Depressive symptoms in older long-term colorectal cancer survivors: a population-based analysis using the SEER-Medicare healthcare outcomes survey
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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.
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.
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.
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.
KeywordsColorectal cancer Elderly Quality of life Cancer survivor Depression Surgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.SEER. SEER Stat Fact Sheets: colon and rectum cancer. Natl Cancer Inst 2015. http://perma.cc/HXD2-SDSK.
- 2.Siegel R, Jemal A. Colorectal cancer facts and figures 2011-2013. Am Cancer Soc 2013:1–27.Google Scholar
- 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.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
- 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
- 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
- 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
- 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.Surveillance Epidemiology and End Results (SEER) program: an overview. NIH Publ No 05–4772 2005.Google Scholar
- 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.SEER Brochure – NIH Publication No. 05–4772. 2005.Google Scholar
- 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/.
- 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.National Cancer Institute. Brief description of the SEER-MHOS Level Analysis File 2014. http://perma.cc/V4Z6-CFNM (accessed January 1, 2015).
- 28.Group Health Services Advisory. Report on the health status of managed care smokers and nonsmokers. 2007.Google Scholar
- 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.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.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.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