Graduation Date

Fall 12-15-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Medical Sciences Interdepartmental Area

First Advisor

Robin M. Lally, PhD, RN, MS, BA, AOCN, FAAN

Second Advisor

Melissa Acquazzino, MD, MS

Third Advisor

Kati Cordts, PhD

MeSH Headings

Cancer Survivorship, Cancer Survivors, Colorectal Cancer, Qualify of Life, Metastasis, Colorectal Neoplasms


Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in both men and women and is the second leading cause of cancer deaths when men and women are combined. CRC survivors are living longer with an increase in 5-year survival, rising from 52% in the 1980s to 62% in the 2000s. The objective of this dissertation was to explore the QoL and unmet needs of stage III and IV CRC survivors and contribute to the field of survivorship research through an integrative literature review of the state of the science and a sequential, explanatory mixed methods study.

The conceptual framework was the Ferrell QoL model. Electronic databases searched included PubMed, CINAHL, and Embase from 2010 to November 2020 and updated in 2023 to form an integrated review of existing literature. The mixed method study used a cross-sectional FACT-C survey and semi-structured interviews to explore QoL and unmet needs of stage III and IV CRC survivors. Descriptive statistics were used for the quantitative analysis. A group of participants who completed the FACT-C also participated in a one-time interview. Qualitative analysis was conducted using directed content analysis, followed by integration with summative content analysis and joint displays.

The integrative review identified five articles, including three quantitative and two qualitative studies. Factors that led to an increase in unmet needs in this population were age, distress, fear, lack of emotional support, and spiritual uncertainty. In the mixed methods study, n=31 CRC survivors participated, n=24 completed the FACT-C, and n=12 participated in the semi-structured interviews. Results identified eight QoL themes: control, acceptance, normalcy, resilience, trust, isolation, and anger/frustration. Two unmet needs were also identified: ostomy appliance support and the desire for shared experiences from other CRC survivors.

This study explored the complex needs and QoL of stage III and IV CRC survivors. Overall, CRC survivors face a plethora of physical, psychological, social, and spiritual cancer-related challenges. Future research is needed to better understand the factors that impact QoL for stage III and IV CRC survivors, as are clinical interventions aimed at improving QoL and minimizing unmet needs.


2023 Copyright, the authors

Available for download on Tuesday, December 02, 2025