Patients, partners affected by colorectal cancer course

By Sarah Guy

Partners of individuals with colorectal cancer, as well as the patients themselves, are at risk for psychologic morbidity according to the type of treatment given, show Portuguese study results.

Specifically, colorectal cancer patients treated surgically have lower levels of depression, anxiety, and traumatic stress symptoms than their counterparts treated with surgery plus either chemotherapy or radiation. And the psychologic effects followed suit among the patients' partners, say the researchers.

Patients who had been diagnosed for longer than a year were also at risk for traumatic stress symptoms, possibly because the threat for recurrence becomes more real as time goes on.

The findings highlight a need for greater understanding of "factors that may predict cancer-specific distress," thereby enabling better clinical or psychoeducational interventions, suggest Maria Graça Pereira, from the University of Minho in Braga, and co-workers.

The team evaluated the influence of treatment on quality of life, depression, anxiety, and traumatic stress symptoms using data for 141 colorectal cancer patients, of whom 35 underwent only surgical treatment (19 partners), 41 underwent surgery followed by chemotherapy (26 partners), and 38 who underwent surgery then radiotherapy (22 partners).

The researchers found significant differences in anxiety symptoms (measured using the Hospital Anxiety and Depression Scale) by patient treatment group, with surgically treated patients scoring significantly lower than surgery plus chemotherapy/radiotherapy groups at 5.97, 10.41, and 9.73, respectively. Similar-direction associations were found for depression and traumatic stress symptoms.

Furthermore, partners of surgical patients also presented lower levels of anxiety and traumatic stress than partners of patients treated with the other methods analyzed, report Graça Pereira et al.

Duration of diagnosis also had an effect on anxiety and the other outcomes; patients who had been diagnosed for over a year presented significantly more global traumatic stress, intrusion, and hypervigilance than those who had been diagnosed less than 6 months previously or between 6 months and 1 year beforehand.

Finally, as measured using the Quality of Life Scale-Cancer measure, anxiety and depression had the biggest effect on patient-reported quality of life, explaining 78.4% of variance, while traumatic stress and anxiety together predicted symptom distress, reports the research team.

"Early identification of high-risk couples is critical," say Graça Pereira and co-authors. "Hospitals should provide interventions to help patients and partners adapt to cancer and go through the illness' stages in order to promote their quality of life," they conclude in the European Journal of Oncology Nursing.

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