Increased Risk of Mental Health Disorders in Colorectal Cancer Survivors

Results of a retrospective study showed an increased risk for short- and long-term development of mental health disorders, as well as decreased survival, in patients with colorectal cancer (CRC). This study was published online in the American Journal of Clinical Oncology.¹

Five-year overall survival (OS) rates of 90%, 71%, and 14% have been estimated for patients with a diagnosis of localized, regional, and distant CRC, respectively.² Beyond disease diagnosis, issues related to adverse events associated with multimodality treatment, and possible colostomy, can negatively affect the quality of life of CRC survivors.

The purpose of this study was three-fold:

• To determine whether patients who have been diagnosed with CRC have an increased risk of being diagnosed with a mental health disorder compared with the general population

• To evaluate whether specific risk factors in CRC survivors can increase the likelihood of developing a mental health disorder

• To assess whether there is a relationship between developing a mental health disorder and OS in CRC survivors

The Utah Population Database (UPDB) was used to obtain demographic, socioeconomic, and clinical data for 8961 patients diagnosed with CRC, as well as 35,897 matched general population controls. Individuals with a prior history of mental illness were excluded from this analysis.

Of the CRC survivors, 24.8%, 12.8%, 26.9% developed a mental health disorder at 0 to 2 years, 2 to 5 years, and after 5 years, respectively. Corresponding frequencies for the general population were, 8.7%, 11.4%, and 21.7%.

At 0 to 2 years, the hazard ratio for developing a mental health disorder compared with the general population was 3.70 (95% CI, 3.47-3.95), although risks were also elevated at more than 2 to 5 years and greater than 5 years.

Of the CRC survivors 7.9%, 5.2%, and 9.0% developed depression at 0 to 2 years, 2 to 5 years, and more than 5 years, respectively. Corresponding frequencies for the general population were 3.42%, 4.41%, and 4.74%. At 0 to 2 years, the hazard ratio for developing a depression compared with the general population was 2.62 (95% CI, 2.35-2.93) although risks were also elevated at 2 to 5 years and 5 years.

Furthermore, colostomy was associated with increased risk of depression at 0 to 2 years (hazard ratio=1.99; 95% CI, 1.52-2.61. Charleston Comorbidity Index 1+ was associated with an increased risk of any health disorder (hazard ratio=1.67; 95% CI, 1.39-2.00) and depression (hazard ratio=1.51; 95% CI, 1.19-1.91) at more than 5 years.

After adjusting for confounding factors, CRC survivors diagnosed with any mental health disorder had a higher risk of death compared with CRC survivors without a mental health diagnosis (hazard ratio=2.18; 95% CI, 2.02-2.35); when this analysis was performed only for those CRC survivors with a diagnosis of depression, the increased risk of death remained (hazard ratio=2.10; 95% CI, 1.92-2.28).

The study authors concluded that “the need for supportive care among CRC survivors persists throughout all periods of follow-up. Mental health screening should be incorporated into surveillance and survivorship visits.”

References

1. Lloyd S, Baraghoshi D, Tao R, et al. Mental health disorders are more common in colorectal cancer survivors and associated with decreased overall survival. [published online March 5, 2019]. Am J Clin Oncol. doi: 10.1097/COC.0000000000000529

2. American Cancer Society. Survival rates for colorectal cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html. Revised February 1, 2019. Accessed March 11, 2019.