Depression in patients with colorectal cancer in Saudi Arabia

The association of benzodiazepine and benzodiazepine-related drugs with outcomes after surgery for colorectal cancer

Benzodiazepines increase plasma brain-derived neurotrophic factor (BDNF) level which, in turn, may improve survival in colorectal cancer (CRC) patients. This study aimed to evaluate the associations between benzodiazepine and benzodiazepine-related drugs (BZRD) use and outcomes of patients operated for CRC. This is a retrospective cohort study including patients operated for CRC at Limoges' University Hospital between 2010 and 2019. Data were collected from two sources: medical records of patients in the digestive, general and endocrine surgery department at Limoges University Hospital and from the Haute-Vienne general cancer registry. Patients were divided into benzodiazepine users and non-users. Outcomes were overall survival (OS) and recurrence-free survival (RFS). Among 504 patients who underwent surgery for CRC, 125 (24.8%) patients were treated with benzodiazepine/BZRD drugs. Users and non-users of benzodiazepine/BZRD showed no statistically significant differences in 5-year OS (45.5 ± 1.9% vs. 46.5 ± 1.1% p = 0.25) and 5-year RFS (41.0 ± 2.1% vs. 39.6 ± 1.3%, p = 0.94), even after adjustment for confounders and propensity score (OS: aHR=1.02, 95%CI: 0.71-1.48; RFS: aHR=1.00, 95%CI: 0.72-1.40). Subgroup analysis on CRC patients with psychiatric disorders revealed that benzodiazepine users had better RFS (aHR=0.58, 95%CI: 0.35-0.96) compared with non-users, particularly, patients with stages III or IV of CRC had better OS (aHR=0.27; 95%CI: 0.12-0.59) and RFS (aHR=0.30, 95%CI: 0.15-0.62). OS and RFS was significantly better in patients taking benzodiazepines classified as anxiolytics, having longer half-life, and producing active metabolites. In conclusion, benzodiazepine use was not associated with outcomes in CRC patients. Nevertheless, in subgroup of patients with psychiatric disorders and advanced CRC stage, benzodiazepine could improve survival.

Dual burden of chronic physical conditions and mental disorders: Findings from the Saudi National Mental Health Survey

Introduction

Comorbidities of mental disorders and chronic physical conditions are a common medical burden reported among Western countries. National estimates of such comorbidities among the general population of Arab countries like Saudi Arabia are unknown. This study examined the prevalence of lifetime chronic physical conditions among the Saudi general population with DSM-IV 12-month mental disorders, and the associations with disability in the Kingdom of Saudi Arabia (KSA).

Methods

The Saudi National Mental Health Survey, a cross-sectional household study - part of the World Mental Health (WMH) Survey Consortium - was conducted between 2013-2016 in the KSA, with 4,001 Saudi citizens aged 15-65 (response rate 61%). The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess prevalence of lifetime chronic physical conditions and 12-month mental disorders; disability was measured in terms of days out of role.

Results

The prevalence of any comorbid 12-month mental disorder among those with chronic physical conditions was 24%. Major depressive disorder, social phobia, and adult separation anxiety disorder were the most common comorbid mental disorders across all chronic physical conditions. Gender, education, income, urbanicity, region, and employment were associated with the presence of any chronic physical condition. Respondents with mental / physical comorbidities had 2.97 days out of role (on average) in the last 30 days.

Conclusion

Comorbidities of mental disorders and chronic physical conditions are common among Saudis. National efforts are needed to increase awareness of such comorbidities among the general population, and develop prevention and treatment services tailored to the needs of individuals at-risk for comorbidities.

Rehabilitation interventions for depression symptoms among cancer patients in Palestine: A systematic review

Background

Depression enhances the disease burden in patients with cancer. Psychological interventions and the rehabilitation of depression are required as a part of palliative care for cancer patients to improve their quality of life and mental health.The aim of the study was to review the literature about depression rehabilitation interventions among patients with cancer in Palestine.

Method

The electronic databases used: PubMed, Science Direct, Research Gate, and Google Scholar to search for systematic review articles for the review study.

Results

A total of 23 articles were reviewed, including five from Palestine and five from Arab and Islamic nations. Pharmacological and non-pharmacological interventions used to decrease symptoms of depression and enhance mental health among cancer patients represent the majority of interventions for depression rehabilitation in cancer patients. Interventions for depression rehabilitation among cancer patients in Palestine are only available from the perspective of palliative care, which also involves family education, managing the symptoms of cancer patients, and providing psychological support.

Conclusion

In Palestine, non-pharmacological interventions, such as psychological interventions, are the primary options for treating and recovering from symptoms of depression. The management of symptoms in cancer patients also has a favorable impact on mental health and recovery from depression. In Palestine, there is a need for improvement in palliative care, particularly interventions for depressive symptoms. The main reason Palestinian patients with cancer have such limited treatment and recovery options are because of Israeli occupation.

The prevalence of depression and anxiety in patients with cancer in Iran: a systematic review and meta-analysis

BACKGROUND

Cancer is one of the most prevalent diseases and is recognized as a global problem that is currently showing a growing trend. Cancer is one of the most stressful circumstances that a person may experience. Given how the mental state of patients with depression and anxiety may have a negative impact on their experience with cancer, this study was conducted with the aim to investigate the prevalence of anxiety and depression in cancer patients in Iran.

METHODS

This study was conducted using a systematic review method and based on the guideline Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). The studies used were searched for via databases, Scopus, Web of Science (WOS), Google Scholar, SID, Magiran, and using keywords related to anxiety, depression, and cancer. After extracting the required data, statistical analysis was performed based on the random model and using the second version of Comprehensive Meta-Analysis Software.

RESULTS

In a review of 24 studies with a sample size of 3225 people, the overall prevalence of depression in cancer patients in Iran was reported to be 50.1% (95% CI: 40.6-59.6). Additionally, in a review of 15 studies with a sample size of 2009, the overall prevalence of anxiety in cancer patients in Iran was reported to be 40.9% (95% CI: 30.9-51.6). The highest reported prevalence of depression in cancer patients in Iran according to the Beck questionnaire is 64.6 (95% CI: 48.2-78.1). Specifically, the highest prevalence of depression was reported in patients with breast cancer with a prevalence of 66 (95% CI: 50.9-78.4). The highest prevalence of anxiety in patients with cancer in Iran according to the Depression, Anxiety, and Stress Scale was 49.2 (95% CI: 18.9-80.1). Comparatively, the highest prevalence of anxiety in patients with breast cancer was reported to be 53.2 (95% CI: 25.8-78.7).

CONCLUSION

The prevalence of depression and anxiety among cancer patients in Iran, in particular patients with breast cancer, is significantly higher than in other parts of the world. The prevalence found in our study was even higher than the reported number by studies that have examined the disorder globally. Therefore, it is of great urgency for health system policymakers to work to improve the current situation.

Factors Related to Depression Score among Colorectal Cancer Patients in Digestive Surgery Outpatient Clinic of Haji Adam Malik General Hospital, Medan

Introduction: Colorectal cancer has been known as the leading cause of death with depression as the most common coexisting morbidity. Factors related to depression among cancer patients are required to be explored.  Aim: To investigate factors related to depression among colorectal cancer patients in Medan.  Method: This  cross sectional predictive analytical multivariate study was conducted through March to May 2021 in Haji Adam Malik General Hospital Medan involving 105 colorectal patients visiting Digestive Surgery outpatient clinic who fulfilled inclusion and exclusion criteria. Subjects were requested to fill in personal data on participant’s form. Direct interview was conducted in accordance with COVID-19 health protocols. To assess depression score, HADS-D questionnaire was used in the study.  Result: Our study found among independent variables that we assessed, 5 variables ; length of education, number of comorbidities, gender, occupation, and marital status are independent risk factors related to the occurrence of depression among colorectal cancer patients (adjusted R2 = 68.5%).  Conclusion: By acknowledging risk factors related to depression among these patients, early intervention and tailored education for both patients and their loved ones can be done. 

Factors Associated With Depression in Breast Cancer Patients in Saudi Arabia

BACKGROUND

Depressive symptoms in Arab women with breast cancer (AWBC) in Saudi Arabia can be influenced by spirituality, religiosity, social support, and breast cancer's stigma. Understanding the role of these factors can raise awareness and help create policies to improve care for breast cancer patients. Yet, there is limited research addressing the impact of these factors on depressive symptoms in AWBC.

OBJECTIVE

The aim of this study was to investigate factors influencing depressive symptoms in AWBC in Saudi Arabia.

METHODS

A cross-sectional design and convenience sampling were used to recruit 59 AWBC from oncology departments in Jeddah, Saudi Arabia, who were receiving active treatment to participate in this study. Participants completed an online survey or paper-based survey including questions on sociodemographics, social support, spirituality, religiosity, depressive symptoms, and breast cancer's stigma. Pearson correlation and multiple regression analysis were used to examine the influence of numerous factors on depressive symptoms in AWBC; Student t test statistic was used to distinguish the depressive symptom scores between online and paper-based survey.

RESULTS

The average age of participants was 49 years (SD = 8.31). The mean (SD) of depressive symptoms was 20.52 (12.36). Pearson correlation analyses indicated that cancer patients with high levels of depressive symptoms were associated with low levels of spiritualty and religiosity, and high levels of breast cancer stigma.

CONCLUSIONS

Religiosity and spirituality work as protective factors against depressive symptoms in AWBC.

IMPLICATIONS FOR PRACTICE

Including religiosity and spirituality in the intervention plan should be considered when caring for AWBC.

The longitudinal changes of anxiety and depression, their related risk factors and prognostic value in colorectal cancer survivors: a 36-month follow-up study

OBJECTIVE

This study was to investigate the longitudinal change of post-operative anxiety and depression, their related risk factors and prognostic value in colorectal cancer (CRC) patients after resection.

METHODS

Totally, 302 CRC patients who underwent resection were consecutively recruited. Their anxiety and depression were assessed by hospital anxiety and depression scale (HADS) at Month 0 (M0) and then every 3 months till Month 36 (M36).

RESULTS

Within 36-month follow-up period, HADS-A score (from 8.3 ± 3.3 at M0 to 8.8 ± 3.4 at M36, P = 0.179) exhibited an upward trend with time but without statistical significance; while anxiety rate (from 46.4% at M0 to 52.6% at M36, P = 0.019) was increased steadily with time longitudinally. Meanwhile, both HADS-D score (from 7.4±3.0 at M0 to 9.2±3.5 at M36, P < 0.001) and depression rate (from 33.8% at M0 to 57.9% at M36, P < 0.001) were elevated greatly with time longitudinally. Furthermore, multivariate logistic regression revealed that female and tumor size (≥5 cm) were common independent risk factors for baseline/1-year/2-year/3-year anxiety (all P < 0.05); meanwhile, female, marry status (single/divorced/widowed vs. married) and advanced TNM stage were common independent risk factors for baseline/1-year/2-year/3-year depression (all P < 0.05). As for new-onset anxiety and depression, no independent factor associated with new-onset anxiety was observed; meanwhile, female and TNM stage were independent risk factors for new-onset depression (both P < 0.05). Additionally, baseline/1-year anxiety and baseline/1-year/2-year/3-year depression were associated with lower accumulating OS (all P < 0.05).

CONCLUSION

Post-operative anxiety and depression are highly prevalent and continuously progress, which also correlate with worse survival prognosis in CRC patients.

Depression and Anxiety in Patients With Cancer: A Cross-Sectional Study

Objectives

Depression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among cancer patients in the inpatient and outpatient settings.

Materials and Methods

A total of 1,011 patients (399 inpatients and 612 outpatients) formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.

Results

The prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized (37.1%) compared with patients in the outpatient setting (14.5%) (p < 0.001). Similarly, anxious symptomatology was more prevalent in the inpatient setting (p < 0.001). In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.

Conclusion

Our study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required.

Prevalence of Anxiety and Depression in Persons With Ostomies: A Cross-sectional Study

PURPOSE

The purpose of this study was to measure the prevalence of anxiety and depression in adults with ostomies and to identify associated factors.

DESIGN

A descriptive cross-sectional study.

SUBJECTS AND SETTING

The sample comprised 120 adults; all reside in a health region in the state of Minas Gerais in southeastern Brazil.

METHODS

Participants responded to a questionnaire designed for purposes of this study. The questionnaire included 2 validated instruments-the Beck Depression Inventory and the Beck Anxiety Inventory. In addition to measuring the prevalence of depression and anxiety, we used logistic regression models to identify factors associated with depression and anxiety. A backward method was adopted and the goodness-of-fit of the model was evaluated through the Hosmer and Lemeshow goodness-of-fit test. An odds ratio (OR) with a 95% confidence interval (95% CI) was used to measure the effect size of these associations.

RESULTS

The prevalence of depression in our sample was 26.7% (n = 32; 95% CI, 18.6-34.6). Slightly more than half of respondents (53.1%, n = 17) had mild depression, 34.3% (n = 11) had moderate depression, and 12.6% (n = 4) had had severe depression. The prevalence of anxiety in our sample was 52.5% (n = 63; 95% CI, 43.4-61.5). Slightly less than half 47.6% (n = 30) had mild anxiety; 36.5% (n = 23) reported moderate and 15.9% (n = 10) reported severe anxiety. The final multiple logistic regression model indicated that respondents with less supportive family relationships were more likely to have depression than respondents with greater family support (OR, 3.83; 95% CI, 1.30-11.25). Similarly, respondents with anxiety were more likely to experience depression when compared to individuals reporting no anxiety (OR, 6.32; 95% CI, 2.26-17.65).

CONCLUSIONS

Anxiety and depression are prevalent in adults living with an ostomy; anxiety was more prevalent than depression. Respondents with less support from their family and those with anxiety were more likely to experience depression.

Paroxetine combined with fluorouracil plays a therapeutic role in mouse models of colorectal cancer with depression through inhibiting IL-22 expression to regulate the MAPK signaling pathway

The objective of the present study was to observe the therapeutic effect of paroxetine combined with fluorouracil on mice with colorectal cancer (CRC) complicated with depression and to explore its mechanism of action. Using chronic mild stress and xenograft tumor methods to model CRC complicated with depression, 60 BALB/c mice were randomly divided into control, tumor model, tumor depression model, tumor depression antidepressant, tumor depression chemotherapy and tumor depression antidepressant plus chemotherapeutic drug groups. Changes in mouse sucrose preference and forced swimming tests were tracked. Changes in tumor volume and weight were compared, the tumor inhibition rate was calculated, Ki-67 expression in tumor tissues was detected using immunohistochemistry and IL-22 levels in peripheral blood were detected using ELISAs. Additionally, protein expression levels of IL-22, Bcl-2, Bax, caspase-3, p38, phosphorylated (p)-p38, ERK, p-ERK, JNK and p-JNK in tumor tissue were detected using western blotting. Following treatment with paroxetine and chemotherapy drugs, the sucrose preference index was increased, autonomic behavior dysfunction was alleviated and tumor growth was significantly inhibited. Furthermore, the expression levels of Ki-67 and apoptosis-related proteins, Bax and caspase-3, increased in tumor tissues, anti-apoptosis protein Bcl2 expression levels decreased significantly, IL-22 levels in the blood and tumor tissues were reduced and p-p38, p-ERK and p-JNK proteins were significantly reduced. It was concluded that paroxetine combined with chemotherapy drugs improved depressive behavior and promoted the survival state in a mouse model of CRC and depression, possibly through inhibiting IL-22 expression to regulate the activity of the MAPK signaling pathway.

Correlation between emotional regulation and peripheral lymphocyte counts in colorectal cancer patients

Background

Colorectal cancer is one of the most common cancers worldwide. Psychological morbidity has an important impact on quality of life and major clinical outcomes. Several data have shown that the immune system may be a key player on the relation between psychological features and cancer outcomes. Natural Killer (NK) cells have been shown to be influenced by psychological factors. The aim of this investigation was to assess the impact of anxiety, depression, and anger state, trait, and expression on the immune response, particularly, their effect on NK cells and CD8⁺ T cells in surgical colorectal cancer patients.

Methods

We studied 54 surgical colorectal cancer patients and assessed patients pre-surgically, post-surgically, and 12 months after surgery (follow-up). We applied the Hospital Anxiety and Depression Scale and the State-Trait Anger Expression Inventory and measured peripheral T cells, CD8⁺ T cells, and NK cells. We did a cross-sectional analysis as well as a longitudinal assessment of the variables during the follow-up period.

Results

Pre-surgical assessment: Trait anger, angry reaction, and anger-out had a significant negative correlation with NK cells. The lymphocytes values were unaffected by the presence of clinical anxiety or depression. Post-surgical assessment: Patients without clinical anxiety had higher levels of T cells. Angry reaction was negatively correlated with NK cells. Lymphocytes values were unaffected by the presence of clinical depression. Follow-up assessment: Patients without clinical depression had higher T cell counts. Trait anger and angry reaction were negatively correlated with the levels of NK cells. The lymphocytes values were unaffected by the presence of clinical anxiety. Longitudinal assessment: Angry-temperament, anger expression, and anger-in reduced significantly from the first to the second assessment. Anxiety, state anger, and trait anger significantly diminished from the pre-surgical to the follow-up assessment. Depression levels did not alter during the follow-up period. The lymphocyte count, and particularly T cells and CD8⁺ T cells, was significantly higher in the follow-up when compared with the pre-surgical assessment.

Conclusion

Our study suggests the existence of a relation between psychological response and immune response in colorectal cancer patients. We identified the importance of emotional regulation as a potential modulator for NK cell counts. Higher values of propensity to experience anger states and express them outwards seem to be associated with lower NK cell counts.

Psychological symptoms in adult Saudi Arabian cancer patients: prevalence and association with self-rated oral health

Background

Although psychological symptoms and oral health status are associated with health management and outcomes among cancer patients, their association has not been assessed in Saudi Arabia. We aimed to assess the symptoms of depression, anxiety, and stress and their association with their oral health status, adjusting for sociodemographic and clinical factors.

Methods

A self-reported study included 375 adult cancer patients who received outpatient healthcare services in the Oncology Department, King Abdulaziz Medical City-Riyadh, Saudi Arabia, between April 1 and August 31, 2017. We used the Arabic version of the Depression Anxiety Stress Scale to dichotomize a binary outcome for each. Oral health was evaluated by self-rating from "very good" to "bad".

Results

A high prevalence of subjective depression, anxiety, and stress was found (44.8%, 52.5%, and 42.7%, respectively). Of the sample, 17.9% self-reported "bad" oral health, which is associated with a high risk of anxiety and stress, and its association remains significant after controlling for other factors (adjusted odds ratio=6.48 and 4.73, respectively). Being <60 years old, high level of formal education, low income, breast cancer, and lung cancer were associated with increased psychological symptoms.

Conclusion

Every 6 in 10 cancer patients in this study reported at least one psychosocial symptom. The findings suggest that there exists an association between self-reported "bad" oral health and psychosocial symptoms. Being <60 years old, low income, high level of formal education, breast cancer, and lung cancer were associated with psychological symptoms. Routine psychological counseling and oral health screening in outpatient oncology clinics may improve psychological outcomes and cancer management.

Social support following diagnosis and treatment for colorectal cancer and associations with health-related quality of life: Results from the UK ColoREctal Wellbeing (CREW) cohort study

Objective

Social support is acknowledged as important in cancer survivorship, but little is known about change in support after cancer diagnosis and factors associated with this, particularly in colorectal cancer. The CREW cohort study investigated social support up to 2 years following curative intent surgery for colorectal cancer.

Methods

A total of 871 adults recruited pre‐treatment from 29 UK centres 2010 to 2012 consented to follow‐up. Questionnaires at baseline, 3, 9, 15, and 24 months post‐surgery included assessments of social support (Medical Outcomes Study‐Social Support Survey, MOS‐SSS) and health‐related quality of life (HRQoL). Socio‐demographic, clinical and treatment details were collected. Longitudinal analyses assessed social support over follow‐up, associations with participant characteristics, and HRQoL.

Results

Around 20% were living alone and 30% without a partner. Perceived social support declined in around 29% of participants, with 8% of these reporting very low levels overall from baseline to 2 years (mean MOS‐SSS overall score < 40 on a scale from 0 to 100). Older age, female gender, greater neighbourhood deprivation, presence of co‐morbidities, and rectal cancer site were significantly associated with reductions in perceived support. Poorer HRQoL outcomes (generic health/QoL, reduced wellbeing, anxiety, and depression) were significantly associated with lower levels of social support.

Conclusions

Levels of social support decline following colorectal cancer diagnosis and treatment in nearly a third of patients and are an important risk factor for recovery of HRQoL. Assessment of support early on and throughout follow‐up would enable targeted interventions to improve recovery, particularly in the more vulnerable patient groups at risk of poorer social support.