Table 2.

Illustrative studies examining mental health outcomes during long-term colorectal cancer survivorship

Reference	Sample demographics at baseline	Cancer site and stage	Study design	Theoretical framework	Mental health measures	Results
Caravati- Jouvenceaux et al., 2011 [35]	N = 542, 57% male, mean age = 71 years, France	63% colon cancer, 37% rectal cancer, 41% stage I, 26% stage II, 19% stage III, 2% stage IV, 12% unknown	Cross-sectional, population-based, case-controlled (N = 1,181 controls), surveyed at 5, 10, and 15 years post- diagnosis	None	SF-36: MCS, EORTC QLQ-C30: Emotional functioning scale, STAI	There were no significant differences between survivors and non-cancer controls in overall mental health or anxiety.
Dunn et al., 2013 [28]*	N = 1,703, 60% male, 71% aged between 60 and 80 years, Australia	Type of CRC not reported, 55% stage 0, I, or II, 35% stage III or IV, 11% unknown	Longitudinal, surveyed at 5, 12, 24, 36, 48, 60 months post- diagnosis, population-based	None	BSI	Rates of high psychological distress were between 32% and 44% over the 5-year study period. Four different distress trajectories were identified, including: (1) constantly low distress (19%); (2) medium distress that fluctuated across time points (30%); (3) medium distress that increased gradually over time (39%); and (4) high decrease in distress over time (13%). Men reported more distress than women. The most distressed men were more likely to be younger and have lower levels of education, poor social support, and late-stage disease.
Goldzweig et al., 2009 [37]	N = 339, 55% male, mean age = 71 years, Israel	Type of CRC not reported, 18% stage 0 or I, 62% stage II, 20% stage III	Cross-sectional, surveyed between 2 and 6 years post- treatment	None	BSI, IES, MAC	Unmarried, male survivors reported the highest rates of distress and helplessness. Levels of family support were comparable between married and unmarried survivors; however, greater family support was only related to less distress among married survivors.
Jansen et al., 2011 [33]	N = 439, 57% male, mean age = 65 years, Germany	59% colon cancer, 41% rectal cancer, 51% local, 31% regional, 17% distal, 1% unknown	Longitudinal, surveyed at 1, 3, 5, and 10 years post- diagnosis, population-based, case-controlled (N = 2,028 controls)	None	EORTC QLQ-C30: Emotional functioning scale	At 1, 3, and 10 years post-diagnosis, survivors reported significantly worse emotional functioning compared to controls; however, the differences were not clinically meaningful (i.e., >10 points). Compared to older survivors (age ≥ 70 years at diagnosis), younger survivors (age < 60 years) reported significantly worse emotional functioning at 1 and 3 years post-diagnosis, and these differences were clinically meaningful.
Krouse et al., 2009 [42]	N = 491, 62% male, mean age = 72 years, 76% non-Hispanic White, USA	100% rectal cancer, 53% local, 41% regional, 1% distal, 5% unknown	Cross-sectional, surveyed at least 5 years post- diagnosis, case- controlled: ostomies (n = 246 cases) vs. anastomoses (n = 245 controls)	None	Modified COH-QOL- Ostomy, SF- 36 version 2: MCS	Females with ostomies reported worse psychological well-being compared to females with anastomoses. Male and female survivors with ostomies were also more likely to report depressive symptoms following their surgery compared to those with anastomoses.
Thong et al., 2013 [30]	N = 1,419, 53% male, mean age = 70 years, Netherlands	59% colon cancer, 41% rectal, 33% stage I, 38% stage II, 26% stage III, 2% stage IV, 1% unknown	Cross-sectional, surveyed at an average of 8 years post-diagnosis (minimum of 5 years post- diagnosis), population-based, case-controlled (N = 338 normative population controls)	None	HADS	Using a cut-off of ≥ 8 on the HADS, 20% of survivors reported clinical levels of anxiety compared to 10% of the normative population; similarly, 18% of survivors reported clinical levels of depressive symptoms compared to 12% of the normative population. Using a more stringent cut-off of ≥ 11, 8% of survivors reported clinical levels of anxiety compared to 3% of the normative population; additionally, 7% of survivors reported clinical levels of depressive symptoms compared to 3% of the normative population.

BSI, Brief Symptom Inventory; COH-QOL-Ostomy, City of Hope Quality of Life-Ostomy; 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; IES, Impact of Event Scale; MAC, Mental Adjustment to Cancer; SF-36: MCS, Medical Outcomes Study 36-Item Short-Form Health Survey: Mental Component Summary; STAI, State-Trait Anxiety Inventory.

^*Study sample overlaps with Lynch et al., 2008 [3] sample.