Impact of Prediagnosis Risk of Major Depressive Disorder and Health-Related Quality of Life on Treatment Choice for Stage II-III Rectal Cancer.

Abstract

PURPOSE/OBJECTIVE(S)\nWe hypothesized that depressive symptoms and health-related quality of life (HRQOL) reported by patients prior to their cancer diagnoses would be associated with treatment choice for stage II and III rectal cancer. During the period of study and at the time of this writing, the standard of care for stage II-III rectal cancer has been neoadjuvant radiation followed by surgical resection with or without adjuvant chemotherapy.\n\n\nMATERIALS/METHODS\nThe SEER and Medicare Health Outcomes Survey (SEER-MHOS) linked dataset was used to identify patients with stage II and III rectal adenocarcinoma diagnosed between 2004 and 2013 who had completed the health outcomes survey within 36 months before their cancer diagnoses. Risk for major depressive disorder (MDD) was determined based on responses to screening questions for depressive disorders. HRQOL was assessed using the Mental Component Summary (MCS) and Physical Component Summary (PCS) of the 36-Item Short Form Survey (SF-36) and the Veterans RAND 12-Item Health Survey (VR-12). Using both univariable and multivariable analysis to control for potentially confounding patient characteristics, we assessed for associations between these health survey responses and ultimate treatment choice, specifically regarding whether patients underwent surgery for their rectal cancer.\n\n\nRESULTS\nWe identified 142 evaluable patients with stage II-III rectal cancer, of whom 109 (76.8%) underwent surgery. Thirty patients (21.1%) met criteria for being at risk for MDD before their cancer diagnoses. Patients at risk for MDD were significantly less likely to undergo surgery than those not at risk (63.3% vs. 80.4%, P\u202f=\u202f0.0499), and this association strengthened after adjusting for patient characteristics (OR 0.17, 95% CI 0.04-0.82, P\u202f=\u202f0.027). There was a nonsignificant trend between higher MCS scores (equating with higher self-reported mental HRQOL) and increased likelihood of undergoing surgery (P\u202f=\u202f0.081). There were no significant associations between the PCS and treatment modality.\n\n\nCONCLUSION\nIn patients with stage II-III rectal cancer, there was a significant association between prediagnosis risk of MDD and treatment choice, such that patients at risk for MDD were less likely to undergo standard-of-care treatment with surgery. Further studies are warranted to assess the effect of MDD risk and HRQOL on clinical decision making with this patient population.