Over a third of bowel cancer patients experienced clinically significant depression after surgery to treat their cancer, with one in seven still experiencing symptoms five years after undergoing surgery. The findings, ‘Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study’, were published in the journal Colorectal Disease.
"Depression in people living with colorectal cancer is an important clinical problem. Our study shows that the level of depression exceeds that of general population over time,” said lead author, Dr Lynn Calman, Associate Professor in Nursing at the University of Southampton. “The research has also helped us to identify important time points where certain patients are at a high risk of depression which can inform strategies for recognition and referral for appropriate support. In this study we investigated risk factors of depression at two key time points: close to diagnosis before surgery and two years after surgery, when routine oncological check-ups end.”
A research team, led by the University of Southampton and funded by Macmillan Cancer Support, surveyed 872 adult patients with non-metastatic colorectal cancer before surgery and conducted follow up surveys at regular intervals until 60 months post-surgery.
The results of the survey showed that before surgery over a fifth of participants (21 percent) reported clinically significant levels of depression, which reduced to 14 percent at five years. Risk factors identified before surgery that predict subsequent depression were pre-existing clinically significant depression and anxiety, previous mental health service use, low confidence to manage illness related problems, poor health, and low social support.
Further analysis of the findings suggests that people with bowel cancer who have reduced levels of social support are nearly 2.5 times more likely to also have depression. Among participants with the highest levels of social support at diagnosis, 16 percent developed clinical levels of depression within five years of their cancer treatment, compared with 37 percent of those with lower levels of social support.
While the above results are based on people's experiences pre-COVID, evidence suggests the social isolation linked to the pandemic could be further worsening the mental health of people with cancer. The research team are currently carrying out another study into the impact of COVID-19, also funded by Macmillan Cancer Support; interim results from this have found that four in five (81 percent) cancer patients surveyed remained at home at all times in the pandemic, and nearly half (45 percent) of these have experienced at least two serious psychological impacts from the pandemic, such as feeling afraid, depressed or helpless.
"We know that for many people, being diagnosed with cancer and going through treatment is one of the scariest things they have ever faced, and this can often have a serious impact on people's mental health,” said Dany Bell, Strategic Advisor for Treatment, Medicines and Genomics at Macmillan Cancer Support. "Cancer affects people differently and at Macmillan we're here to ensure everyone living with cancer gets the support that's right for them. We're urging anyone in need of help - or simply someone to talk to - to get in touch with the trained nurses and advisors on our Support Line who are available at the end of the phone, seven days a week. Anyone in need of cancer support can call the Macmillan Support Line on 0808 808 00 00, which is open 7 days a week, 8am to 8pm."
The new findings also showed that people with bowel cancer who had undergone neoadjuvant chemotherapy were also more likely to experience depression, perhaps explained by the fact these patients usually face more complex treatment, side effects and increased treatment time.
"Depression in people living with cancer can lead to poor health and wellbeing and this has an impact on long term outcomes,” added Calman. “Recognising those colorectal cancer patients who are at a higher risk and referring them to the right support services could therefore lead to overall improved outcomes for patients."
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