A Cross-sectional Study of Knowledge, Attitude and Barriers to Colorectal Cancer Screening among Cancer Survivors

Document Type: Research Articles


1 Department of Haematology-Oncology, National University Cancer Institute, Singapore.

2 Department of Radiation Oncology, National University Cancer Institute, Singapore.

3 Division of Oncology Nursing, National University Cancer Institute, Singapore.

4 University Medicine Cluster, National University Health System, Singapore.

5 Saw Swee Hock School of Public Health, National University of Singapore, Singapore.

6 Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore.

7 Cancer Science Institute of Singapore,National University of Singapore, Singapore.


Introduction: Understanding behaviour of cancer survivors is imperative as they are at risk of recurrence or second cancers. Colorectal cancer (CRC) is one of the most common cancers globally. We aim to determine the uptake rate, barriers and predictors of CRC screening among cancer survivors. Methods: Within a public hospital in Singapore, 150 non-CRC survivors were enrolled. Questionnaire on knowledge, screening behaviour, motivators and barriers towards CRC screening was administered. Results: Majority were survivors of breast (69.3%), prostate (7.3%), endometrial (4%) and ovarian (4%) cancers. More than half had high knowledge scores for CRC symptoms, screening tests and risk factors. About a third had received physician’s recommendation on CRC screening. Approximately half had undergone screening. The most common barriers to CRC screening were lack of symptoms and physician’s recommendation. Cancer survivors with higher education, higher household income, family history and those who perceived “great need” or “some need” were more likely to have undergone screening (56.4% vs 30.6%, p=0.003; 62.2% vs 41.9%, p=0.022; 70.6% vs 45.1%, p=0.048; 70.8% vs 27.4%, p<0.001). Physician’s recommendation (76.4% vs 31.6%, p<0.001) and high CRC symptom knowledge (55.8% vs 34.5%, p=0.012) were associated with increased likelihood of screening.On multivariate analysis, physician’s recommendation, higher household income and survivors’ perceived need to undergo screening remained strong predictors for CRC screening (p<0.001; p=0.010; p<0.001). Conclusion: The uptake rate of CRC screening among non-CRC survivors was modest. Physicians need to be more active in discussing CRC screening with cancer survivors as part of the survivorship care plan.


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