Quality of Life of Colorectal Cancer patients and its association with Anxiety and Depression: Cross sectional study at a tertiary care hospital in low-middle income country

Abstract

Abstract Background: Colorectal cancer (CRC) and its therapy have an enormous impact on the health related quality of life (QoL) of cancer patients. The emotional distress like anxiety & depression also negatively affect wellbeing of such patients. This study aims to evaluate the QoL, anxiety & depression in CRC patients and their association with clinic-pathological features at a tertiary care hospital in Karachi Pakistan, a low middle income country (LMIC). Methods: An analytical cross sectional study was conducted on adult patients with CRC presenting to Aga Khan University Hospital, Karachi, Pakistan. The European Organization for Research and Treatment of Cancer, QoL questionnaire C30 and CR29 were used to assess the QoL; while Hospital Anxiety & Depression Score (HADS) was utilized to evaluate the anxiety and depression. Data were analyzed using STATA version 12. Multivariable linear and MANOVA were performed to analyze the correlation between independent factors and the global QoL as well as the item specific QoL scores, respectively. A p value of <0.05 was considered as significant. Results: A total of 127 CRC patients were included in this study with a mean age of 53±15 years. Majority were male (70%), married (83.5%), and living in combined family system (52.7%). Mean Global QoL score in our patients was 69.08±1.78. Among symptoms scales, stoma care problem, dry mouth and urinary frequency were 3 worst symptoms respectively. Among functional scales, sexual interest (women > men) was the most significantly affected aspect. Anxiety and Depression were seen in 26 (20.9%) and 24 (18.9%) patients, respectively. On multivariable linear regression adjusted for covariates, lower global QoL was significantly associated with depression (Adjusted Beta Coefficient: -25.33 [95% Confidence Interval: −34.4, −16.23]), patients on adjuvant treatment (−15.14 [−21.84, −8.44]), and those who received neo adjuvant treatment (-11.75 [-19.84, -3.65]). Conclusions: This is the first study to assess the QoL in CRC patients in Pakistan. Depression was found to be significantly associated with poor quality of life. Numerous factors were identified which correlated with QoL indicating the need to develop local guidelines to help our patients cope with the psychological distress.