Risk of Pharmacological or Hospital Treatment for Depression in Patients with Colorectal Cancer–Associations with Pre-Cancer Lifestyle, Comorbidity and Clinical Factors

Abstract

We investigated the risk of depression in colorectal cancer (CRC) patients and associated risk factors. The 1324 patients with CRC and 6620 matched cancer-free participants from the Diet, Cancer and Health study were followed for up to 16 years for either a first hospitalization for depression or antidepressant prescription after diagnosis of CRC cancer or study entry date. Information on the outcome and covariates was retrieved from the Danish Colorectal Cancer Group database, the national health registries and questionnaires. Cumulative incidence of depression was estimated, and Cox regression models were used to evaluate the association between risk factors and depression incidence. During follow-up, 191 (14.4%) patients with CRC and 175 (2.6%) cancer-free comparison persons experienced depression. After adjustments, in the first year after cancer diagnosis, patients with CRC had a 12-fold higher hazard compared with the cancer-free population (HR, 12.01; 95% CI, 7.89–18.28). The risk decreased during follow-up but remained significantly elevated with an HR of 2.65 (95% CI, 1.61–4.36) after five years. Identified risk factors were presence of comorbidities, advanced disease stage and use of radiotherapy, while life style factors (pre-cancer or at diagnosis) and chemotherapy did not seem to contribute to the increased risk.

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

“…Out of the included studies, six studies [ 6 , 8 , 17 , 18 , 19 , 20 ] assessed both anxiety and depression, and two studies [ 7 , 21 ] assessed depression only. Included studies were predominantly conducted in developed countries: United States ( n = 3) [ 6 , 17 , 21 ], Taiwan ( n = 2) [ 18 , 20 ], Netherlands ( n = 1) [ 19 ], Denmark ( n = 1) [ 7 ], and Canada ( n = 1) [ 8 ]. All studies used administrative health data from their respective countries as their main data source.…”

“…However, we note that, although studies were assessed to be reporting sex, as generally administrative health data do not capture gender, sex and gender terminology were conflated in half of the studies ( n = 2) [ 17 , 21 ], where the terms ‘men’ and ‘women’ (which refer to sex) were used interchangeably with ‘males’ and ‘females’ (which refer to gender), respectively. In regard to age, the majority of studies ( n = 7) [ 6 , 8 , 17 , 18 , 19 , 20 , 21 ] reported the age at the time of CRC diagnosis and one study [ 7 ] reported age at the time of the study. However, all studies varied in their reporting of age, as we observed either the reporting of mean and standard deviation or proportion according to varying age categories.…”

“…The pooled age at CRC diagnosis was 68.2 years (95% CI 65.54 to 70.85). Regarding cancer stage at diagnosis, two studies [ 18 , 20 ] did not report cancer stage, three studies [ 6 , 7 , 19 ] included CRC patients with stage 1 to IV disease, two studies [ 8 , 17 ] included CRC patients with stage 0 to IV disease, and one study [ 21 ] included CRC patients with stage 1 to III disease. Lastly, the quality assessment scores of included studies resulted in a “Fair” ranking for two studies [ 17 , 19 ], with scores ranging from 3 to 5, and a “Good” ranking for six studies [ 6 , 7 , 8 , 18 , 20 , 21 ], with scores ranging from 6 to 8.…”

“…A US cohort study in 2019 used the Utah Population Database to show that patients with a CRC diagnosis were at an increased risk of any mental health disorders after diagnosis at 0–2 years (adjusted hazard ratio (aHR) 3.70; 95% confidence interval (CI) 3.47 to 3.95), >2–5 years (aHR 1.23; 95% CI 1.09 to 1.38), and ≥5 years (aHR 1.20; 95% CI 1.07 to 1.36) [ 6 ]. In addition, a 2021 cohort study in Denmark found that, compared to the cancer-free population, patients with CRC also had a significantly higher risk of depression, even 5 years after enrollment into the study (aHR 2.65; 95% CI 1.61 to 4.36) [ 7 ]. Recently, a Canadian cohort study in 2022 using administrative health databases evaluated risks of mental health disorders among patients with CRC stratified by sex and found that the risk of depression among males (aHR 1.11; 95% CI 1.06 to 1.16) and the risk of anxiety among both males (aHR 1.15; 95% CI 1.06 to 1.25) and females (aHR 1.09; 95% CI 1.02 to 1.16) were higher for those with CRC compared to the cancer-free group [ 8 ].…”

Cancer Survivorship Issues: Dissemination and Translation of Evidence-Based Knowledge

“…Identified risk factors were presence of comorbidities, advanced disease stage and use of radiotherapy, while lifestyle factors and chemotherapy did not seem to contribute to the increased risk. Care professionals should be aware of this late effect of CRC and its treatments, particularly in patients with comorbid conditions, advanced disease stage and patients who are treated with radiotherapy [ 13 ].…”