Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study

Abstract

Aim: Depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition of depression at key points in the pathway enables timely referral to support. This study aimed to examine depression before and 5 years after surgery to examine its prevalence and identify determinants. Method:The ColoREctal Wellbeing (CREW) study is a prospective UK cohort study involving 872 adults with nonmetastatic CRC recruited before surgery with curative intent.Questionnaires completed before surgery and 3, 9, 15, 24, 36, 48 and 60 months after surgery captured socio-demographics and assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present the prevalence of clinically significant depression (CES-D ≥ 20) over time and its predictors assessed before and 2 years after surgery.Results: Before surgery, 21.0% of the cohort reported CES-D ≥ 20 reducing to 14.7% 5 years after surgery. Presurgery risk factors predicting subsequent depression were clinically significant depression and anxiety, previous mental health service use, low selfefficacy, poor health, having neoadjuvant treatment and low social support. Postsurgery risk factors at 2 years predicting subsequent depression were clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health. Conclusion:Depression is highly pervasive in people with CRC, exceeding prevalence in the general population across follow-up. Our findings emphasize the need to screen and treat depression across the pathway. Our novel data highlight key risk factors of later depression at important and opportune time points: before surgery and at the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.

Experiences of colorectal cancer survivors in returning to primary coordinated healthcare following treatment

“…frequency, irregularity, incontinence), fatigue, disrupted sleep, skin irritations, urinary problems, impact on relationships, informal and formal supportive healthcare needs, and financial and occupational challenges up to 5 years post-cancer treatment. Bowel dysfunction is experienced by as many as 79% of survivors 2 years post-treatment; 65% continue to have mobility problems, 40% report pain and discomfort 3 years post-treatment (Ju et al 2021), and 15% report depression 5 years after surgery (Calman et al 2021). Some require permanent or temporary stomas, which come with their own challenges (Rutherford et al 2020).…”

Health-related quality of life prior to and 1 year after radical cystectomy evaluated with FACT-G and FACT-VCI questionnaires

“…This is probably a normal reaction when facing a cancer diagnosis and treatment including surgery, and the preoperative assessment was performed during a period of newly diagnosed disease and planned treatment with high impact, all this related to worrying, that is, a time of low HRQoL. It is not unusual with depression and even thoughts of suicide before comprehensive cancer surgery [21,22]. In clinical praxis, it can therefore be of value to use a screening instrument for depression to identify persons at risk.…”