Table 4.
Risk factors for Mental Illness and Depression among Colorectal Cancer Survivors (11-11-18 Update)
| 0-2 Years after Cancer Diagnosis | >2-5 Years after Cancer Diagnosis | >5 Years after Cancer Diagnosis | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mental Illness | Depression | Mental Illness | Depression | Mental Illness | Depression | |||||||
| Factor | HR | 95% CI | HR | 95% CI | HR | 95% CI | HR | 95% CI | HR | 95% CI | HR | 95% CI |
| Procedure (-ostomy)1 | ||||||||||||
| None | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| Colostomy only | 1.8 | (1.48, 2.18) | 1.99 | (1.52, 2.61) | 1.54 | (0.99, 2.39) | 2.23 | (1.46, 3.4) | 1.55 | (0.98, 2.46) | 1.19 | (0.65, 2.17) |
| Ileostomy only | 1.13 | (0.57, 2.28) | 3.13 | (1.55, 6.31) | 1.17 | (0.29, 4.7) | 1.01 | (0.14, 7.21) | 1.13 | (0.28, 4.57) | 3.52 | (1.3, 9.54) |
| Colostomy or Ileostomy | 1.61 | (0.89, 2.91) | 1.39 | (0.45, 4.33) | 1.4 | (0.45, 4.36) | - | - | 1.89 | (0.84, 4.24) | 1.1 | (0.27, 4.41) |
| Treatment1 | ||||||||||||
| Surgery | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| Radiation (RT) | 2.48 | (1.03, 5.98) | 2.74 | (0.68, 11.02) | - | - | - | - | - | - | - | - |
| Chemotherapy | 2.28 | (1.7, 3.06) | 2.04 | (1.27, 3.29) | 4.36 | (1.08, 17.63) | 6.58 | (2.41, 17.94) | - | - | - | - |
| Surgery + RT | 0.93 | (0.53, 1.65) | 1.45 | (0.72, 2.92) | 1.17 | (0.48, 2.84) | 1.7 | (0.63, 4.6) | 0.8 | (0.33, 1.94) | 0.38 | (0.05, 2.69) |
| Surgery + Chemo | 1.34 | (1.17, 1.54) | 1.23 | (0.99, 1.52) | 1.23 | (1.05, 1.59) | 1.2 | (0.87, 1.66) | 0.85 | (0.66, 1.1) | 0.89 | (0.64, 1.25) |
| RT + Chemo | 1.82 | (1.31, 2.53) | 1.4 | (0.76, 2.55) | 3.02 | (1.34, 6.78) | 2.92 | (1.08, 7.89) | 2.06 | (0.51, 8.27) | 1.18 | (0.17, 8.48) |
| Surgery + RT + Chemo | 1.5 | (1.3, 1.74) | 1.73 | (1.39, 2.16) | 1.45 | (1.09, 1.91) | 1.25 | (0.87, 1.8) | 0.71 | (0.52, 0.97) | 1.2 | (0.86, 1.66) |
| No Treatment | 1.38 | (1.04, 1.84) | 1.33 | (0.82, 2.14) | 0.8 | (0.26, 2.5) | - | - | 0.65 | (0.16, 2.63) | 1.83 | (0.68, 4.96) |
| AJCC Stage1 | ||||||||||||
| I | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| II | 1.31 | (1.13, 1.51) | 1.38 | (1.11, 1.72) | 1.15 | (0.9, 1.48) | 1.02 | (0.74, 1.41) | 0.99 | (0.81, 1.21) | 1.03 | (0.79, 1.35) |
| III | 1.34 | (1.17, 1.53) | 1.35 | (1.1, 1.67) | 1.38 | (1.09, 1.74) | 1.39 | (1.03, 1.87) | 0.86 | (0.69, 1.07) | 1.08 | (0.81, 1.43) |
| IV | 1.71 | (1.48, 1.99) | 1.68 | (1.32, 2.13) | 2.63 | (1.84, 3.74) | 2.59 | (1.68, 3.98) | 1.03 | (0.58, 1.85) | 0.92 | (0.43, 1.98) |
| Baseline CCI4 | ||||||||||||
| 0 | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| 1+ | 1.1 | (0.99, 1.22) | 1.53 | (1.31, 1.79) | 1.23 | (1.01, 1.49) | 1.12 | (0.88, 1.44) | 1.67 | (1.39, 2.00) | 1.51 | (1.19, 1.91) |
| Baseline BMI5 | ||||||||||||
| < 18 kg/m^2 | 0.87 | (0.53, 1.44) | 1.12 | (0.58, 2.19) | 1.37 | (0.64, 2.93) | 0.87 | (0.28, 2.75) | 1.08 | (0.51, 2.3) | 0.57 | (0.14, 2.33) |
| 18 - 24.9 kg/m^2 | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| 25 - 29.9 kg/m^2 | 0.93 | (0.83, 1.05) | 0.99 | (0.82, 1.2) | 0.94 | (0.75, 1.17) | 0.92 | (0.69, 1.23) | 1.08 | (0.89, 1.33) | 1 | (0.77, 1.31) |
| > 30 kg/m^2 | 0.98 | (0.85, 1.12) | 1.37 | (1.12, 1.68) | 1.09 | (0.85, 1.4) | 1.26 | (0.92, 1.72) | 1.11 | (0.88, 1.41) | 1.24 | (0.92, 1.67) |
| Cancer Site1 | ||||||||||||
| Cecum | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| Ascending Colon | 0.86 | (0.7, 1.05) | 1 | (0.74, 1.36) | 1.29 | (0.88, 1.9) | 1.75 | (1.07, 2.86) | 0.82 | (0.58, 1.15) | 0.86 | (0.55, 1.35) |
| Hepatitic Flexure | 0.9 | (0.64, 1.28) | 0.77 | (0.43, 1.37) | 1.65 | (0.92, 2.97) | 0.8 | (0.28, 2.27) | 0.81 | (0.44, 1.52) | 1.7 | (0.96, 3.02) |
| Transverse Colon | 1.1 | (0.86, 1.41) | 1.45 | (1.03, 2.06) | 1.76 | (1.12, 2.76) | 2.18 | (1.24, 3.84) | 0.79 | (0.48, 1.3) | 0.83 | (0.44, 1.56) |
| Spleneic Flexure | 0.65 | (0.43, 0.99) | 1.07 | (0.61, 1.88) | 1.68 | (0.93, 3.02) | 1.75 | (0.77, 4) | 0.93 | (0.54, 1.61) | 1.03 | (0.49, 2.18) |
| Descending Colon | 0.81 | (0.6, 1.08) | 1.03 | (0.67, 1.59) | 1.28 | (0.77, 2.13) | 1.41 | (0.71, 2.81) | 0.64 | (0.39, 1.04) | 0.49 | (0.24, 1.04) |
| Sigmoid Colon | 0.85 | (0.72, 1) | 0.82 | (0.63, 1.07) | 1.05 | (0.76, 1.47) | 1.33 | (0.86, 2.06) | 0.92 | (0.71, 1.19) | 0.87 | (0.61, 1.23) |
| Large Intestine | 1.24 | (0.84, 1.82) | 1.17 | (0.63, 2.19) | 1.2 | (0.43, 3.3) | 2.13 | (0.75, 6.04) | 0.23 | (0.03, 1.62) | - | - |
| Rectosigmoid Junction | 1.17 | (0.94, 1.45) | 1.27 | (0.91, 1.76) | 1.52 | (0.99, 2.35) | 1.47 | (0.82, 2.64) | 1.02 | (0.7, 1.5) | 0.79 | (0.46, 1.36) |
| Rectum | 1.08 | (0.93, 1.27) | 1.09 | (0.85, 1.39) | 1.43 | (1.04, 1.96) | 1.52 | (0.99, 2.34) | 0.91 | (0.7, 1.18) | 0.91 | (0.64, 1.29) |
| Sex2 | ||||||||||||
| Male | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| Female | 0.79 | (0.88, 0.71) | 1.38 | (1.18, 1.62) | 0.99 | (0.82, 1.2) | 1.48 | (1.16, 1.88) | 0.95 | (0.8, 1.13) | 1.15 | (0.92, 1.44) |
| Age at Diagnosis3 | ||||||||||||
| < 65 Years | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| ≥ 65 Years | 1.05 | (0.95, 1.17) | 0.94 | (0.80, 1.11) | 1.42 | (1.17, 1.72) | 0.98 | (0.77, 1.25) | 2.23 | (1.87, 2.67) | 2.16 | (1.81, 2.57) |
| Race7 | ||||||||||||
| Non-White | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| White | 1.04 | (0.79, 1.38) | 0.96 | (0.64, 1.44) | 1.39 | (0.76, 2.54) | 1.18 | (0.56, 2.51) | 0.9 | (0.57, 1.42) | 1.27 | (0.60, 2.69) |
| Rural6 | ||||||||||||
| No | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| Yes | 1.05 | (0.91, 1.21) | 0.93 | (0.74, 1.17) | 1.23 | (0.96, 1.60) | 1.1 | (0.79, 1.53) | 1.05 | (0.82, 1.34) | 1.2 | (0.89, 1.63) |
| % Bachelors Degree | ||||||||||||
| < 15% | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| 15-24.9% | 0.9 | (0.75, 1.09) | 1.01 | (0.76, 1.35) | 1.18 | (0.8, 1.74) | 0.97 | (0.6, 1.58) | 1.35 | (0.93, 1.95) | 0.8 | (0.51, 1.27) |
| ≥ 25% | 0.81 | (0.68, 0.96) | 1.02 | (0.79, 1.33) | 0.94 | (0.65, 1.36) | 0.84 | (0.53, 1.33) | 1.02 | (0.72, 1.46) | 0.71 | (0.46, 1.1) |
| % Families below poverty | ||||||||||||
| < 7% | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| 7-9% | 1.1 | (0.98, 1.24) | 1.14 | (0.96, 1.36) | 0.85 | (0.68, 1.06) | 0.77 | (0.57, 1.03) | 1.13 | (0.91, 1.41) | 1.04 | (0.78, 1.39) |
| > 9% | 1.03 | (0.87, 1.21) | 1.05 | (0.82, 1.34) | 0.97 | (0.73, 1.31) | 1.2 | (0.85, 1.69) | 1.04 | (0.8, 1.36) | 0.85 | (0.58, 1.23) |
| Median Family Income | ||||||||||||
| < 50,000 | Reference | Reference | Reference | Reference | Reference | Reference | ||||||
| ≥ 50,000 | 1.01 | (0.89, 1.14) | 1.28 | (1.05, 1.58) | 0.74 | (0.60, 0.93) | 0.62 | (0.47, 0.81) | 0.85 | (0.70, 1.03) | 0.69 | (0.54, 0.89) |
1
Adjusted for Race, Sex, BMI, and Age at Diagnosis
2
Crude Hazard Ratio
3
Adjusted for Sex and Cancer Site
4
Adjusted for Stage at Diagnosis
5
Adjusted for Sex and Stage at Diagnosis
6
Adjusted for Baseline BMI and Treatment
7
Adjusted for Baseline BMI and Baseline CCI