Trudel-Fitzgerald Claudia, Tworoger Shelley S, Zhang Xuehong, Giovannucci Edward L, Meyerhardt Jeffrey A, Kubzansky Laura D
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Division of Population Science, Moffitt Cancer Center, Tampa, FL 33612, USA.
J Clin Med. 2020 Sep 30;9(10):3174. doi: 10.3390/jcm9103174.
Given the unalterable nature of most risk factors for colorectal cancer (CRC) survival (e.g., disease stage), identifying modifiable determinants is critical. We investigated whether anxiety and depression were related to CRC survival using data from the Nurses' Health Study (NHS) and Health Professional Follow-up Study (HPFS). Participants who received a CRC diagnosis and provided information about anxiety (n = 335; n = 232) and depression (n = 893; n = 272) within 4 years of diagnosis were included. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) of overall mortality, while controlling for covariates (sociodemographics, cancer characteristics, and lifestyle factors). Pooled risk estimates were derived from fixed effects meta-analyses of the cohorts. Among 1732 CRC patients, 814 deaths occurred during the 28-year follow-up. Each 1 standard deviation increase in anxiety or depression symptoms was associated with a similar 16% higher mortality risk (anxiety: 95% CI = 1.05-1.29; depression: 95% CI = 1.07-1.26). Comparable results were observed across all sensitivity analyses (introducing a 1-year lag, restricting to CRC-related mortality, considering potential behavioral pathways) and stratified models (cancer stage, sex). Our findings suggest greater anxiety and depression symptoms can not only impede adherence to healthy habits and reduce quality of life in cancer patients but could also be a marker for accelerated CRC progression.
鉴于大多数结直肠癌（CRC）生存风险因素的性质不可改变（如疾病分期），确定可改变的决定因素至关重要。我们利用护士健康研究（NHS）和卫生专业人员随访研究（HPFS）的数据，调查焦虑和抑郁是否与CRC生存相关。纳入了在诊断后4年内接受CRC诊断并提供焦虑（n = 335；n = 232）和抑郁（n = 893；n = 272）信息的参与者。Cox回归模型估计了总体死亡率的风险比（HR）和95%置信区间（CI），同时控制协变量（社会人口统计学、癌症特征和生活方式因素）。汇总风险估计值来自各队列的固定效应荟萃分析。在1732例CRC患者中，28年随访期间有814例死亡。焦虑或抑郁症状每增加1个标准差，死亡风险就会相应增加16%（焦虑：95%CI = 1.05 - 1.29；抑郁：95%CI = 1.07 - 1.26）。在所有敏感性分析（引入1年滞后、限制为CRC相关死亡率、考虑潜在行为途径）和分层模型（癌症分期、性别）中均观察到类似结果。我们的研究结果表明，更严重的焦虑和抑郁症状不仅会妨碍癌症患者坚持健康习惯并降低生活质量，还可能是CRC进展加速的一个标志。
