Predictors of preparedness for recovery following colorectal cancer surgery: a latent class trajectory analysis

Figures & data

Table 1. Distributions of patient characteristics for the full sample and the six latent classes.

Variables	N	% / mean	Class 1 30.2%	Class 2 23.6%	Class 3 23.1%	Class 4 12.5%	Class 5 5.6%	Class 6 4.9%	χ^2 (p)^a
Demographics
Sex (% female)	488	44	38	53	39	47	53	49	5.7 (.334)
Age (mean) ^b	483	68	69	68	67	69	67	70	1.9 (.860)
Employment (%)	476								12.2 (.270)
Working		32	30	35	34	26	35	24
Retired		66	69	64	62	74	59	70
Other		2	1	1	4	0	5	6
Education (%)	473								15.9 (.388)
Elementary school		27	27	27	22	37	26	21
High school		23	19	23	28	11	43	21
University/college		32	39	30	27	35	19	41
Other		18	15	20	23	17	13	16
Cohabiting (% Yes)	470	72	77	66	73	72	73	59	3.3 (.769)
Having a partner (% Yes)	488	76	80	70	78	75	84	63	3.4 (.636)
Native language (% Swedish)	436	88	90	91	83	86	82	86	2.9 (.712)
Country of birth (% Swedish)	476	85	86	93	81	78	75	85	5.4 (.374)
Parents’ country of birth (% Both Sweden)	476	82	87	88	78	66	80	85	7.1 (.217)
Diagnoses
Type of cancer (% colon cancer)	477	60	38	40	40	43	34	51	1.6 (.900)
Tumour stage (%)	457								44.6 (.000)
I/II		31	32	39	28	26	20	29
III		61	58	55	64	64	79	63
IV		8	11	6	8	10	1	7
ASA Class (% ASA 3/ASA 4)	485	19	86	86	72	74	86	78	8.4 (.134)
Presence of other cancer diagnosis in addition to the CRC (% Yes)	486	14	13	17	14	13	13	12	0.6 (.987)
Treatments and care
Hospital (%)	488								85.3 (.000)
I (University hospital)		54	32	55	68	87	26	79
II (Regional hospital)		19	21	23	13	6	44	17
III (Local hospital)		27	48	23	19	8	30	4
Type of surgery (%)	487								4.3 (.932)
Rectal resection		24	22	23	21	34	27	30
Abdominoperineal rectal resection, or larger resection of colon with ostomy		15	15	16	18	5	14	16
Rectal-sigmoid resection, or right hemicolectomy		61	63	61	62	61	60	54
Laparoscopic surgery (% Yes)	487	29	30	34	25	24	40	13	8.3 (.142)
Ostomy (% Yes)	486	39	38	43	37	33	36	51	1.4 (.925)
Intervention (% Yes)	488	49	53	46	50	40	57	42	3.1 (.681)
# times in contact with assigned cancer contact nurse at the outpatient clinic before surgery (%):	486								15.6 (.113)
0		18	25	22	12	7	32	9
1		48	43	48	53	48	41	45
2/3		34	32	29	35	46	27	46
# times in contact with assigned cancer contact nurse over the phone before surgery (%)	486								34.6 (.003)
0		50	40	49	52	68	59	56
1		29	33	35	20	27	20	34
2		13	16	11	19	3	5	6
> =3		8	12	5	10	2	16	4
Days of hospital stay (mean)^c	487	7.5	7.0	8.0	7.0	8.2	7.2	8.6	6.4 (.265)
Presence of reoperation(s) (% Yes)	482	8	5	12	4	10	25	0	42.8 (.000)
At least one readmission (% Yes)	442	24	20	22	27	35	46	17	5.7 (.338)
Adjuvant chemotherapy (% Yes)	480	29	29	22	24	43	27	50	7.0 (.218)
Self-perceived health
Global Health (mean: 0–100)	476	70.1	77.7	67.0	65.0	73.7	65.5	52.6	49.9 (.000)
Physical functioning (mean: 0–100)	474	85.4	88.2	84.2	81.6	85.5	89.8	81.5	10.3 (.067)
Role functioning (mean: 0–100)	470	80.0	86.1	74.3	74.4	84.7	80.9	71.1	15.6 (.008)
Emotional functioning (mean: 0–100)	476	72.5	79.2	67.4	68.3	78.6	72.9	58.1	30.7 (.000)
Cognitive functioning (mean: 0–100)	476	86.4	90.9	84.8	81.5	88.3	88.1	76.5	19.0 (.002)
Social functioning (mean: 0–100)	476	84.3	89.5	82.2	77.5	90.2	82.5	80.1	22.5 (.000)
Financial difficulties (% yes)	470	11	7	8	17	8	9	36	29.3 (.015)
Symptoms
Distress thermometer (mean: 0-10)	408	3.1	2.4	3.8	3.6	2.8	2.6	4.8	33.9 (.000)
Fatigue (mean: 0-100)	474	27.9	23.7	29.8	33.4	22.4	33.3	35.0	14.0 (.016)
Nausea (mean: 0-100)	476	4.8	3.9	5.2	4.7	4.2	4.7	12.4	5.6 (.353)
Pain (mean: 0-100)	476	16.7	13.0	18.5	20.8	13.8	16.3	25.8	9.3 (.101)
Dyspnoea (% Yes)	469	41	38	45	54	34	29	50	51.9 (.000)
Insomnia (% Yes)	473	59	43	68	69	43	62	72	28.8 (.017)
Appetite (% Yes)	474	31	28	38	36	12	39	45	63.1 (.000)
Constipation (% Yes)	474	27	19	27	26	38	50	41	54.6 (.000)
Diarrhoea (% Yes)	476	42	36	39	53	44	38	51	107.4 (.000)
Sense of coherence
Meaningfulness (mean: 1–7)	466	4.2	4.1	4.2	4.2	4.0	4.3	4.4	9.3 (.100)
Manageability (mean: 1–7)	465	4.3	4.3	4.4	4.3	4.3	4.5	4.2	5.4 (.372)
Comprehensibility (mean: 1–7)	464	4.9	5.3	4.8	4.7	5.1	4.8	4.5	39.0 (.000)

Notes. Bolded fonts indicate the highest values among the classes.

^aWald chi-square test comparing differences across the six classes.

^bAge range: 32–92 years.

^cCalculated based on natural logarithm of days and subsequently exponentiated.

Figure 1. Average and observed individual preparedness for surgery and recovery trajectories.

Table 2. Fit statistics and class proportions for latent classes models.

								Class proportions^a
K	P	LL	BIC	VLMR p-value	BLRT p-value	Entropy	Class 1	Class 2	Class 3	Class 4	Class 5	Class 6	Class 7
1	50	−33095	66501				1
2^b	71	−32537	65513	.000	.000	0.91	0.31	0.69
3	92	−32348	65265	.075	.000	0.85	0.11	0.29	0.60
4	113	−32177	65054	.495	.000	0.83	0.16	0.49	0.06	0.29
5	134	−32048	64926	.244	.000	0.82	0.05	0.25	0.27	0.30	0.13
6	155	−31961	64882	.513	.000	0.82	0.06	0.24	0.23	0.30	0.05	0.13
7^b	176	−31884	64858	.507	.000	0.81	0.29	0.06	0.03	0.27	0.12	0.10	0.14

Notes. N = 488, K = Number of latent classes in the model. P = number of estimated parameters. LL = log likelihood. BIC = Bayesian information criterion (sample-size adjusted). VLMR p-value = Vuong-Lo-Mendell-Rubin likelihood ratio test p-value.

^aProbability of latent class membership predicted by the model.

^bUnreliable estimation due to non-positive definite matrix.

Figure 2. Six classes representing different preparedness for surgery and recovery trajectory profiles.

Figure 3. Odds ratios for the variables that explain different preparedness for surgery and recovery trajectories profiles represented by the six latent classes.

Note. To facilitate comparison, all continuous variables were rescaled to range from 0 to 10.

Data availability statement

Data cannot be shared publicly because the questionnaires include sensitive data about health status. The ethical approval by the Regional Ethical Review Board in Gothenburg, Sweden includes a statement that the data will be kept in a private repository. Requests for the data used in our analyses can be made to Swedish National Data Service [email protected].