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Mental Health Disorders are More Common in Colorectal Cancer Survivors and Associated With Decreased Overall Survival

Lloyd, Shane, MD*; Baraghoshi, David, MS; Tao, Randa, MD*; Garrido-Laguna, Ignacio, MD; Gilcrease, Glynn W. III, MD; Whisenant, Jonathan, MD; Weis, John R., MD; Scaife, Courtney, MD§; Pickron, Thomas B., MD§; Huang, Lyen C., MD§; Monroe, Marcus M., MD§; Abdelaziz, Sarah, MStat; Fraser, Alison M., MSPH; Smith, Ken R., PhD; Deshmukh, Vikrant, PhD, JD, MS; Newman, Michael, MS; Rowe, Kerry G., PhD#; Snyder, John, MS#; Samadder, Niloy J., MD**; Hashibe, Mia, PhD

American Journal of Clinical Oncology: April 2019 - Volume 42 - Issue 4 - p 355–362
doi: 10.1097/COC.0000000000000529
Original Articles: Gastrointestinal

Objectives: To determine the risk and risk factors for mental illness among colorectal cancer (CRC) survivors across short-term and long-term follow-up periods.

Methods: We used the Utah Cancer Registry to identify CRC survivors diagnosed between 1997 and 2013. Mental health diagnoses were available in electronic medical records and statewide facilities data that were linked by the Utah Population Database. CRC survivors were matched to individuals from a general population cohort. The risk of developing a mental illness was compared between cohorts. The association between mental illness and mortality was also analyzed.

Results: In total, 8961 CRC survivors and 35,897 individuals in a general population cohort were identified. CRC survivors were at increased risk for any mental health diagnosis at 0 to 2 years (hazard ratio [HR], 3.70; 95% confidence interval [CI], 3.47-3.95), >2 to 5 years (HR, 1.23; 95% CI, 1.09-1.38), and >5 years (HR, 1.20; 95% CI, 1.07-1.36) after cancer diagnosis. CRC survivors were also at increased risk of depressive disorders specifically during the same time periods. At >5 years, CRC survivors still had an increased risk of developing many mental health diagnoses. Factors associated with increased risk of any mental health disorder among CRC survivors included colostomy and Charlson Comorbidity Index of 1+. There was an increased risk of death for CRC survivors diagnosed with any mental health disorder (HR, 2.18; 95% CI, 2.02-2.35) and depression (HR, 2.10; 95% CI, 1.92-2.28).

Conclusions: CRC survivors are at increased risk for mental health disorders in the short-term and long-term. Survivors who develop mental health disorders also experience decreased survival.

*Department of Radiation Oncology

Department of Internal Medicine, Division of Medical

§Department of Surgery, Huntsman Cancer Institute, University of Utah

Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute

Department of Family and Preventive Medicine, Division of Public Health, Huntsman Cancer Institute, University of Utah School of Medicine

University of Utah Health Care CMIO Office

#Intermountain Healthcare, Salt Lake City, UT

**Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ

Supported by a grant from the National Cancer Institute at the National Institutes of Health (R21 CA185811), by the Huntsman Cancer Institute, Cancer Control and Population Sciences Program (HCI Cancer Center Support Grant P30CA042014), and the NCRR grant, “Sharing Statewide Health Data for Genetic Research” (R01 RR021746, G. Mineau, PI) with additional support from the Utah State Department of Health and the University of Utah.

S.L. has received fees from Sirtex. The remaining authors declare no conflicts of interest.

Reprints: Shane Lloyd, MD, Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Room 1570, Salt Lake City, UT 84112. E-mail:

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.