Patient‐reported distress and age‐related stress biomarkers among colorectal cancer patients

Abstract

Objective Distress among cancer patients has been broadly accepted as an important indicator of well‐being but has not been well studied. We investigated patient characteristics associated with high distress levels as well as correlations among measures of patient‐reported distress and “objective” stress‐related biomarkers among colorectal cancer patients. Methods In total, 238 patients with colon or rectal cancer completed surveys including the Distress Thermometer, Problem List, and the Hospital Anxiety and Depression Scale. We abstracted demographic and clinical information from patient charts and determined salivary cortisol level and imaging‐based sarcopenia. We evaluated associations between patient characteristics (demographics, clinical factors, and psychosocial and physical measures) and three outcomes (patient‐reported distress, cortisol, and sarcopenia) with Spearman's rank correlations and multivariable linear regression. The potential moderating effect of age was separately investigated by including an interaction term in the regression models. Results Patient‐reported distress was associated with gender (median: women 5.0, men 3.0, p < 0.001), partnered status (single 5.0, partnered 4.0, p = 0.018), and cancer type (rectal 5.0, colon 4.0, p = 0.026); these effects varied with patient age. Cortisol level was associated with “emotional problems” (ρ = 0.34, p = 0.030), anxiety (ρ = 0.46, p = 0.006), and depression (ρ = 0.54, p = 0.001) among younger patients. We found no significant associations between patient‐reported distress, salivary cortisol, and sarcopenia. Conclusions We found that young, single patients reported high levels of distress compared to other patient groups. Salivary cortisol may have limited value as a cancer‐related stress biomarker among younger patients, based on association with some psychosocial measures. Stress biomarkers may not be more clinically useful than patient‐reported measures in assessing distress among colorectal cancer patients.

The effects of proactive approach and integrated medical care on psychological distress in hospitalized patients: A single center experience

“…symptoms, than did older patients (Goulia et al, 2012). This may be because younger patients are more likely to describe their psychological distress and need more help than older patients (Eddington et al, 2021). Another possible explanation for this discrepancy is that older patients make better use of suppression, an emotion regulation strategy, than younger patients when encountering psychological distress (Muazzam et al, 2021).…”

“…Goulia et al even demonstrated that in a cohort of patients with severe chronic medical illnesses, a larger proportion of younger patients (<65 years) had severe psychological distress, predominantly depression, anxiety, and hostility symptoms, than did older patients (Goulia et al, 2012). This may be because younger patients are more likely to describe their psychological distress and need more help than older patients (Eddington et al, 2021). Another possible explanation for this discrepancy is that older patients make better use of suppression, an emotion regulation strategy, than younger patients when encountering psychological distress (Muazzam et al, 2021).…”

Gender Differences in Fears Related to Low-Risk Papillary Thyroid Cancer and Its Treatment

“…The prevalence of thyroid cancer remains 3 times higher in women who are more likely to be diagnosed with small PTCs. 4 Despite these differences, limited investigation exists into how sex and gender influence thyroid cancer-related information processing and decision-making.…”

“…[1][2][3] Concerns expressed by patients with newly diagnosed low-risk papillary thyroid cancer (PTC) relate to the cancer and its associated future outcome uncertainty as well as the potential risks and consequences of its treatment (eg, thyroidectomy). 4 It is important to fully understand the fears experienced by individuals newly diagnosed with thyroid cancer to inform supportive care strategies and patient counseling. This understanding may be more fully informed in considering the context of gender.…”

Clinical relevance of stress biomarkers as health-disease indicators

“…28 It has been observed that the activity of this axis tends to decrease in the elderly, probably due to the reduction in sleep hours, causing the appearance of various neurodegenerative disorders. 30 Another fundamental structure of the HPA axis is the amygdala, related to emotional processing, specifically to the regulation of fear. Chronic stress causes constant exposure to corticotropinreleasing hormone (CRH), altering the volume and functions of the amygdala.…”