Despite advancements in medical technology and early cancer detection, many colorectal cancer (CRC) survivors report unmet care needs after completion of their cancer treatment that compromise their quality of life (QoL). Previous studies on the care needs of cancer survivors have yielded inconsistent results, and few studies have been conducted on survivors of CRC in Taiwan or on predictors of their unmet care needs.

The purpose of this study was to examine the unmet care needs, psychological distress, and QoL of Taiwanese CRC survivors ( n = 100) as well as to assess the mean differences by sociodemographic characteristics in their unmet care needs and other related predictors after treatment completion.

This cross-sectional study using a purposive sampling method was conducted at a regional hospital in northern Taiwan between October 2019 and February 2020. The measurements used in this study included Chinese Cancer Survivors' Unmet Needs, Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-Colorectal Cancer Module 29. The independent t test and one-way analysis of variance were employed to assess sociodemographic differences in unmet care needs, and multivariate linear regression was used to identify significant predictors.

More than half of the participants (63.2%) reported at least one unmet care need, with the highest categories including information needs ("signs and symptoms of cancer recurrence" 31.7% and "information related to health promotion" 31.7%), "medical care needs" ("managing health with the medical team" 13.9%), and "physical/psychological effect needs ("concerns about cancer recurrence" 23.8%). Also, 7%-57% of the participants experienced differing degrees of distress symptoms including fatigue, intestinal and urogenital dysfunctions, and anxiety or depression. The results of the univariate analyses showed unmet needs to differ significantly by age ( p = .021), employment status ( p = .007), and chronic disease status ( p = .025). The findings revealed being of older age (β = 0.23, p = .049), being employed (β = 0.26, p = .014), and having a lower functional level (β = -0.31, p = .012) to be associated with significantly higher levels of unmet care needs, collectively accounting for nearly 27.3% of the variance (adjusted R2 = .273).

CRC survivors continue to experience unmet care needs and various forms of physical-psychological distress for an average of almost 2 years after their completion of CRC treatment. The findings of this study may assist healthcare providers in identifying the major risk factors that interfere with survivor care needs following treatment, thus facilitating the development of timely interventions to mitigate the impact of cancer on this vulnerable population.

Identifying additional immune checkpoints hindering antitumor T cell responses is key to the development of next-generation cancer immunotherapies. Here, we report the induction of serotonin transporter (SERT), a regulator of serotonin levels and physiological functions in the brain and peripheral tissues, in tumor-infiltrating CD8 T cells. Inhibition of SERT using selective serotonin reuptake inhibitors (SSRIs), the most widely prescribed antidepressants, significantly suppressed tumor growth and enhanced T cell antitumor immunity in various mouse syngeneic and human xenograft tumor models. Importantly, SSRI treatment exhibited significant therapeutic synergy with programmed cell death protein 1 (PD-1) blockade, and clinical data correlation studies negatively associated intratumoral SERT expression with patient survival in a range of cancers. Mechanistically, SERT functions as a negative-feedback regulator inhibiting CD8 T cell reactivities by depleting intratumoral T cell-autocrine serotonin. These findings highlight the significance of the intratumoral serotonin axis and identify SERT as an immune checkpoint, positioning SSRIs as promising candidates for cancer immunotherapy.

Despite numerous shared health challenges during treatment and recovery, the interdependence of health between patients with colorectal cancer and their family caregivers remains underexplored. This study applied the actor-partner interdependence model (APIM) to examine this dyadic relationship.

This descriptive correlational survey involved patients with colorectal cancer who visited the outpatient department for postoperative follow-up, along with their family caregivers. From 343 consenting participants, responses from 100 matched patient-caregiver pairs were analyzed. Data collection occurred at J Hospital from August 2023 to May 2024. Key variables included the psychological health and quality of life (QoL) of both patients and caregivers, patient self-care, and caregiver contribution to self-care. Statistical analysis was performed using Stata 16.1, with structural equation modeling.

The mean age of patients was 65.57 years; 51% were male, 66% had colon cancer, and 34% rectal cancer. The caregivers' mean age was 56.11 years; 55% were female, and 66% were spouses. The analysis of actor effects showed that the psychological health and QoL of both patients and caregivers independently influenced their respective outcomes. The analysis of partner effects revealed mutual influences between the psychological health of patients and caregivers; moreover, the psychological health of caregivers impacted patients' self-care. While there was a correlation between the QoL of patients and caregivers, it was not statistically significant in the structural equation modeling.

This study underscores the profound interdependence of health between patients with colorectal cancer and their caregivers, revealing significant mutual impacts on psychological health and, to a lesser extent, self-care. These insights suggest the need for targeted interventions to improve both patient recovery and caregiver support, even where some correlations lack statistical significance.

Prospectively registered with the Clinical Research Information Service (CRIS) under the Clinical Trial Number KCT0008743 (Registration Date: 2023.08.25).

Globally, colorectal cancer (CRC) is the third most common type of cancer and the second most deadly. CRC significantly impairs patients' overall and health-related quality of life, as well as their psychological and physical function. However, in Ethiopia, there is insufficient local evidence about the quality of life of patients with colorectal cancer. Hence, this study aimed to assess the quality of life of adult colorectal cancer patients who have follow-ups at the cancer center in Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.

An institutional-based cross-sectional study was conducted among 159 colorectal cancer patients attending the Tikur Anbessa Specialized Hospital Cancer Center from February to April 2019. The validated Amharic version of the European Organisation for Research and Treatment of Cancer Core 30 questionnaire (EORTC QLQ C-30) and the disease-specific colorectal cancer questionnaire (EORTC QLQ CR-29) were used. A binary logistic regression model was used to identify the factors associated with quality of life. The adjusted measure of effect (AOR) with a 95% CI was presented and P < 0.05 was used to declare statistical significance.

There were 159 colorectal cancer patients, 89 of whom were male, and the median time from diagnosis was 12.5 months. The patients had a low global health status score with a mean (± SD) of 52.88 ± 21.02. Being employed (AOR = 3.41; 95% CI 1.15, 10.17), early-stage clinical diagnosis (AOR = 4.98; 95% CI 1.51, 16.4), physical functioning (AOR = 1.04, 95% CI 1.01, 1.06), and social functioning (AOR = 1.02; 95% CI 1.01, 1.04) were associated with good quality of life. Whereas, being female (AOR = 0.16; 95% CI 0.05, 0.52), having financial difficulty (AOR = 0.98; 95% CI 0.96, 0.99), and having blood and mucus in the stool (AOR = 0.94; 95% CI 0.91, 0.96) were associated with poor quality of life.

In our study, half of our study participants had poor quality of life. The responsible stakeholders should identify and address the patients' respective symptoms. Female patients, those in severe clinical stages, unemployed patients, those experiencing financial difficulties, and those with blood and mucus in their stool should receive due attention.

Background: Up to 80% of patients experience late effects (LE) one year after surgery for peritoneal metastases (PM) from colorectal cancer (CRC). We tested the feasibility and outcome of a treatment strategy to address LEs. Methods: During January 2021-May 2023, patients who had undergone surgery for CRC-PM in Denmark were screened for biopsychosocial LEs (anxiety, depression, fear of cancer recurrence, insomnia, cognitive impairment, pain, fatigue). Patients scoring according to clinical cut-offs were referred to a Multi-Disciplinary Team conference (MDT). The patients, surgeon(s), nurse(s), and psychologists participated in the MDT, identified key concerns and proposed a personalized intervention. Pre- and post-intervention, patients completed a "Measure Yourself Concerns and Wellbeing" (MYCaW) questionnaire, rating the two most distressing LEs and general wellbeing on a 7-point Likert scale. Results: Of 28 eligible patients, 13 (59 years (mean), 85% women) accepted referral, participated in the MDT, and were offered a personalized intervention. The intervention was completed by 11 patients. Improvement in MYCaW score was observed 1 month postintervention for all three items: (1) the primary LE (p = 0.003, Hedges's g 1.54), (2) the secondary LE (p < 0.001, Hedges's g 1.65), and (3) general wellbeing (p = 0.005, Hedges's g 1.09). This improvement was sustained 6 months postintervention. The 15 non-participants were, in general, older (66 years (mean), men 73%). Conclusions: Screening for LEs and conducting an MDT can provide a personalized intervention plan, which patients are able to complete and may benefit from.

Despite the availability of patient reported outcome (PRO) measures (PROMs) for assessing survivorship care needs, their successful implementation remains limited. This study aimed to improve the likelihood of implementation success by actively engaging end-users in developing a PROM designed to address implementation barriers.

Selected barriers for implementation were: (1) PROMs do not adequately address relevant issues, (2) PROMs can inhibit patient-clinician interaction, and (3) PROMs are not suitable for all patients. Management of these barriers were discussed at two 1-day workshops at Vejle Hospital with in-person attendance by colorectal cancer (CRC) survivors and informal caregivers (ICs). Relevant issues of CRC survivorship care (barrier 1) were defined based on data from four distinct sources. Solutions to overcoming barriers 2 and 3 were discussed at the workshops. Workshop data were guided by the Qualitative Analysis Guide of Leuven (QUAGOL) guide.

The four distinct sources provided data from 4,545 CRC survivors. Thirteen individuals attended the in-person workshops. The following constructs were identified as relevant (barrier 1): self-rated well-being relative to pre-diagnosis, late effects encompassing both psychological and physical aspects, the role of caregivers, identity considerations, support systems, economic impacts, rehabilitation needs, and information provision. Specific element (e.g., keywords, prioritisation and agenda-setting) were incorporated to facilitate patient-clinician interactions (barrier 2). All constructs were considered relevant across all stages of CRC survivorship (barrier 3). The final PROM comprised 34 items.

This dialogue-tool is designed to address implementation barriers by providing direct feedback on relevant late effects and supportive care needs from CRC survivors to clinicians.

To identify the heterogeneity in depression trajectories and factors influencing depression during radiotherapy in patients with gastrointestinal cancer.

Between August 2023 and May 2024, we longitudinally tracked the symptoms of 146 patients with gastrointestinal cancer at T0 (pre-radiotherapy), T1 (mid-radiotherapy), and T2 (1-month post-radiotherapy). Group-based trajectory models were used to identify subgroups of depression trajectories. A fit-criteria assessment plot was used to assess the accuracy of grouping, and univariate and multivariate logistic regression models were used to analyze the potential independent factors associated with the subgroups.

Patients were categorized into three subgroups: no depression (31.5 %), mild depression (54.1 %), and moderate depression (14.4 %) group. Patients aged >65 years (P < 0.05), those with a malnutrition-inflammation complex (P < 0.05), and those accompanied by children (P < 0.05) were more likely to belong to the moderate depression group. Between-group and within-group differences in psychoneurologic symptoms, such as fatigue, remained consistent with depression. Depressive symptoms were most severe mid-radiotherapy, and moderately depressed patients were at risk of developing major depression.

There was significant heterogeneity in depression during radiotherapy among patients with gastrointestinal cancer. Clinicians should focus on identifying high-risk patients with depression aged >65 years, those with a malnutrition-inflammation complex, and those accompanied by children. They should actively implement pharmacological and non-pharmacological treatments and refer them to specialized psychological clinics, if necessary, to prevent the occurrence of major depression.

Identifying and selecting determinants of health behaviours is an important step in the design of behaviour change interventions. Many colorectal cancer (CRC) survivors experience disease- and treatment-related complaints, which may make it difficult to implement behavioural changes. In this systematic review, we aimed to identify determinants of a healthy lifestyle, i.e. dietary behaviours and physical activity, in CRC survivors who finished treatment.

We searched Web of Science, PubMed and PsychINFO, to retrieve quantitative and qualitative studies on determinants of a healthy lifestyle in CRC survivors who finished treatment. Synonyms of the following search terms were used: 'CRC survivors', 'lifestyle', 'physical activity', 'nutrition' and 'determinant'. The level of evidence for each determinant was classified as 'convincing', 'moderately convincing' or 'unconvincing' based on consistency of findings between studies and quality of studies assessed with the Mixed Methods Appraisal tool.

Twenty-one studies were retrieved of which twenty were classified as 'high-quality studies' and one as 'low-quality study'. Determinants that were convincingly associated with less healthy lifestyle behaviours were smoking, depression, body image distress/consciousness, experiencing pain, dealing with symptoms and bad health status. A good functional status was convincingly associated with more healthy lifestyle behaviours. Determinants with convincing evidence for an association with less or more healthy lifestyle behaviours were time and other priorities, knowledge, motivation, (false) beliefs, perceived and expected outcomes, skills, social support, social norms and influence, access to facilities and equipment and weather.

Interventions for changing health behaviours in CRC survivors who finished treatment could use these determinants to tailor and personalize the intervention to the target group.

This study investigated the relationship between fragmented care (patient care provided at multiple hospitals) and incident mood disorders in elderly colorectal cancer patients. Fragmented care was defined as a change in the medical institution providing first cancer treatment within 180 days of cancer diagnosis. The aim of this study was to investigate the impact of fragmented care on the incidence of mood disorder after cancer diagnosis in elderly colorectal cancer patients.

This study used NHIS Senior cohort data between 2002 and 2019 in South Korea. The participants included individuals aged 60 to 80 years who were diagnosed with colorectal cancer between 2008 and 2014. The primary outcome measure was the incidence of mood disorders within five years after cancer diagnosis. The independent variable was fragmented care. Regression analysis was conducted using the Cox proportional hazard model, and a sensitivity analysis was performed to enhance the robustness of the study findings.

Of the total 3,726 participants, 878 (23.6%) were diagnosed with mood disorders, and 328 (8.8%) experienced fragmented care. The mood disorder incidence rate per 100,000 person-days was higher among those who experienced fragmented care (18.9 cases) compared to those who did not (14.6 cases). Participants who received fragmented care had a significantly higher risk of incident mood disorders (hazard ratio 1.39, 95% confidence interval 1.10-1.77). The results of the sensitivity analysis, which extended the fragmented care observation period, remained consistent with the original findings. Additionally, subgroup analysis revealed that the effect of fragmented care on incident mood disorders was significantly associated with female sex, chronic diseases, lower economic status, and type of colon cancer (C18).

Fragmented care increased the risk of incident mood disorders within the first five years of diagnosis in elderly patients with colorectal cancer. The findings highlight the potentially important role of a cohesive health system in managing the mental health of patients with colorectal cancer, which is important considering that depression is relatively commonly found in these patients.

To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.

Colorectal cancer (CRC) survivors commonly experience bowel dysfunction symptoms because of treatment, leading to psychological distress. While previous studies have focused on managing physical symptoms and the impact of a stoma on psychological outcomes, CRC patients without a stoma may also suffer from psychological distress, including body image distress due to their bowel dysfunction symptoms. Body image distress may mediate the relationship between bowel dysfunction symptoms and psychological outcomes in CRC patients.

This study aims to (1) identify bowel dysfunction symptoms, body image distress, and psychological outcomes in CRC survivors and (2) examine the mediating role of body image in the relationship between bowel dysfunction symptoms and psychological outcomes.

A cross-sectional and correlational design was employed, and CRC survivors completed the Low Anterior Resection Syndrome (LARS) Score, Body Image Scale (BIS), and Hospital Anxiety and Depression Scale (HADS) questionnaires. The mediated role of body image was examined using Hayes' PROCESS macro.

A total of 193 CRC patients provided data, with 65.8% reporting experiencing bowel dysfunction symptoms, 44.6% reporting body image distress, and 40.4% experiencing anxiety and depression. Body image was found to partially mediate the effect of bowel dysfunction symptoms on both anxiety (β = 0.0446, 95% CI = 0.0061, 0.0968) and depression (β = 0.0411, 95% CI = 0.0034, 0.0941).

The significant mediating role of body image underscores the importance of addressing both bowel dysfunction symptoms and body image distress. Healthcare professionals should integrate both physical and psychological aspects to promote psychological well-being.

Gastrointestinal (GI) cancers impose a significant burden on global public health. Patients often experience mental health challenges due to physical changes and treatment-related symptoms, which can worsen their condition or delay recovery. Although research is mounting in this field, visual bibliometric analysis has not yet been conducted. This study aims to reveal the research hotspots and frontiers in this field using bibliometrics to guide future research.

The publications on GI cancer and mental health were retrieved in the Web of Science Core Collection from 2004 to 2024. VOS Viewer and CiteSpace, as commonly used bibliometric analysis tools, were employed to visualize the network structure of bibliometric data and uncover the evolving trends in scientific research fields. VOS Viewer was used to identify keyword co-occurrences, while CiteSpace was utilized to generate network visualizations, produce dual-map overlays of journals, and perform burst keyword analysis.

A total of 1,118 publications were included for analysis. China had the highest number of publications in this field (341, 30.5%), while the United States held a central position (centrality = 0.48). The most productive author and institution were Floortje Mols and Tilburg University, respectively. Keyword analysis highlighted that "quality of life" (QoL) is a prominent research topic in the field, while "complications," "cancer-related fatigue," (CRF) "chronic stress," and "epidemiology" have been identified as key areas for future research.

Research interest in this field continues to grow. The research direction is mainly focused on personalized mental health interventions to improve QoL, as well as preoperative mental healthcare and ongoing care through internet-based multidisciplinary collaboration to reduce postoperative complications. More detailed clinical symptom assessment is needed to distinguish between CRF and mental health issues and to provide targeted intervention measures in the future. The mechanism of mental health effects on the occurrence and development of GI cancer will be a frontier.

An increasing number of people resumes life after cancer treatment. Although the (long-term) side-effects of cancer and its treatment can be significant, less is known about the impact on cancer survivors' participation in daily life. The aim of this study was to explore the common experiences of cancer survivors in resuming life after treatment.

A semi-structured interview study was conducted among 22 cancer survivors having a favorable prognosis after treatment. Purposive sampling was used to select a variable sample in terms of diagnoses (e.g. breast cancer, colorectal cancer, melanoma), age (18-77 years), and time after diagnosis (0-7 years). Interviews were audio-taped, transcribed verbatim and analyzed in a thorough thematic analysis.

Four main themes were identified. First, cancer survivors reported an emotional fallout episode to often follow treatment, which was characterized by a loss of direction and control due to discontinuation of medical care, decreased support from healthcare professionals and their social network, and an emotional set back. Second, survivors experienced challenges with getting back on track such as the impact of impaired physical and cognitive functions, and challenges and uncertainty related to work and finances. Third, in coping with changes and regaining trust they tried to find a balance between dealing with patient stigma and fear of recurrence on the one hand, and maintaining a positive mindset on the other hand. Fourth, the disease often led to re-evaluating values in life, health and work, which included realizing and accepting change and having a more conscious outlook on life.

In resuming life after treatment, cancer survivors experience several challenges and changes in values in different life domains that extend beyond the specific diagnosis. To improve supportive care, healthcare professionals should focus on the (changed) individual needs and values of survivors in the domains considered relevant to them.

Mental health (MH) conditions are common in patients with colorectal cancer (CRC) due to the unique challenges these patients encounter. The primary aim was to investigate predictors of new onset MH conditions after a diagnosis of CRC and determine the association of new MH conditions on survival.

A single institution, retrospective study was conducted. A multivariable Fine-Gray competing risks model was used to describe the primary study outcome of new MH diagnosis in patients at least 18 years of age with CRC. Survival was modeled using Cox proportional hazards regression with a time-varying covariate for new MH diagnosis.

456 patients were identified for inclusion, with 16% developing a new MH condition and 29% dying during follow-up. A new MH condition was more likely among non-Hispanic white patients compared to non-Hispanic black and were less likely among those who are male or had a pre-cancer MH condition. The onset of a new MH condition was associated with a threefold decrease in survival. In addition, having a pre-cancer MH condition decreased survival nearly twofold.

Our findings emphasize the importance of new-onset MH in patients after CRC diagnosis. Standardized screenings may alleviate some of the MH burden that patients with CRC experience in addition to potentially improving the overall health of patients.

MH conditions may impact not only CRC outcomes but may direct future studies analyzing the risks of new onset MH conditions in other types of cancers, further expanding the importance of psychiatric support in patients with cancer.

When the field of cancer survivorship research was in its infancy, the PROFILES registry was set up in 2004 to monitor patient-reported outcomes (PROs) in survivors and a normative population. This scoping review aims to summarize lessons learned from developing a population-based PRO registry, focusing on study methodologies, data collection shifts, data utilization, multidisciplinary collaboration, societal impact, and data sharing.

A systematic computerized literature search through PubMed was performed to collect all publications using data from the PROFILES registry between January 1, 2004, and December 31, 2023.

The PROFILES registry's research today encompassed 249 papers from 35 studies. Key insights include the importance of multi-hospital collaboration, which enhances participant inclusion and result generalizability. Optimizing response rates and patient inclusion is achieved through proactive data collection methods such as inclusion by health care professionals, and using both web-based and paper questionnaires. Longitudinal studies, despite their intensive data collection efforts, provide critical insights into the consequences of cancer and its treatment on patient-reported outcomes (PROs) from diagnosis through survivorship. Combining PRO data with comprehensive clinical registry data ensures reliable datasets, crucial for drawing meaningful conclusions. The shift towards multidisciplinary collaboration, open-access publishing, and data sharing all contribute to accessible and impactful research.

This review highlights key insights from the PROFILES registry, emphasizing multi-hospital collaboration, proactive data collection, and the integration of PROs with clinical data.

These lessons can guide future research on cancer survivorship, improving methodologies to enhance survivorship care and quality of life through multidisciplinary collaboration and data sharing.

Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety.

Using Arksey and O'Malley's (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included.

We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used.

This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods.

This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.

Colorectal cancer (CRC) can significantly impact mental health, increasing suicide risk. Variables such as pain and threat perception may be crucial. This study aims to identify predictors of suicide risk in individuals with CRC.

A total of 71 participants (76.06% men) aged 27 to 88 years (M = 65.18, SD = 12.02) were assessed using the SF-36 for pain, the Brief Illness Perception Questionnaire (B-IPQ) for threat perception, the Hospital Anxiety and Depression Scale (HADS) for emotional distress, and the Plutchik suicide risk scale for suicide risk. Descriptive, comparative, and correlational analyses were performed, followed by a linear regression analysis.

Nearly 20% of participants exhibited high suicide risk. There was a moderate-to-high association between suicide risk and the perception of threat, pain, and emotional distress. The linear regression model explained 39% of the variance in suicide risk, with threat perception, pain, and emotional distress as significant predictors.

These results indicate the need for multidisciplinary care for individuals with CRC, including emotional support from health psychologists, and holistic, human-centered care from nursing and medical professionals. Future research is necessary to further explore these relationships and improve patient care strategies.

Colorectal cancer (CRC) and its therapy profoundly affect the quality of life (QoL) of patients. The emotional distress: anxiety and depression also negatively affect wellbeing of these patients. This study aims to evaluate the QoL, anxiety, and depression in CRC patients and their association with clinic-pathological features at a tertiary care hospital in Karachi Pakistan, a low middle income country.

An analytical cross-sectional study was conducted on adult CRC patients. QoL was assessed using the European Organization for Research and Treatment of Cancer QoL questionnaire C30 and CR29. Hospital Anxiety and Depression Score was used to evaluate the anxiety and depression. Analyses were performed using STATA version 12, including multivariable linear and multivariate analysis of variance. A P value of < 0.05 was considered as significant.

A total of 127 CRC patients with mean age of 53 ± 15 y participated. Mean global QoL score was 69.08 ± 1.78. Among symptoms scales: stoma care problem and among functional scales: sexual interest (women > men) were the most significantly affected aspect. Anxiety and depression were seen in 26 (20.9%) and 24 (18.9%) patients, respectively. Lower global QoL was significantly associated with depression (-25.33 [95% confidence interval: -34.4, -16.23]), on adjuvant treatment (-15.14 [-21.84, -8.44]), and neoadjuvant treatment (-11.75 [-19.84, -3.65]).

This is the first study assessing the QoL in CRC patients in Pakistan. Depression was found to be significantly associated with poor QoL. Numerous factors correlated with low QoL scores indicating the need to develop local guidelines to address psychological distress in our patients.

Background: Colorectal cancer (CRC) stands as one of the most prevalent and burdensome malignancies worldwide. Similar to other cancers, CRC has been associated with the development of psychiatric diseases, including anxiety and depression. However, temporal trends in psychiatric disorders rates within CRC patients have not been investigated so far. Methods: The present study included 15,619 individuals with colorectal cancer and 78,095 propensity score-matched individuals without cancer, who were identified within the Disease Analyzer (IQVIA) database in Germany between 2005 and 2022. Cox regression analysis was conducted to assess the association between CHC and subsequent psychiatric diseases, including depression, anxiety disorders, and adjustment disorder, by period (2005-2010, 2011-2016, 2017-2022). Results: The 12-month cumulative incidence of any psychiatric disorder diagnosis in the CRC cohort increased from 6.3% in 2005-2010 to 8.2% in 2017-2022. The strongest increase was observed for reaction to severe stress and adjustment disorder (1.0% in 2005-2010 to 2.6% in 2017-2022). Notably, the strong increase in psychiatric disorders was not specific for cancer patients since a slight increase in psychiatric disorders was also observed in the non-cancer cohort. Regression analyses revealed that CRC was strongly and significantly associated with an increased risk of depression, anxiety disorders, reaction to severe stress and adjustment disorders, as well as any psychiatric disorder. Of note, the extent of the association was stronger in 2017-2022 compared to 2005-2010, clearly proving a "real" increase in the rates of psychiatric disorders over time. Conclusions: This study presents novel data from a large cohort of outpatients in Germany, providing strong evidence for an increase in psychiatric disorders in the recent years. These findings contribute to the existing body of literature and should trigger the recognition of psychiatric problems in cancer survivors.

Patients with advanced colorectal cancer (CRC) have multiple concurrent physical and psychological symptoms. This study aimed to explore the relationship between anxiety, depression, and symptom burden in advanced CRC.

A multicenter cross-sectional study was conducted in 10 cancer centers from geographically and economically diverse sites in China. A total of 454 patients with advanced CRC completed the Hospital Anxiety and Depression Scale and the MD Anderson Symptom Inventory. Multiple regression analysis was applied to explore the relationship between anxiety, depression and symptom burden.

About one-third of the patients showed symptoms of anxiety or depression. Patients with anxiety or depression reported significantly higher symptom burden than those without (p < 0.001). Patients with anxiety or depression reported a higher proportion of moderate-to-severe (MS) symptom number than those without (p < 0.001). About 52% of the patients with anxiety or depression reported at least three MS symptoms. The prevalence of MS symptoms was ranging from 7.3% (shortness of breath) to 22% (disturbed sleep), and in patients with anxiety or depression was 2-10 times higher than in those without (p < 0.001). Disease stage (β = -2.55, p = 0.003), anxiety (β = 15.33, p < 0.001), and depression (β = 13.63, p < 0.001) were associated with higher symptom burden.

Anxiety and depression in patients with advanced cancer correlated with higher symptom burden. Findings may lead oncology professionals to pay more attention to unrecognized and untreated psychological symptoms in symptom management for advanced cancer patients.

Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with rare cancers.

This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis.

We included 32 studies with 57,470 patients with rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes.

We highlight the need for early identification of psychological maladjustment in patients with rare cancers. Additionally, studies to identify effective interventions are imperative.

This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.

While sex differences in the incidence and mortality of colorectal cancer (CRC) are well documented, less is known about sex differences in patients' health-related quality of life (HRQoL) and psychological distress. To enhance patient-tailored care, we aimed to longitudinally examine sex differences in HRQoL and psychological distress among CRC patients from diagnosis up until 2-year follow-up.

Newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 334) completed questions on HRQoL (EORTC QLQ-C30) and psychological distress (HADS) before initial treatment (baseline), 4 weeks after surgery, and at 1 and 2 years after diagnosis. Also, HRQoL and psychological distress were assessed in a sex- and age-matched reference population.

When directly comparing female (N = 126, 38%) and male (N = 208, 62%) CRC patients, female patients reported significantly worse HRQoL, such as more insomnia at baseline, worse physical and role functioning 4 weeks after surgery, more diarrhea at 1 year, and more pain and constipation at 2-year follow-up. However, a comparison with the reference population revealed larger differences between patients and reference in males than in females. For example, at 1- and 2-year follow-up, male patients reported significantly worse cognitive and social functioning, more insomnia, and more anxiety compared with a reference population.

Especially male CRC patients reported worse HRQoL and more psychological distress when compared with a reference population.

Knowledge of sex-specific differences in HRQoL and psychological distress among CRC patients may help healthcare providers anticipate and appropriately address patients' unique healthcare needs.

(1) Background: Evidence suggested inconsistent results in anxiety and depression scores among female and male cancer patients. The present systematic review and meta-analysis aimed to assess how anxiety and depression conditions among cancer patients vary according to sex. (2) Methods: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The protocol was registered in PROSPERO with id no. CRD42024512553. The search strategy involved combining keywords using Boolean operators, including "Anxiety", "Cancer", and "Depression", across several databases: Embase, PubMed, Scopus, and Web of Science. The outcomes were evaluated using the Hospital Anxiety and Depression Scale (HADS). (3) Results: Data were collected from five studies, enrolling a total of 6317 cancer patients, of whom 2961 were females and 3356 males. For each study, HADS-A and HADS-D scores were considered, also differentiating HADS scores according to cancer typology, and then three different meta-analyses were performed. Generally, females reported significantly higher levels of depression scores than males and, conversely, males reported significantly greater levels of anxiety than females. (4) Conclusions: Previous studies suggested higher rates of depression and anxiety conditions in females than in males, but the present data highlighted controversial findings, since males reported significantly higher levels of anxiety than females. In this scenario, the theoretical approach justified females being more open than males to expressing anxiety or depression conditions. It would be necessary for healthcare professionals to improve effective measures purposed at assessing and mitigating depressive symptoms in cases of advanced cancer, thereby improving their mental health, given the high rates of depression in advanced cancer patients, due to the difficulty level of performing their daily living activities, which deteriorate further over time.

Various psychological interventions have been demonstrated to be effective at preventing anxiety and depression symptoms in patients with gastrointestinal (GI) cancer. However, it remains unclear which intervention is the best option. This study aimed to evaluate the impact of various psychological interventions on anxiety and depression in symptomatic patients with GI cancer.

The PubMed, Cochrane Library, Embase, CNKI, WanFang Data, and VIP databases were systematically searched from inception to June 2023 to identify randomized controlled trials (RCTs). The primary outcomes were anxiety and depression levels. Two reviewers independently selected the studies, extracted the data based on prespecified criteria, and evaluated the risk of bias using the Cochrane Collaboration risk of bias tool. Stata 14.0 was used to conduct network meta-analysis.

Thirty-two RCTs (2453 patients) involving 9 psychological interventions were included. The results of the network meta-analysis showed that cognitive-behavioral therapy (CBT; mean difference [MD] = -4.98, 95% CI (-7.04, -2.93), relaxation therapy (MD = -4.39, 95% CI (-7.90, -0.88), reminiscence therapy (MD = -5.01, 95% CI (-8.20, -1.81)), and narrative nursing (MD = -4.89, 95% CI (-8.54, -1.23)) significantly reduced anxiety levels, and CBT (MD = -2.15, 95% CI (-4.28, -0.02), reminiscence therapy (MD = -7.20, 95% CI (-10.48, -3.91), and narrative nursing (MD = -7.20, 95% CI (-10.48, -3.91)) significantly reduced depression levels in patients with GI cancer compared with conventional nursing care.

The findings of this network meta-analysis revealed that CBT, reminiscence therapy and narrative nursing can be actively considered as part of sequential therapy to reduce anxiety and depression levels in patients with GI cancer.

This systematic review aims to examine the health-related quality of life (QOL) in Iranian patients with colorectal cancer (CRC) and its related factors.

A thorough, systematic search was conducted in different international electronic databases, including Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords such as "Colorectal neoplasm", "Colorectal tumors", "Colorectal cancer", "Quality of life", and "Life quality" from the earliest to 17 October 2022. The quality of the studies included in this systematic review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool).

There were 820 CRC patients in the five cross-sectional studies that made up this systematic review. The mean score of QOL in patients with CRC was 61.99 (SD=15.87) out of 100 based on EORTC-QLQ-C30, which indicates a moderate to good level of QOL. Factors such as age, gender, living conditions, level of education, occupation, monthly income, health insurance, physical activity, performance status, and comorbidities had a significant relationship with QOL in patients with CRC.

In sum, the findings of the five studies that were a part of this systematic review revealed that Iranian patients with CRC had a moderate to good QOL. Therefore, managers and health policymakers can create psychological counseling programs with an emphasis on the factors affecting the QOL of patients in light of how crucial it is to raise patients' understanding of the long-term impacts of CRC and how they affect their QOL.

Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment.

Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models.

Patient characteristics and clinical factors explained 4-10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55-65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured.

We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment.

This trial is registered with ClinicalTrials.gov No. NCT00297791.

Colorectal cancer with peritoneal metastases can be treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Treatment may result in biopsychosocial late effects (LEs). We explored the frequency and severity of the following biopsychosocial LEs: anxiety, depression, fear of cancer recurrence (FCR), insomnia, fatigue, cognitive impairment, and pain, and evaluated their impact on quality of life (QoL).

This was a national prospective cohort study screening for LEs during the period January 2021-May 2023. Patients completed the following questionnaires: General Anxiety Disorder-7, Patient Health Questionnaire-9, FCR Inventory-Short Form, Insomnia Severity Index, Functional Assessment of Chronic Illness Therapy-Fatigue, cognitive impairment (six items from the European Organisation for Research and Treatment of Cancer Item Library), and the Rectal Cancer Pain Score. Preregistration was completed at ClinicalTrials.gov (NCT04956107).

In total, 99 patients were included. The mean age was 61 years and 57% were women. At 3 months after surgery, the frequent LEs were fatigue (72%), FCR (58%), and pain (48%), and at 12 months after surgery, the frequent LEs were FCR (65%), fatigue (40%), and insomnia (33%). More than half of the patients (54%) reported at least two LEs after 12 months. Patients with moderate-to-severe LEs reported a lower QoL than patients with no/mild LEs. Patients with no/mild LEs had a similar QoL as the Danish norm population.

Biopsychosocial LEs were prevalent. The QoL of patients reporting LEs in the worst severity categories was negatively impacted. Screening and treatment for these LEs should be a focus in cancer survivor follow-up.

The results of previous studies on the effects of lifestyle interventions on the quality of life (QoL) in colorectal cancer (CRC) survivors remain controversial, and there have been several new publications in this area in recent years.

To assess whether lifestyle interventions can lead to favorable health outcomes and improved QoL in CRC survivors, we performed a meta-analysis.

PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched to obtain relevant literature published from January 1, 1990, to November 1, 2021. The required data were extracted and summarized to compare the physical activity levels, QoL, mental health assessment, and anthropometric data between lifestyle interventions and routine nursing.

Twelve studies were included. Compared with the control group, lifestyle interventions could significantly increase the physical activity time (weighted mean difference [WMD], 9.84; 95% confidence interval [CI], 1.20-18.48; P = .026), metabolic equivalent task levels (WMD, 10.40; 95% CI, 5.30-15.49; P < .001), and Functional Assessment of Cancer Therapy Scale-Colorectal scores (WMD, 3.12; 95% CI, 0.24-5.99; P = .034). However, lifestyle interventions were not noticeably able to improve the fatigue, depression levels, anxiety levels, waist circumference, or body mass index in CRC survivors.

Lifestyle interventions could generate an increase in physical activity time, metabolic equivalent task levels, and QoL in CRC survivors.

Lifestyle interventions in the future that include physical activity, diet, or comprehensive programs are needed to increase physical activity levels and improve QoL in CRC survivors.

The aim of the present study was to explore potential differences in the sociodemographic (with a special focus on gender differences) and psychological predictors of quality of life in individuals diagnosed with cancer.

A cross-sectional, observational study was carried out involving individuals struggling with different forms of cancer (N = 430). Linear regression was used to investigate the concurrent predictive role of the independent variables, stratified by gender, for each of the five cancer-specific quality of life domains and overall quality of life.

Sociodemographic characteristics had only a negligible to small role in predicting quality of life in both men and women. In contrast, the psychological variables explained a significantly larger portion of the variance in both genders. There were no statistically significant gender differences regarding the raw quality of life domain scores; however, their predictors were markedly different in the two groups.

The results of the present study indicate that it is imperative to take gender differences into consideration when planning psychosocial interventions also focusing on strengths, resources, and coping strategies. Considering the consistently emerging importance of family support in patients' quality of life, offering psychological interventions to caregivers/family members seems warranted to empower them to provide support to patients throughout the illness trajectory.

Colorectal cancer survivors (CRCS) often experience high levels of distress. The objective of this randomized controlled trial was to evaluate the effect of blended cognitive behavior therapy (bCBT) on distress severity among distressed CRCS.

CRCS (targeted N = 160) with high distress (Distress Thermometer ≥5) between 6 months and 5 years post cancer treatment were randomly allocated (1:1 ratio) to receive bCBT, (14 weeks including five face-to-face, and three telephone sessions and access to interactive website), or care as usual (CAU). Participants completed questionnaires at baseline (T0), four (T1) and 7 months later (T2). Intervention participants completed bCBT between T0 and T1. The primary outcome analyzed in the intention-to-treat population was distress severity (Brief Symptom Inventory; BSI-18) immediately post-intervention (T1).

84 participants were randomized to bCBT (n = 41) or CAU (n = 43). In intention-to-treat analysis, the intervention significantly reduced distress immediately post-intervention (-3.86 points, 95% CI -7.00 to -0.73) and at 7 months post-randomization (-3.88 points, 95% CI -6.95 to -0.80) for intervention compared to CAU. Among secondary outcomes, at both time points, depression symptoms, anxiety symptoms, cancer worry, and cancer-specific distress were significantly lower in the intervention arm. Self-efficacy scores were significantly higher. Overall treatment satisfaction was high (7.4/10, N = 36) and 94% of participants would recommend the intervention to other colorectal cancer patients.

The blended COloRectal canceR distrEss reduCTion intervention seems an efficacious psychological intervention to reduce distress severity in distressed CRCS. Yet uncertainty remains about effectiveness because fewer participants than targeted were included in this trial.

Netherlands Trial Register NTR6025.

We examined the awareness, interest, and information sources relating to cannabis use for cancer management (including management of cancer symptoms and treatment-related side effects) and determined factors associated with cancer survivors' awareness and interest in learning about cannabis use for cancer management.

This was a cross-sectional study of adult cancer survivors (N = 1886) receiving treatment at a comprehensive cancer center. Weighted prevalence and multivariable logistic regression analyses were conducted.

Among cancer survivors, 88% were aware and 60% were interested in learning about cannabis use for cancer management. Common sources of information to learn about cannabis use for cancer management were cancer doctors/nurses (82%), other patients with cancer (27%), websites/blogs (26%), marijuana stores (20%), and family/friends (18%). The odds of being aware of cannabis use for cancer management was lower among male compared to female survivors (adjusted odds ratio [AOR]: 0.61; 95% confidence interval [CI]: 0.41-0.90), non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 0.36; 95% CI: 0.21-0.62), and survivors who do not support the legalization of cannabis for medical use compared to those who do (AOR: 0.10; 95% CI: 0.04-0.23). On the other hand, the odds of being interested in cannabis use for cancer management was higher among non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 1.65; 95% CI: 1.04-2.62), and among cancer survivors actively undergoing cancer treatment compared to patients on non-active treatment (AOR: 2.25; 95% CI: 1.74-2.91).

Awareness of cannabis use for cancer management is high within the cancer survivor population. Results indicated health care providers are leading information source and should receive continued medical education on cannabis-specific guidelines. Similarly, tailored educational interventions are needed to guide survivors on the benefits and risks of cannabis use for cancer management.

Colorectal cancer is the second deadliest cancer worldwide. One of the risk factors for the development of this type of cancer is alcohol consumption. Patients with colorectal cancer may be stigmatized regarding their cancer and regarding drinking behaviors they may exhibit. This study aimed to analyze community persons' and health professionals' acceptability judgments regarding alcohol drinkers having colorectal cancer.

This study relies on an experimental method enabling the identification of variables involved in one's judgment, based on the exhaustive combination of factors yielding several scenarios rated by participants. Scenarios implemented factors possibly influencing participants' perception of a woman character having colorectal cancer. Factors included her drinking habits, post-diagnosis drinking behavior and type of diagnosis/prognosis. The participants were community persons (N' = 132) or health professionals (N" = 126). Data were analyzed using a within-subject factorial ANOVA.

In both samples, the "Post-diagnosis behavior" factor had large effect sizes, with drinking cessation being more acceptable than other drinking behaviors. Another factor, "Drinking habits", had significant influences on participants judgments, as higher drinking was considered less acceptable. A third factor, "Diagnosis" (polyps, early- or late-stage cancer), was taken into account by participants when it interacted with "Drinking habits" and "Post-diagnosis behavior". Indeed, participants considered most acceptable to continue drinking in the case of late-stage cancer, especially in the health professional sample where the acceptability of continuing drinking was almost doubled when the character had advanced- rather than early-cancer.

The lesser the drinking behavior, the better the acceptability. However, advanced cancer stage attenuated the poor acceptability of drinking in both samples, as participants' attitudes were more permissive when the patient had advanced cancer.

Despite growing interest in the use of cannabis for the treatment of cancer-related symptoms, there are limited studies that have assessed the use pattern, type, and mode of delivery of cannabis products used by cancer survivors. This study describes the current state of the use pattern, product type, and mode of delivery of cannabis used by cancer survivors. This was a cross-sectional study of cancer survivors from 41 U.S. states who received treatment at the largest NCI-designated comprehensive cancer center. The weighted prevalence of the use patterns, product types, and modes of delivery of cannabis used by cancer survivors was estimated. A total of 1886 cancer survivors were included in the study, with 915 (48% [95% CI: 45-51]) reporting ever using cannabis. Of survivors who had ever used cannabis, 36% (95% CI: 33-40) were current users. Among survivors who reported cannabis use after diagnosis, 40% used cannabis during and after cancer treatment, 35% used cannabis during treatment, and 25% used cannabis after completing their cancer treatment. Additionally, 48% of survivors reported an increase in cannabis use since cancer diagnosis. The commonest types of cannabis products used by cancer survivors were dry leaf cannabis (71%), cannabidiol (CBD) oil (46%), and cannabis candy (40%). Moreover, cancer survivors frequently used baked goods (32%), creams and gels (21%), and tinctures (18%). Furthermore, among ever users, the predominant mode of use was cannabis inhalation/smoking (69%) compared to eating/drinking (59%). More so, the common mode of inhalation/smoking of cannabis products were rolled cannabis cigarettes (79%), pipes (36%), water pipes (34%), vaporizers or vapes (14%), and e-cigarette devices (14%). A substantial number of cancer survivors use cannabis during cancer treatment, with increased use following cancer diagnosis. The forms and modes of delivery of cannabis varied among survivors, with most survivors inhaling or smoking cannabis. There is a need to educate healthcare providers (HCPs) and survivors on current evidence of cannabis use and strengthen cannabis regulatory frameworks to optimize benefits and minimize adverse events from cannabis use during cancer treatment.

Anxiety and depression are common issues in gastrointestinal cancer, bringing negative impacts on patients' quality of life and long-term prognosis. This study aimed to identify the prevalence, longitudinal variation, risk factors, and prognostic value of anxiety and depression in postoperative gastrointestinal cancer patients.

A total of 320 gastrointestinal cancer patients after surgical resection (210 colorectal cancer (CRC) patients and 110 gastric cancer (GC) patients) were enrolled in this study. During the 3-year follow-up period, Hospital Anxiety and Depression Scale (HADS)-anxiety (HADS-A) and HADS-depression (HADS-D) scores were determined at baseline, 12th month (M12), 24th month (M24), and 36th month (M36).

The prevalence of anxiety and depression at baseline was 39.7% and 33.4% in postoperative gastrointestinal cancer patients, respectively. Female (vs. male), single/divorced/widowed (vs. married), CRC (vs. GC), hypertension, higher TNM stage, neoadjuvant chemotherapy, and postoperative complications were independent risk factors of anxiety or depression in patients with gastrointestinal cancer (all P < 0.050). Furthermore, anxiety (P = 0.014) and depression (P < 0.001) were associated with shortened overall survival (OS); after further adjustment, depression was independently linked with shortened OS (P < 0.001), while anxiety was not. During the follow-up period, HADS-A score (from 7.78 ± 3.180 to 8.57 ± 2.854, P < 0.001), HADS-D score (from 7.23 ± 2.711 to 8.01 ± 2.786, P < 0.001), anxiety rate (from 39.7 to 49.2%, P = 0.019), and depression rate (from 33.4 to 42.6%, P = 0.023) were all gradually increased from baseline to M36.

Anxiety and depression gradually exacerbate and relate to poor survival in postoperative gastrointestinal cancer patients.

Colorectal cancer (CRC) preferentially affects older adults. Modifiable factors, such as anxiety, can be measured as part of cancer-specific geriatric assessments (GA) completed prior to the start of treatment. We hypothesized that anxiety is prevalent among older adults with CRC and is associated with increased depression, increased frailty, and impaired health-related quality of life (HRQOL).

Patients ≥60 years old with newly diagnosed CRC completed a cancer-specific GA called the Cancer and Aging Resilience Evaluation (CARE). Between September 2017 and February 2023, we analyzed patients with CRC who had not yet received any systemic treatment. Anxiety was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety 4-item short form and reported as t-scores. We used modified Poisson models with robust variance estimation to assess for differences in the prevalence of depression, frailty, and impaired HRQOL.

We analyzed 277 older adults with CRC. The median age of the study sample was 68 years. 57% were male, 72% were non-Hispanic White, and most had advanced CRC (35% stage III and 39% stage IV). Moderate/severe anxiety was present in 17% of older adults with newly diagnosed CRC. In adjusted models, as compared to patients without moderate/severe anxiety, patients with moderate/severe anxiety had significantly increased risk of depression (prevalence ratio [PR] 7.60, CI 4.90-11.78), frailty (PR 4.93, CI 3.01-8.07), impaired physical HRQOL (PR 3.57, CI 2.03-6.28), and impaired mental HRQOL (PR 3.82, CI 2.12-6.89).

Among older adults with CRC, anxiety is associated with increased depression and frailty as well as reduced HRQOL.

Limited research has employed a longitudinal approach to investigate the role of education level as an effect modifier on the relationship between cancer diagnosis history and the experience of major depressive disorder (MDD) with a nationally representative sample.

We harnessed data from three installments of the MIDUS Longitudinal study (n = 7108). A Marginal Structural Model facilitated the investigation of associations between a history of cancer diagnosis, MDD, and potential modifying effects of education level. Inverse probability weighting helped manage confounding factors.

Findings indicated that a cancer diagnosis made one year prior was linked with 3.741 times greater odds of experiencing MDD (95 % CI: 1.411-9.918, p < 0.01). This connection was absent for diagnoses made two years earlier. Among individuals with education up to high school, a recent cancer diagnosis significantly increased the likelihood of MDD in the subsequent wave by 3.45 times (95 % CI: 1.31-9.08, p < 0.05). This pattern was not apparent among better-educated individuals.

As the exposure variable was dependent on self-reported questionnaires, recall bias could be a potential limitation. Moreover, unaccounted variables like genetic factors could introduce confounding.

A recent cancer diagnosis, particularly among less educated individuals, correlated with an increased probability of MDD, while the impact was not observed for older diagnoses. These findings emphasize that the timing of a cancer diagnosis and education level need consideration in the mental health assessment of cancer survivors.

Gastric cancer (GC) diagnosed in the elderly population has become a serious public health problem worldwide. Given the combined effects of frailty and the consequences of cancer treatment, older individuals with GC are more likely than young patients to suffer from postoperative complications and poor clinical outcomes. Nutrition, functional capacity and psychological state-based multimodal prehabilitation, which is dominated by Enhanced Recovery After Surgery (ERAS) pathway management, has been shown to reduce postoperative complications, promote functional recovery and decrease hospitalisation time in certain malignancies. However, no previous studies have investigated the clinical application of multimodal prehabilitation in frail older patients with GC.

The study is a prospective, multicentre randomised controlled trial in which a total of 368 participants who meet the inclusion criteria will be randomised into either a prehabilitation group or an ERAS group. The prehabilitation group will receive multimodal prehabilitation combined with ERAS at least 2 weeks before the gastrectomy is performed, including physical and respiratory training, nutritional support, and therapy and psychosocial treatment. The ERAS group patients will be treated according to the ERAS pathway. All interventions will be supervised by family members. The primary outcome measures are the incidence and severity of postoperative complications. Secondary outcomes include survival, functional capacity and other short-term postoperative outcomes. Overall, the multimodal prehabilitation protocol may improve functional capacity, reduce the surgical stress response and concomitant systemic inflammation, and potentially modulate the tumour microenvironment to improve short-term and long-term clinical outcomes and patients' quality of life.

All procedures and participating centres of this study were approved by their respective ethics committees (QYFYKYLL 916111920). The final study results will be published separately in peer-reviewed journals.

NCT05352802.

(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.

Although depression is associated with poor treatment outcomes in patients with cancer, little is known about whether lifestyle modifications could help prevent depression. The authors aimed to identify the effect of lifestyle modifications, including smoking cessation, alcohol abstinence, and starting regular physical activity, on new-onset depression in patients with gastric cancer who underwent surgery.

By using the Korean National Health Insurance Service database, patients with gastric cancer who underwent surgery between 2010 and 2017 were identified. Self-reported lifestyle behaviors within 2 years before and after surgery were analyzed using the health examination database. Patients were classified according to changes in lifestyle behaviors, and their risk of new-onset depression was compared.

Among 18,902 patients, 2302 (12.19%) developed depression (26.00 per 1000 person-years). Smoking cessation (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91) and alcohol abstinence (HR, 0.79; 95% CI, 0.69-0.90) were associated with reduced risk of depression development compared with persistent smoking and persistent drinking, respectively. Starting regular physical activity was not associated with risk of depression. When lifestyle behaviors after gastrectomy were scored from 0 to 3 points (1 point each for not smoking, not drinking, and being physically active), the risk of depression tended to decrease as lifestyle scores increased from 0 points (reference) to 1 point (HR, 0.69; 95% CI, 0.55-0.83), 2 points (HR, 0.60; 95% CI, 0.50-0.76), and 3 points (HR, 0.55; 95% CI, 0.45-0.68).

Smoking cessation and alcohol abstinence are associated with reduced risk of developing depression in patients with gastric cancer who undergo surgery.