comprehensively by integrating mobile health into a nurse-led approach to optimise geographic diversity and improve social HRQoL.
References
- 1.Do, P. N. V., Nguyen, T. K., Qi, Y., Choi, K. C., Hoang, T. X. H., Le, B. P., Lam, Y. T., Tse, M., & Wong, C. L. (2026). Effectiveness of survivorship programmes to enhance health-related quality of life of colorectal cancer survivors: a systematic review and meta-analysis of randomised controlled trials. Supportive Care in Cancer. https://doi.org/10.1159/000543921
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