Colorectal Cancer and Onset of Anxiety and Depression: A Systematic Review and Meta-Analysis

Abstract

Research suggests that colorectal cancer (CRC) is associated with mental health disorders, primarily anxiety and depression. To synthesize this evidence, we conducted a systematic review and meta-analysis of studies evaluating the onset of anxiety and depression among patients with CRC. We searched EMBASE and Medline from inception to June 2022. We included original, peer-reviewed studies that: used an epidemiologic design; included patients with CRC and a comparator group of individuals without cancer; and evaluated anxiety and depression as outcomes. We used random effects models to obtain pooled measures of associations. Quality assessment was completed using the Newcastle-Ottawa scale. Of 7326 articles identified, 8 were eligible; of which 6 assessed anxiety and depression and 2 assessed depression only. Meta-analyses showed a non-significant association between CRC and anxiety (pooled HR 1.67; 95% CI 0.88 to 3.17) and a significant association between CRC and depression (pooled HR 1.78; 95% CI 1.23 to 2.57). Predictors of anxiety and depression among patients with CRC included clinical characteristics (e.g., comorbidities, cancer stage, cancer site), cancer treatment (e.g., radiotherapy, chemotherapy, colostomy), and sociodemographic characteristics (e.g., age, sex). The impacts of anxiety and depression in patients with CRC included increased mortality and decreased quality of life. Altogether, our systematic review and meta-analysis quantified the risks and impacts of CRC on anxiety and depression, particularly an increased risk of depression after CRC diagnosis. Findings provide support for oncologic care that encompasses mental health supports for patients with CRC.

Care Delivery Interventions for Individuals with Cancer: A Literature Review and Focus on Gastrointestinal Malignancies

“…Patients with cancer often need a multifaceted approach to address their myriad of supportive care concerns, including co-existing mental health needs [ 78 , 79 , 80 ]. For example, in patients with gastrointestinal cancers, the prevalence of depression and anxiety remains high, even after receiving cancer treatment [ 79 , 80 ]. Thus, innovation is necessary, especially in the mental health domain, to address these complex needs of patients with cancer.…”

The associates of anxiety among lung cancer patients: Dehydroepiandrosterone (DHEA) as a potential biomarker

“…In previous literature, anxiety in cancer patients was positively associated with female sex, younger age, lower educational level, CRF, depression, more comorbidities, more advanced cancer stage, those who received cancer treatment (chemotherapy, radiotherapy, surgery), and those with a previous history of mental health problems [ 9 , 13 , 54 ]. By contrast, we found that a higher educational level was positively correlated with anxiety.…”

Prognostic value of depression and anxiety on colorectal cancer-related mortality: a systematic review and meta-analysis based on univariate and multivariate data

“…Previous studies have confirmed that anxiety and depression are related to cancer mortality; however, to the best of our knowledge, no study has analyzed their relationship with all-cause mortality in patients with CRC [ 25 ]. Thus, we performed a meta-analysis to investigate the association of anxiety and depression with CRC along with their predictive factors, but we did not compile or analyze data on mortality [ 26 ]. Our meta-analysis is the first study to investigate the predictive value of depression and anxiety on CRC-related mortality.…”

“…In 2019, Peng et al [ 8 ] published a literature review of 15 studies and reported that the prevalence rates of anxiety and depression in patients diagnosed with CRC were 1.0–47.2% and 1.6–57%, respectively. Studies have also shown that patients with CRC have a 51% increased risk of depression after diagnosis (pooled hazard ratio (HR), 1.51; 95% confidence interval (CI), 1.10–2.09) but have no association with anxiety (pooled HR, 1.43; 95% CI, 0.79–2.57) [ 9 ]. In addition, in 2021, a cohort study in Denmark reported that patients with CRC had a significantly higher risk of depression than cancer-free individuals, even after participating in the study for 5 years (HR, 2.65; 95% CI, 1.61–4.36) [ 10 ].…”