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Open AccessArticle

Anxiety, Depression, and Colorectal Cancer Survival: Results from Two Prospective Cohorts

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Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Division of Population Science, Moffitt Cancer Center, Tampa, FL 33612, USA
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Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Channing Division of Network Medicine, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA
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Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(10), 3174; https://doi.org/10.3390/jcm9103174
Received: 18 August 2020 / Revised: 24 September 2020 / Accepted: 29 September 2020 / Published: 30 September 2020
(This article belongs to the Special Issue Cancer Rehabilitation and Survivorship)
Given the unalterable nature of most risk factors for colorectal cancer (CRC) survival (e.g., disease stage), identifying modifiable determinants is critical. We investigated whether anxiety and depression were related to CRC survival using data from the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS). Participants who received a CRC diagnosis and provided information about anxiety (nNHS = 335; nHPFS = 232) and depression (nNHS = 893; nHPFS = 272) within 4 years of diagnosis were included. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) of overall mortality, while controlling for covariates (sociodemographics, cancer characteristics, and lifestyle factors). Pooled risk estimates were derived from fixed effects meta-analyses of the cohorts. Among 1732 CRC patients, 814 deaths occurred during the 28-year follow-up. Each 1 standard deviation increase in anxiety or depression symptoms was associated with a similar 16% higher mortality risk (anxiety: 95% CI = 1.05–1.29; depression: 95% CI = 1.07–1.26). Comparable results were observed across all sensitivity analyses (introducing a 1-year lag, restricting to CRC-related mortality, considering potential behavioral pathways) and stratified models (cancer stage, sex). Our findings suggest greater anxiety and depression symptoms can not only impede adherence to healthy habits and reduce quality of life in cancer patients but could also be a marker for accelerated CRC progression. View Full-Text
Keywords: anxiety; anxiolytics; antidepressants; cancer; colorectal cancer; depression; health behaviors; mortality; psychological distress; survival anxiety; anxiolytics; antidepressants; cancer; colorectal cancer; depression; health behaviors; mortality; psychological distress; survival
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MDPI and ACS Style

Trudel-Fitzgerald, C.; Tworoger, S.S.; Zhang, X.; Giovannucci, E.L.; Meyerhardt, J.A.; Kubzansky, L.D. Anxiety, Depression, and Colorectal Cancer Survival: Results from Two Prospective Cohorts. J. Clin. Med. 2020, 9, 3174. https://doi.org/10.3390/jcm9103174

AMA Style

Trudel-Fitzgerald C, Tworoger SS, Zhang X, Giovannucci EL, Meyerhardt JA, Kubzansky LD. Anxiety, Depression, and Colorectal Cancer Survival: Results from Two Prospective Cohorts. Journal of Clinical Medicine. 2020; 9(10):3174. https://doi.org/10.3390/jcm9103174

Chicago/Turabian Style

Trudel-Fitzgerald, Claudia; Tworoger, Shelley S.; Zhang, Xuehong; Giovannucci, Edward L.; Meyerhardt, Jeffrey A.; Kubzansky, Laura D. 2020. "Anxiety, Depression, and Colorectal Cancer Survival: Results from Two Prospective Cohorts" J. Clin. Med. 9, no. 10: 3174. https://doi.org/10.3390/jcm9103174

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