Cancer patients with depression ‘struggle to get their lives back after treatment
People with depression are significantly less likely to recover well after treatment for colorectal cancer compared to those without depression, according to new research by Macmillan Cancer Support and the University of Southampton.
The major new study, published yesterday (Thursday) in the journal PLOS ONE*, showed that 1 in 5 colorectal cancer patients are depressed** at the time of diagnosis. These people are 7 times more likely to have ‘very poor health’, which could include things like severe difficulty with walking around or being confined to bed, two years after treatment has ended compared to those without depression. They are also 13 times more likely to have ‘very poor quality of life’, which could include problems with thinking and memory or sexual functioning.***
Previous Macmillan research has shown that more than half a million people who have received a cancer diagnosis are also living with a mental health issue, such as depression.****
Macmillan warns that unless people undergoing cancer treatment are asked about other illnesses, concerns and worries by their healthcare professionals, mental health issues may get missed and they could lose out on vital support. It says many people risk being unable to get their lives back and live well after their cancer treatment has ended.
As well as providing support for people affected by cancer through its support line and professionals, the charity is working with a range of organisations and patients on a Mental Health and Cancer Taskforce which aims to understand related issues and ensure patients receive care which is personalised to address their wider health and emotional needs.
The groundbreaking study, the largest of its kind, is following the lives of more than a thousand colorectal cancer patients from before surgery until at least five years afterwards. It assesses their recovery by measuring indicators of health, quality of life and wellbeing.
Prof Jane Maher, Joint Chief Medical Officer of Macmillan Cancer Support, says: “This research tells us that having depression has an enormous impact on how people live after their cancer treatment. In fact, it affects their recovery more than whether or not they’ve been diagnosed early. We know that depression and anxiety often go hand in hand with cancer but now we can see the extent to which people are struggling to live with these illnesses.
“Colorectal cancer can have some difficult physical consequences, such as incontinence and sexual difficulties – it’s more than enough for anyone to have to deal with. Mental health issues can be a real barrier to people getting better.
“People can live well after cancer, but only if they get the right support. This is a stark reminder that every cancer patient is different and so many people are living with many issues on top of coping with cancer. As healthcare professionals we need to consider each person’s individual needs to ensure they get the best support possible. And not just while they’re going through treatment, but for many years afterwards.”
Claire Foster, Professor of Psychosocial Oncology and Director of the Macmillan Survivorship Research Group at the University of Southampton, says: “Our study has highlighted the importance of taking into account psychological factors when thinking about how best to support patients recently diagnosed with colorectal cancer. We have shown that self-reported depression before cancer treatment starts predicts quality of life and health status during treatment and up to two years later.
“Identification of those most at risk of poorer quality of life through assessment of depression soon after diagnosis will identify those patients most in need of support. Support should then be available to those who need it. These results have the potential to revolutionise patient assessment and care-planning to enhance patient care and improve recovery experiences after cancer. However these results are just the beginning, we now need to assess whether they can be applied to patients with different types of cancer and improve access to psychological resources and services for those experiencing depression.”
Professor Dame Jessica Corner, DBE, a co-author of the paper, says: “This study shows for the first time the different journeys that people face while recovering from colorectal cancer and how depression at diagnosis can have a bearing on recovery. It underlines the importance of preparing people for cancer treatment and providing support and expert intervention for psychological problems. It also shows the value of undertaking long-term studies of this kind.”
Notes for editors
*Foster C, Haviland J, Winter J et al. Pre-surgery depression and confidence to manage problems predict recovery trajectories of health and wellbeing in the first two years following colorectal cancer: results from the CREW cohort study. PLOS ONE 2016 (in press). http://dx.plos.org/10.1371/journal.pone.0155434 (link live from 7pm UK time; embargoed PDF version of paper available to journalists in advance, on request)
**The overall baseline prevalence of clinical depression in this study is around 20%. This represents various degrees of depression using a cut off score of 20 points or more on the CES-D measure of depression and is in line with that reported for cancer patients by other studies (eg Katz et al., 2004). Using the higher cut-off of 27+ for the CES-D that indicates major depression, we have a prevalence of around 8% at baseline which is consistent with other studies using this cut-off (eg. Walker et al., 2014).
***The findings showed that people can be categorised into one of four groups depending on how well they recover from colorectal cancer and its treatment. Of the 147 people who were clinically depressed at the start of the study, 21% of those with depression were in the group with the worst health two years after treatment, compared with 2.9% of those without depression. 18.4% were in the group with the worst quality of life two years after treatment, compared with just 1.4% of people without depression.
****Macmillan Cancer Support/Monitor Deloitte. The burden of cancer and other long-term health conditions. April 2015. www.macmillan.org.uk/documents/press/cancerandotherlong-termconditions.pdf (accessed May 2016