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

Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study
Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study
Aim: depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition at key points in the pathway enables timely referral to support. This study aimed to examine depression pre- and 5 years post-surgery to examine its prevalence and identify determinants.

Methods: the ColoREctal Wellbeing (CREW) study is a prospective UK cohort involving 872 adults with non-metastatic CRC recruited before curative-intent surgery. Questionnaires completed pre-surgery, and 3, 9, 15, 24, 36, 48 and 60 months post-surgery, captured socio-demographics, assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present prevalence of clinically significant depression (CES-D≥20) over time and its predictors assessed pre-surgery and 2 years post-surgery.

Results: pre-surgery, 21.0% of the cohort reported CES-D≥20 reducing to 14.7% 5 years post-surgery. Pre-surgery risk factors predicting subsequent depression: clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Post-surgery risk factors at 2 years predicting subsequent depression: clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health.

Conclusions: depression is highly pervasive in people with CRC, exceeding general population prevalence across follow-up. Our findings emphasise the need to screen and treat depression across the pathway. Our novel data highlights key risk factors of later depression at important and opportune timepoints: pre-surgery and the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.
1462-8910
Calman, Lynn
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Turner, Joshua
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Fenlon, Deborah R
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Permyakova, Natalia Vadimovna
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Wheelwright, Sally
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Patel, Mubarak I
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Din, Amy
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Winter, Jane
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Richardson, Alison
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Smith, Peter W.F.
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Foster, Claire
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Calman, Lynn
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Turner, Joshua
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Fenlon, Deborah R
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Permyakova, Natalia Vadimovna
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Wheelwright, Sally
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Patel, Mubarak I
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Din, Amy
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Winter, Jane
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Richardson, Alison
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Smith, Peter W.F.
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Foster, Claire
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Calman, Lynn, Turner, Joshua, Fenlon, Deborah R, Permyakova, Natalia Vadimovna, Wheelwright, Sally, Patel, Mubarak I, Din, Amy, Winter, Jane, Richardson, Alison, Smith, Peter W.F. and Foster, Claire (2021) Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study. Colorectal Disease. (doi:10.1111/codi.15949).

Record type: Article

Abstract

Aim: depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition at key points in the pathway enables timely referral to support. This study aimed to examine depression pre- and 5 years post-surgery to examine its prevalence and identify determinants.

Methods: the ColoREctal Wellbeing (CREW) study is a prospective UK cohort involving 872 adults with non-metastatic CRC recruited before curative-intent surgery. Questionnaires completed pre-surgery, and 3, 9, 15, 24, 36, 48 and 60 months post-surgery, captured socio-demographics, assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present prevalence of clinically significant depression (CES-D≥20) over time and its predictors assessed pre-surgery and 2 years post-surgery.

Results: pre-surgery, 21.0% of the cohort reported CES-D≥20 reducing to 14.7% 5 years post-surgery. Pre-surgery risk factors predicting subsequent depression: clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Post-surgery risk factors at 2 years predicting subsequent depression: clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health.

Conclusions: depression is highly pervasive in people with CRC, exceeding general population prevalence across follow-up. Our findings emphasise the need to screen and treat depression across the pathway. Our novel data highlights key risk factors of later depression at important and opportune timepoints: pre-surgery and the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.

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Accepted/In Press date: 17 June 2021
Published date: 25 November 2021
Additional Information: ACKNOWLEDGEMENTS We thank all CREW study participants and recruiting NHS Trusts; Carol Hill, Kerry Coleman, Bjoern Schukowsky, Christine May (study support); Matthew Breckons, Cassandra Powers, Alex Recio-Saucedo, Bina Nausheen, Ikumi Okamoto, Kim-Chivers Seymour, Joanne Haviland (researchers); Jo Clough, Alison Farmer (research partners). Members of the Study Advisory Committee: Jo Armes, Janis Baird, Andrew Bateman, Nick Beck, Graham Moon, Claire Hulme, Peter Hall, Karen Poole, Susan Restorick-Banks, Paul Roderick, Claire Taylor, Jocelyn Walters, Fran Williams, Lynn Batehup, Jessica Corner and Deborah Fenlon. We would also like to thank Michael Sharpe for his valuable feedback on our manuscript and Angus McNair for his valuable advice. Professor Alison Richardson is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Identifiers

Local EPrints ID: 451498
URI: http://eprints.soton.ac.uk/id/eprint/451498
ISSN: 1462-8910
PURE UUID: 1d98b84d-b148-4dff-acc8-69aeee76424f
ORCID for Lynn Calman: ORCID iD orcid.org/0000-0002-9964-6017
ORCID for Joshua Turner: ORCID iD orcid.org/0000-0002-7918-2294
ORCID for Sally Wheelwright: ORCID iD orcid.org/0000-0003-0657-2483
ORCID for Alison Richardson: ORCID iD orcid.org/0000-0003-3127-5755
ORCID for Peter W.F. Smith: ORCID iD orcid.org/0000-0003-4423-5410
ORCID for Claire Foster: ORCID iD orcid.org/0000-0002-4703-8378

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Date deposited: 04 Oct 2021 16:30
Last modified: 17 Jun 2022 04:01

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Contributors

Author: Lynn Calman ORCID iD
Author: Joshua Turner ORCID iD
Author: Deborah R Fenlon
Author: Natalia Vadimovna Permyakova
Author: Mubarak I Patel
Author: Amy Din
Author: Jane Winter
Author: Claire Foster ORCID iD

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