Table 1.

Illustrative studies examining mental health outcomes during acute colorectal cancer survivorship

Reference	Sample demographics at baseline	Cancer site and stage	Study design	Theoretical framework	Mental health measures	Results
Emmertsen and Laurberg, 2013 [21]	N = 260, 60% male, mean age = 66 years, Denmark	100% rectal cancer, 29% stage I, 35% stage II, 36% stage III	Longitudinal, surveyed at diagnosis and 3 and 12 months post-surgery	None	EORTC QLQ-C30: Emotional functioning scale	At 3 and 12 months post-surgery, those with major bowel dysfunction reported reduced emotional functioning compared to those without major bowel dysfunction.
Hart and Charles, 2013 [6]	N = 139, 55% male, mean age = 59 years, 76% Caucasian, USA and Canada	60% rectal cancer, 40% colon cancer, 60% stage III or IV	Longitudinal, surveyed at baseline (pre- surgery) and 6, 12, and 18 months post-surgery	Strength and Vulnerability Integration Theory	CES-D, PANAS	Compared to younger adults, older adults reported more rapid decrease in negative affect; in contrast, positive affect did not significantly change over time and was not related to age. Depressive symptoms also did not significantly change over time; however, younger adults reported more depressive symptoms than older adults. Older adults’ more adaptive appraisals of their cancer accounted for their more rapid decrease in negative affect relative to younger adults.
Hou et al., 2010 [7]	N = 234, 62% male, mean age = 64 years, Hong Kong	53% colon cancer, 47% rectal cancer, 3% stage I, 20% stage II, 57% stage III, 20% stage IV	Longitudinal, surveyed within 12 weeks of diagnosis (baseline) and 3 and 12 months post-baseline	Conservation of Resources Theory	HADS	Four different classes of survivors were identified: (1) those in the chronic distress class reported consistently high distress (7%-9%); (2) those in the delayed distress class reported an increase from normative to high distress (10%-13%); (3) those in the recovery class reported a decrease from high to normative distress (13%-16%); and (4) those in the resilient class reported consistently normative distress (65%– 67%).
Lynch et al., 2008 [3]	N = 1,822, 60% male, 72% between 60 and 80 years, Australia	70% colon cancer, 30% rectal cancer, 29% Dukes A, 35% Dukes B, 33% Dukes C, 3% Dukes D	Longitudinal, surveyed at 6 and 12 months post- diagnosis, population-based	None	BSI	Rates of anxiety and depressive symptoms were low at both 6 and 12 months post-diagnosis (range = 7%- 8%). Controlling for distress at 6 months, greater distress at 12 months was associated with more comorbidities, less optimism, greater cancer threat appraisal, and less social support.
Quach et al., 2015 [22]	N = 349, 46% male, all ≥ 65 years, mean age = 75 years, 79% non-Hispanic White, USA	At follow-up: 70% colon cancer, 18% rectal cancer, 12% rectosigmoid, 53% stage I or II, 78% stage III, 72% stage IV	Longitudinal, surveyed at baseline (pre- diagnosis) and 2 years post- baseline (mean time since CRC diagnosis = 12 months), population-based, case-controlled (N = 1,745 controls)	None	SF-36: MCS, VR- 12: MCS; 3 items from MHOS to assess risk for major depressive disorder (MDD)	At baseline, those who would develop CRC before 2-year follow-up had a similar risk of MDD compared to non-cancer controls (28% and 24%, respectively); however, at 2-year follow-up, CRC survivors were at an increased risk of MDD compared to non-cancer controls (34% and 25%, respectively). Relative to stage I and II survivors, stage IV survivors had an increased risk of MDD. Moreover, compared to non-cancer controls, survivors reported greater declines in mental health at 2-year follow-up.
Walling et al., 2015 [2]	N = 3,011, USA	Type of CRC not reported, 81% early stage, 19% late stage	Cross-sectional, between 3 and 6 months post- diagnosis	None	CES-D-8	Moderate-to-severe depressive symptoms were reported by 13% of early-stage survivors and 14% of late- stage survivors.

BSI, Brief Symptom Inventory; CES-D, Center for Epidemiologic Studies Depression Scale; CRC = colorectal cancer; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30; HADS, Hospital Anxiety and Depression Scale; MHOS = Medicare Health Outcomes Survey; PANAS, Positive and Negative Affect Scale; SF-36: MCS, Medical Outcomes Study 36-Item Short-Form Health Survey: Mental Component Summary; VR-12: MCS, Veterans RAND 12-Item Health Survey: Mental Component Summary.