Penelope E Schofield1,2,3, M R Stockler4, D Zannino5, N C Tebbutt5, T J Price6, R J Simes4, N Wong4, N Pavlakis7, D Ransom8, E Moylan9, C Underhill10, D Wyld11,12, I Burns13, R Ward14, N Wilcken15, M Jefford16,17. 1. Department of Psychology, Swinburne University of Technology, John Road, Hawthorn, Australia. pschofield@swin.edu.au. 2. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Australia. pschofield@swin.edu.au. 3. Sir Peter MacCallum Department of Oncology, and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. pschofield@swin.edu.au. 4. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia. 5. Ludwig Institute Oncology Unit, Ludwig Institute for Cancer Research, Melbourne, Australia. 6. Department of Oncology, Queen Elizabeth Hospital, Adelaide, Australia. 7. Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia. 8. Department of Medical Oncology, St John of God Hospital, Subiaco, Australia. 9. Department of Medical Oncology, Liverpool Hospital, Sydney, Australia. 10. Border Medical Oncology, Wodonga, Australia. 11. Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia. 12. School of Medicine, University of Queensland, Brisbane, Australia. 13. Department of Oncology, St Vincent's Hospital, Melbourne, Australia. 14. Prince of Wales Clinical School and Lowy Cancer Research Centre, Faculty of Medicine, UNSW, Sydney, Australia. 15. Department of Medical Oncology, Westmead Hospital, Sydney, Australia. 16. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Australia. 17. Sir Peter MacCallum Department of Oncology, and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Abstract
PURPOSE: Psychological responses to cancer are widely believed to affect survival. We investigated associations between hope, optimism, anxiety, depression, health utility and survival in patients starting first-line chemotherapy for metastatic colorectal cancer. METHODS:Four hundred twenty-nine subjects with metastatic colorectal cancer in a randomised controlled trial of chemotherapy completed baseline questionnaires assessing the following: hopefulness, optimism, anxiety and depression and health utility. Hazard ratios (HRs) and P values were calculated with Cox models for overall survival (OS) and progression-free survival (PFS) in univariable and multivariable analyses. RESULTS: Median follow-up was 31 months. Univariable analyses showed that OS was associated negatively with depression (HR 2.04, P < 0.001) and positively with health utility (HR 0.56, P < 0.001) and hopefulness (HR 0.75, P = 0.013). In multivariable analysis, OS was also associated negatively with depression (HR 1.72, P < 0.001) and positively with health utility (HR 0.73, P = 0.014), but not with optimism, anxiety or hopefulness. PFS was not associated with hope, optimism, anxiety or depression in any analyses. CONCLUSIONS: Depression and health utility, but not optimism, hope or anxiety, were associated with survival after controlling for known prognostic factors in patients with advanced colorectal cancer. Further research is required to understand the nature of the relationship between depression and survival. If a causal mechanism is identified, this may lead to interventional possibilities.
RCT Entities:
PURPOSE: Psychological responses to cancer are widely believed to affect survival. We investigated associations between hope, optimism, anxiety, depression, health utility and survival in patients starting first-line chemotherapy for metastatic colorectal cancer. METHODS: Four hundred twenty-nine subjects with metastatic colorectal cancer in a randomised controlled trial of chemotherapy completed baseline questionnaires assessing the following: hopefulness, optimism, anxiety and depression and health utility. Hazard ratios (HRs) and P values were calculated with Cox models for overall survival (OS) and progression-free survival (PFS) in univariable and multivariable analyses. RESULTS: Median follow-up was 31 months. Univariable analyses showed that OS was associated negatively with depression (HR 2.04, P < 0.001) and positively with health utility (HR 0.56, P < 0.001) and hopefulness (HR 0.75, P = 0.013). In multivariable analysis, OS was also associated negatively with depression (HR 1.72, P < 0.001) and positively with health utility (HR 0.73, P = 0.014), but not with optimism, anxiety or hopefulness. PFS was not associated with hope, optimism, anxiety or depression in any analyses. CONCLUSIONS:Depression and health utility, but not optimism, hope or anxiety, were associated with survival after controlling for known prognostic factors in patients with advanced colorectal cancer. Further research is required to understand the nature of the relationship between depression and survival. If a causal mechanism is identified, this may lead to interventional possibilities.
Entities:
Keywords:
Colorectal cancer; Depression; Health utility; Hope; Optimism; Survival
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