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. 2021 Dec;23(12):3234-3250.
doi: 10.1111/codi.15949. Epub 2021 Nov 25.

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

Lynn Calman  1 , Joshua Turner  1 , Deborah Fenlon  2 , Natalia V Permyakova  3 , Sally Wheelwright  1 , Mubarak Patel  4 , Amy Din  1 , Jane Winter  1   5 , Alison Richardson  1   5 , Peter W F Smith  6 , Claire Foster  1 ; members of the CREW Study Advisory Committee
Collaborators, Affiliations

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

Lynn Calman et al. Colorectal Dis. 2021 Dec.

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 self-efficacy, 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.

Keywords: colorectal cancer; depression; determinants; quality of life; risk factors.

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Conflict of interest statement

LC has received an honorarium for teaching from Boehringer Ingelheim. DF has received an honorarium for teaching from Roche.

Figures

FIGURE 1
FIGURE 1
CREW study participant flowchart. Note: participants who were not sent a questionnaire because of mental capacity issues or through administrative error remained eligible for the questionnaire at the next time point. Definitions: full consent, participants consented to questionnaire follow‐up and the collection of medical details; reduced consent, participants consented to the collection of medical details only. Abbreviations: F/U, follow‐up; MC, mental capacity; Q, questionnaire
See this image and copyright information in PMC

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