Supportive Care in Cancer

, Volume 24, Issue 9, pp 3907–3914 | Cite as

Depressive symptoms in older long-term colorectal cancer survivors: a population-based analysis using the SEER-Medicare healthcare outcomes survey

  • Clancy J. Clark
  • Nora F. Fino
  • Jia Hao Liang
  • David Hiller
  • Jaime Bohl
Original Article

Abstract

Purpose

Colorectal cancer survivorship has improved significantly over the last 20 years; however, few studies have evaluated depression among older colorectal cancer survivors, especially using a population-based sample. The aim of this study was to identify correlates for positive depression screen among colorectal cancer survivors who underwent potentially curative surgery.

Methods

Using the 1998–2007 Surveillance, Epidemiology, and End-Result registry and the Medicare Health Outcome Survey linked dataset, we identified patients over 65 with pathology confirmed and resected colorectal cancer enrolled in Medicare. Using univariate and multiple variable analyses, we identified characteristics of patients with and without positive depression screen.

Results

Resected colorectal cancer patients (1785) (median age 77, 50.8 % female) were identified in the dataset with 278 (15.6 %) screening positive for symptoms of depression. Median time from diagnosis to survey was 62 months. On univariate analysis, larger tumor size, advanced cancer stage, and extent of resection were not correlates of depressive symptoms (all p > 0.05). After adjusting for confounders, income less than US$30,000 per year (OR 1.50, 1.02–2.22, 95 % CI, p = 0.042), non-white race (OR 1.51, 1.05–2.17, 95 % CI, p = 0.027), two or more comorbidities (OR 1.78, 1.25–2.52, 95 % CI, p = 0.001), and impairment in activities of daily living (OR 5.28, 3.67–7.60, 95 % CI, p < 0.001) were identified as independent correlates of depressive symptoms in colorectal cancer survivors.

Conclusions

In the current study, socioeconomic status and features of physical health rather than tumor characteristics were associated with symptoms of depression among long-term colorectal cancer survivors.

Keywords

Colorectal cancer Elderly Quality of life Cancer survivor Depression Surgery 

Notes

Compliance with ethical standards

Funding source

None.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    SEER. SEER Stat Fact Sheets: colon and rectum cancer. Natl Cancer Inst 2015. http://perma.cc/HXD2-SDSK.
  2. 2.
    Siegel R, Jemal A. Colorectal cancer facts and figures 2011-2013. Am Cancer Soc 2013:1–27.Google Scholar
  3. 3.
    Levin B, DA L, McFarland B, RA S, D B, KS A, et al. (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US multi-society task force on colorectal cancer, and the American College of Radiology. CA Cancer J Clin 58:130–160. doi: 10.3322/CA.2007.0018 CrossRefPubMedGoogle Scholar
  4. 4.
    Cukier M, Smith AJ, Milot L, Chu W, Chung H, Fenech D, et al. (2012) Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience. Eur J Surg Oncol 38:677–682. doi: 10.1016/j.ejso.2012.05.001 CrossRefPubMedGoogle Scholar
  5. 5.
    Taylor WE, Donohue JH, Gunderson LL, Nelson H, Nagorney DM, Devine RM, et al. (2002) The mayo clinic experience with multimodality treatment of locally advanced or recurrent colon cancer. Ann Surg Oncol 9:177–185. doi: 10.1007/BF02557371 CrossRefPubMedGoogle Scholar
  6. 6.
    Weinberger MI, Bruce ML, Roth AJ, Breitbart W, Nelson CJ (2011) Depression and barriers to mental health care in older cancer patients. Int J Geriatr Psychiatry 26:21–26. doi: 10.1002/gps.2497 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Parpa E, Tsilika E, Gennimata V, Mystakidou K (2015) Elderly cancer patients’ psychopathology: a systematic review: aging and mental health. Arch Gerontol Geriatr 60:9–15. doi: 10.1016/j.archger.2014.09.008 CrossRefPubMedGoogle Scholar
  8. 8.
    Pinheiro LC, Wheeler SB, Chen RC, Mayer DK, Lyons JC, Reeve BB. The effects of cancer and racial disparities in health-related quality of life among older Americans: a case-control, population-based study. Cancer 2014:1–9. doi:10.1002/cncr.29205.Google Scholar
  9. 9.
    Marventano S, Forjaz M, Grosso G, Mistretta A, Giorgianni G, Platania A, et al. (2013) Health related quality of life in colorectal cancer patients: state of the art. BMC Surg 13(Suppl 2):S15. doi: 10.1186/1471-2482-13-S2-S15. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Zhao G, Okoro CA, Li J, White A, Dhingra S, Li C (2014) Current depression among adult cancer survivors: findings from the 2010 behavioral risk factor surveillance system. Cancer Epidemiol 38:757–764. doi: 10.1016/j.canep.2014.10.002 CrossRefPubMedGoogle Scholar
  11. 11.
    Daly EJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Gaynes BN, Warden D, et al. (2010) Health-related quality of life in depression: a STAR*D report. Ann Clin Psychiatry 22:43–55PubMedGoogle Scholar
  12. 12.
    Brown LF, Kroenke K, Theobald DE, Wu J, Tu W (2010) The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 19:734–741. doi: 10.1002/pon.1627 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Reeve BB, Stover AM, Jensen RE, Chen RC, Taylor KL, Clauser SB, et al. (2012) Impact of diagnosis and treatment of clinically localized prostate cancer on health-related quality of life for older Americans: a population-based study. Cancer 118:5679–5687. doi: 10.1002/cncr.27578 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Medeiros M, Oshima CTF, Forones NM (2010) Depression and anxiety in colorectal cancer patients. J Gastrointest Cancer 41:179–184. doi: 10.1007/s12029-010-9132-5 CrossRefPubMedGoogle Scholar
  15. 15.
    Rojas-García A, Ruiz-Perez I, Rodríguez-Barranco M, Gonçalves Bradley DC, Pastor-Moreno G, Ricci-Cabello I (2015) Healthcare interventions for depression in low socioeconomic status populations: a systematic review and meta-analysis. Clin Psychol Rev 38:65–78. doi: 10.1016/j.cpr.2015.03.001 CrossRefPubMedGoogle Scholar
  16. 16.
    Ambs A, Warren JL, Bellizzi KM, Topor M, Haffer SC, Clauser SB (2008) Overview of the SEER–Medicare health outcomes survey linked dataset. Health Care Financ Rev 29:5–21PubMedPubMedCentralGoogle Scholar
  17. 17.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. (2007) Annals of internal medicine academia and clinic the strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting. Ann Intern Med 147:573–578CrossRefGoogle Scholar
  18. 18.
    Surveillance Epidemiology and End Results (SEER) program: an overview. NIH Publ No 05–4772 2005.Google Scholar
  19. 19.
    Haffer SC (2003) Using multiple survey vendors to collect health outcomes information: how accurate are the data? Health Qual Life Outcomes 1:6CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Warren JL, Harlan LC, Fahey A, Virnig B A, Freeman JL, Klabunde CN, et al. Utility of the SEER-Medicare data to identify chemotherapy use. Med Care 2002;40:IV – 55–61. doi:10.1097/01.MLR.0000020944.17670.D7.Google Scholar
  21. 21.
    SEER Brochure – NIH Publication No. 05–4772. 2005.Google Scholar
  22. 22.
    Nathan H, Pawlik TM (2008) Limitations of claims and registry data in surgical oncology research. Ann Surg Oncol 15:415–423. doi: 10.1245/s10434-007-9658-3 CrossRefPubMedGoogle Scholar
  23. 23.
    Howlader N, Noone A, Krapcho M, Garshell J, Neyman N, Altekruse S, et al. SEER Cancer Statistics Review, 1975-2010. Natl Cancer Inst 2013. http://seer.cancer.gov/csr/1975_2010/.
  24. 24.
    Jones N, Jones SL, Miller NA (2004) The Medicare health outcomes survey program: overview, context, and near-term prospects. Health Qual Life Outcomes 2:33. doi: 10.1186/1477-7525-2-33 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Centers for Medicare and Medicaid Services. Medicare Health Outcomes Survey (HOS) response rates 2014. http://perma.cc/RYG8-RTL4 (accessed January 1, 2015).
  26. 26.
    National Cancer Institute. Brief description of the SEER-MHOS Level Analysis File 2014. http://perma.cc/V4Z6-CFNM (accessed January 1, 2015).
  27. 27.
    Rost K, Burnam MA, Smith GR (1993) Development of screeners for depressive disorders and substance disorder history. Med Care 31:189–200CrossRefPubMedGoogle Scholar
  28. 28.
    Group Health Services Advisory. Report on the health status of managed care smokers and nonsmokers. 2007.Google Scholar
  29. 29.
    Stafford L, Judd F, Gibson P, Komiti A, Mann GB, Quinn M (2015) Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome. Support Care Cancer. doi: 10.1007/s00520-014-2571-y Google Scholar
  30. 30.
    Massie MJ (2004) Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 10021:57–71. doi: 10.1093/jncimonographs/lgh014 CrossRefGoogle Scholar
  31. 31.
    Damián J, Pastor-Barriuso R, Valderrama-Gama E, de Pedro-Cuesta J. Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people. Epidemiol Psychiatr Sci 2016:1–10. doi: 10.1017/S2045796015001171.
  32. 32.
    Cancer Program Standards 2012: Ensuring patient-centered care. Comm Cancer 2012. https://www.facs.org/~/media/files/quality programs/cancer/coc/programstandards2012.ashx (accessed September 3, 2016).
  33. 33.
    Reeve BB, Stover AM, Jensen RE, Chen RC, Taylor KL, Clauser SB, et al. (2012) Impact of diagnosis and treatment of clinically localized prostate cancer on health-related quality of life for older Americans: a population-based study. Cancer 118:5679–5687. doi: 10.1002/cncr.27578 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, et al. (2008) Cancer, comorbidities, and health-related quality of life of older adults. Health Care Finance Rev 29:41–56Google Scholar
  35. 35.
    Schoormans D, Czene K, Hall P, Brandberg Y (2015) The impact of co-morbidity on health-related quality of life in breast cancer survivors and controls. Acta Oncol (Madr) 54:727–734. doi: 10.3109/0284186X.2014.998277 CrossRefGoogle Scholar
  36. 36.
    Krupski TL, Fink A, Kwan L, Maliski S, Connor SE, Clerkin B, et al. (2005) Health-related quality-of-life in low-income, uninsured men with prostate cancer. J Health Care Poor Underserved 16:375–390. doi: 10.1353/hpu.2005.0037 CrossRefPubMedGoogle Scholar
  37. 37.
    Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee P-J, Vourlekis B (2008) Economic stress among low-income women with cancer: effects on quality of life. Cancer 112:616–625. doi: 10.1002/cncr.23203 CrossRefPubMedGoogle Scholar
  38. 38.
    Poulakis V, Witzsch U, de Vries R, Moeckel M, Becht E (2003) Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron-sparing surgery. Urology 62:814–820. doi: 10.1016/S0090-4295(03)00687-3 CrossRefPubMedGoogle Scholar
  39. 39.
    Earlam S, Glover C, Fordy C, Burke D, Allen-Mersh TG (1996) Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases. J Clin Oncol 14:171–175PubMedGoogle Scholar
  40. 40.
    Vironen JH, Kairaluoma M, Aalto A-M, Kellokumpu IH (2006) Impact of functional results on quality of life after rectal cancer surgery. Dis Colon rectum 49:568–578. doi: 10.1007/s10350-006-0513-6 CrossRefPubMedGoogle Scholar
  41. 41.
    Andersson J, Angenete E, Gellerstedt M, Angerås U, Jess P, Rosenberg J, et al. (2013) Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg 100:941–949. doi: 10.1002/bjs.9144 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Clancy J. Clark
    • 1
  • Nora F. Fino
    • 2
  • Jia Hao Liang
    • 3
  • David Hiller
    • 1
  • Jaime Bohl
    • 1
  1. 1.Department of General SurgeryWake Forest School of MedicineWinston SalemUSA
  2. 2.Division of Public Health SciencesWake Forest School of MedicineWinstonUSA
  3. 3.Wake Forest School of MedicineWinstonUSA

Personalised recommendations