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Tesio V, Benfante A, Franco P, Romeo A, Arcadipane F, Carlo Iorio G, Bartoncini S, Castelli L. The time course of health-related Quality of Life in rectal cancer patients undergoing combined modality treatment. Clin Transl Radiat Oncol 2024; 48:100824. [PMID: 39161735 PMCID: PMC11332791 DOI: 10.1016/j.ctro.2024.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/28/2024] [Accepted: 07/24/2024] [Indexed: 08/21/2024] Open
Abstract
Background and purpose This exploratory prospective observational study investigated the changes in Health-related Quality of Life (HRQoL) in rectal cancer patients (RCPs), from diagnosis to one-year-post-surgery follow-up and explored the role of physical symptoms and psychological determinants on HRQoL at the different time points. Materials and methods We assessed HRQoL, psychological distress, coping, affectivity, alexithymia and social support in 43 RCPs treated with preoperative (chemo)radiation and surgery, at three different assessment time points: diagnosis (T0), one month after the end of preoperative treatment (T1), one month after resection surgery (T2), and at follow-up (T3). Results The data showed that HRQoL decreased during active treatments, especially between T1 and T2 (p = 0.005), before increasing again at follow-up (p = 0.002).Baseline intestinal symptoms (p < 0.001) and negative affectivity trait (p = 0.03) significantly predicted HRQoL at T0. Baseline pain (p < 0.001), intestinal (p = 0.003) and urinary (p = 0.009) symptoms at T1 significantly predicted HRQoL at T1. A fatalistic coping style at T1 (p = 0.013), psychological distress (p = 0.003), mouth symptoms (p = 0.001) at T2 significantly predicted HRQoL at T2. Similarly, a fatalistic coping style at T1 (p = 0.006), psychological distress (p = 0.004), mouth (p = 0.002) and pain symptoms (p = 0.002) at T3 significantly predicted HRQoL at T3. Conclusion Several physical and psychological factors are involved in the changes occurring after diagnosis in RCPs' HRQoL. While cancer-related symptoms and treatment-related physical side effects are the main predictors of HRQoL at diagnosis and during active treatments, early psychological reactions have a higher predictive weight in post-treatment HRQoL.These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.
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Affiliation(s)
- Valentina Tesio
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy
| | - Agata Benfante
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
- Department of Radiation Oncology, "Maggiore della Carità" University Hospital, Corso Mazzini 18, 28100 Novara, Italy
| | - Annunziata Romeo
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy
| | | | - Giuseppe Carlo Iorio
- Department of Oncology - Radiation Oncology, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Sara Bartoncini
- Department of Oncology - Radiation Oncology, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy
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Li YC, Hsu HH, Yang SP, Hu GC, Wang HM, Huang WC, Wang TJ. Healthy Lifestyle and Quality of Life in Post-Operative Colorectal Cancer Patients: A Five-Month Observational Study. Nutrients 2023; 16:68. [PMID: 38201897 PMCID: PMC10781141 DOI: 10.3390/nu16010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Health-related quality of life (HRQOL) is an important indicator of treatment effectiveness. An unhealthy lifestyle can have a negative impact on quality of life. This study aimed to investigate changes in health-related lifestyle over time after surgery for colorectal cancer and their impact on HRQOL. Healthy lifestyle habits examined in this study included physical activity, smoking, alcohol consumption, fruit and vegetable intake, sleep, and obesity levels. An observational study design was used. A total of 75 post-operative colorectal cancer patients were recruited from two medical centers in Taiwan. Data were collected through structured questionnaires. Mean HRQOL scores at 1, 3, and 5 months after discharge were 102.5 (SD = 18.8), 102.9 (SD = 20.1), and 103.0 (SD = 18.9), respectively. A generalized estimating equation analysis showed that alcohol consumption (p = 0.009), fruit and vegetable intake (p = 0.020), physical activity (p = 0.023), sleep quality (p < 0.001), and obesity (p = 0.035) were important predictors of post-operative quality of life in patients with colorectal cancer. The impact of smoking on HRQOL did not reach statistical significance. Colorectal cancer patients tend to have better HRQOL after surgery if they stay physically active, eat enough fruits and vegetables, and sleep well.
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Affiliation(s)
- Yi-Chiu Li
- Division of Colorectal, Department of Surgery, MacKay Memorial Hospital, Taipei City 10449, Taiwan; (Y.-C.L.); (H.-H.H.)
| | - Hsi-Hsien Hsu
- Division of Colorectal, Department of Surgery, MacKay Memorial Hospital, Taipei City 10449, Taiwan; (Y.-C.L.); (H.-H.H.)
- MacKay Junior College of Medicine Nursing and Management, Taipei City 11260, Taiwan
| | - Shu-Ping Yang
- Department of Nursing, Cathay General Hospital, Taipei City 10630, Taiwan; (S.-P.Y.); (H.-M.W.)
| | - Gwo-Chi Hu
- Department of Rehabilitation, MacKay Memorial Hospital, Taipei City 10449, Taiwan;
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Hui-Mei Wang
- Department of Nursing, Cathay General Hospital, Taipei City 10630, Taiwan; (S.-P.Y.); (H.-M.W.)
| | - Wen-Chien Huang
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei City 10449, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 11219, Taiwan
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Sun L, Pang Y, Wang Z, Liu J, Peng R, Yan Y, Yang Y, Tang L. Effect of traditional Chinese medicine combined group psychotherapy on psychological distress management and gut micro-biome regulation for colorectal cancer survivors: a single-arm phase I clinical trial. Support Care Cancer 2023; 31:698. [PMID: 37964024 DOI: 10.1007/s00520-023-08131-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To evaluate the efficacy and feasibility of utilizing Traditional Chinese Medicine (TCM) combined group psychotherapy intervention on psychological distress management and gut micro-biome regulation for colorectal (CRC) survivors. METHODS A single-arm phase I clinical trial was conducted between December 2020 and December 2021 in Xiyuan Hospital and Beijing Cancer Hospital in China. Inclusion criteria included stage I-III CRC survivors after radical surgery with age between 18 and 75. The intervention was a 6-week online TCM combined group psychotherapy intervention including 90-min communication, TCM lifestyle coaching, self-acupressure guidance, and mindfulness practice led by TCM oncologist and psychiatrist each week. Outcomes were measured by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Fear of Cancer Recurrence Inventor (FCRI), and Quality of Life Questionnaire (QLQ-C30). Fecal samples before and after intervention were collected for 16Sr RNA analysis. RESULTS We recruited 40 CRC survivors and 38 of them finally completed all interventions with average age of 58±13 years' old. Paired t-test showed that SAS at week 2(35.4±5.8), week 4 (37.9±10.5) and week 6 (31.3±6.4) during the intervention was significantly lower than baseline (42.1±8.3, p<0.05 respectively). SDS score also declined substantially from baseline (38.8±10.7) to week 2 (28.3±8.8, p<0.001) and week 6 (25.4±7.7, p<0.001). FCRI decreased from 19.4±7.2 at baseline to 17.5±7.1 at week 4 (p=0.038) and 16.3±5.8 at week 6 (p=0.008). Although changes of QLQ-C30 were not statistically prominent, symptom burden of insomnia and fatigue significantly alleviated. The abundances of gut microbiota Intestinibacter, Terrisporobacter, Coprobacter, and Gordonibacter were all significantly elevated after intervention. CONCLUSIONS TCM combined group psychotherapy intervention is feasible and effective to reduce CRC survivors' psychological distress and modulate certain gut bacteria which might be associated with brain-gut axis effect. It is necessary to carry out with phase II randomized controlled clinical trial.
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Affiliation(s)
- Lingyun Sun
- Oncology Department, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ying Pang
- Rehabilitation Department, Beijing Cancer Hospital, Beijing, China
| | - Zixu Wang
- Clinical Basic Research Center, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaxi Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Rongyan Peng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yunzi Yan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yufei Yang
- Oncology Department, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Lili Tang
- Rehabilitation Department, Beijing Cancer Hospital, Beijing, China.
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Yu H, Qu T, Yang J, Dai Q. Serotonin acts through YAP to promote cell proliferation: mechanism and implication in colorectal cancer progression. Cell Commun Signal 2023; 21:75. [PMID: 37046308 PMCID: PMC10100184 DOI: 10.1186/s12964-023-01096-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023] Open
Abstract
Serotonin, also known as 5-hydroxytryptamine (5-HT), is a key messenger that mediates several central and peripheral functions in the human body. Emerging evidence indicates that serotonin is critical in tumorigenesis, but its role in colorectal cancer remains elusive. Herein, we report that serotonin transporter (SERT) transports serotonin into colorectal cancer cells, enhancing Yes-associated protein (YAP) expression and promoting in vitro and in vivo colon cancer cell growth. Once within the cells, transglutaminase 2 (TG2) mediates RhoA serotonylated and activates RhoA-ROCK1/2 signalling to upregulate YAP expression in SW480 and SW1116 cells. Blocking SERT with citalopram reversed the serotonin-induced YAP expression and cell proliferation, inhibiting serotonin's effects on tumour formation in mice. Moreover, SERT expression was correlated with YAP in pathological human colorectal cancer samples and the levels of 5-HT were highly significant in the serum of patients with colorectal cancer. Together, our findings suggested that serotonin enters cells via SERT to activate RhoA/ROCK/YAP signalling to promote colon cancer carcinogenesis. Consequently, targeting serotonin-SERT-YAP axis may be a potential therapeutic strategy for colorectal cancer. Video abstract.
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Affiliation(s)
- Huangfei Yu
- Department of Oncology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China.
- Clinical Cancer Center of Zunyi, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China.
- Scientific Research Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China.
| | - Tianyin Qu
- Department of Oncology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
- Clinical Cancer Center of Zunyi, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
- Scientific Research Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
| | - Jinlan Yang
- Department of Oncology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
- Scientific Research Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
| | - Qing Dai
- Department of Oncology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
- Scientific Research Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563003, Guizhou, China
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The Impact of Depression and Anxiety on Adult Cancer Patients’ Health-Related Quality of Life. J Clin Med 2023; 12:jcm12062196. [PMID: 36983197 PMCID: PMC10059703 DOI: 10.3390/jcm12062196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Cancer patients are at high risk for mental illness and, in turn, poorer health-related quality of life. This study used nationally representative United States (US) data to examine nuances of the impact of depression and/or anxiety on HRQoL in different cancer groups (e.g., cancer only, cancer and depression, cancer and anxiety, cancer and both conditions). Methods: Adult patients aged 18 years and older with a cancer diagnosis were identified from the Medical Expenditure Panel Survey data for 2012–2016. HRQoL was measured using the SF-12 Physical and Mental Component Summary (PCS & MCS) scores. Multivariate linear regressions were used, controlling for a multitude of factors. Results: Around 12% of the 1712 identified patients with cancer had depression, 13% had anxiety, and 8.4% had both depression and anxiety. Patients with comorbid depression and anxiety had the lowest mean scores of both PCS and MCS compared to patients in other groups. In addition, cancer patients with either depression and/or anxiety were more likely to have lower MCS scores compared to those with cancer only (depression: β = −6.554; anxiety: β = −3.916; both conditions: β = −11.759, p < 0.001). Interestingly, patients with comorbid depression and anxiety were more likely to have higher PCS scores compared to those with cancer only. Conclusions: The psychological burden of cancer is immense, with a substantial impact on patients’ HRQoL. Routine screening for depression and anxiety, especially for women and those with low poverty status and comorbidities, should be conducted by healthcare providers to identify those with high odds of having a lower HRQoL. Additionally, early psychiatric interventions, such as psychotherapy and prescription drugs, may positively impact patients’ mental well-being and HRQoL.
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Orive M, Barrio I, Lázaro S, Gonzalez N, Bare M, de Larrea NF, Redondo M, Cortajarena S, Bilbao A, Aguirre U, Sarasqueta C, Quintana JM. Five-year follow-up mortality prognostic index for colorectal patients. Int J Colorectal Dis 2023; 38:64. [PMID: 36892600 PMCID: PMC9998584 DOI: 10.1007/s00384-023-04358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To identify 5-year survival prognostic variables in patients with colorectal cancer (CRC) and to propose a survival prognostic score that also takes into account changes over time in the patient's health-related quality of life (HRQoL) status. METHODS Prospective observational cohort study of CRC patients. We collected data from their diagnosis, intervention, and at 1, 2, 3, and 5 years following the index intervention, also collecting HRQoL data using the EuroQol-5D-5L (EQ-5D-5L), European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Multivariate Cox proportional models were used. RESULTS We found predictors of mortality over the 5-year follow-up to be being older; being male; having a higher TNM stage; having a higher lymph node ratio; having a result of CRC surgery classified as R1 or R2; invasion of neighboring organs; having a higher score on the Charlson comorbidity index; having an ASA IV; and having worse scores, worse quality of life, on the EORTC and EQ-5D questionnaires, as compared to those with higher scores in each of those questionnaires respectively. CONCLUSIONS These results allow preventive and controlling measures to be established on long-term follow-up of these patients, based on a few easily measurable variables. IMPLICATIONS FOR CANCER SURVIVORS Patients with colorectal cancer should be monitored more closely depending on the severity of their disease and comorbidities as well as the perceived health-related quality of life, and preventive measures should be established to prevent adverse outcomes and therefore to ensure that better treatment is received. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02488161.
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Affiliation(s)
- Miren Orive
- Department of Social Psychology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria, Spain.
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain.
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain.
| | - Irantzu Barrio
- Department of Mathematics, University of the Basque Country UPV/EHU, Leioa, Spain
- Basque Center for Applied Mathematics, BCAM, Bilbao, Spain
| | - Santiago Lázaro
- Servicio de Cirugía General, Hospital Basurto, Bilbao, Bizkaia, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Nerea Gonzalez
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Marisa Bare
- Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
| | - Nerea Fernandez de Larrea
- Centro Nacional de Epidemiología, ISCIII, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maximino Redondo
- Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
| | - Sarai Cortajarena
- Department of Mathematics, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Amaia Bilbao
- Unidad de Investigación, Hospital Basurto, Bilbao, Bizkaia, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
| | - Urko Aguirre
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
| | - Cristina Sarasqueta
- Unidad de Investigación, Hospital Donostia/BioDonostia, Donostia, Gipuzkoa, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
| | - José M Quintana
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de La Salud (RICAPPS), Galdakao, Spain
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The Impact of Bevacizumab and Chemotherapy on Quality of Life in Metastatic Colorectal Cancer Patients. Healthcare (Basel) 2023; 11:healthcare11040591. [PMID: 36833125 PMCID: PMC9956224 DOI: 10.3390/healthcare11040591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Health-related quality is of life of great importance in cancer care. This prospective study aimed to evaluate the impact of chemotherapy and bevacizumab on the activities of daily living, cancer symptoms, and general well-being in 59 metastatic colorectal cancer patients. We gathered information using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. The paired sample t-test, MANOVA test, and Pearson's correlation test were used to analyze the presence of significant differences in mean scores before and after 6 months of treatment. The results revealed significant differences in the functioning and symptoms that influence patients' quality of life after 6 months of treatment: increased pain (p = 0.003), nausea and vomiting (p = 0.003), diarrhea (p = 0.021) and decreased appetite (p = 0.003). At the same time, there were several aspects that improved the quality of life. Increases in emotional function (p = 0.009), cognitive function (p = 0.033), and perception of body image (p = 0.026) were observed after 6 months of treatment. Elderly patients reported a higher frequency of stools (p = 0.028), and young patients had increased concerns about body perception (p = 0.047). Assessing the quality of life of metastatic colorectal cancer patients is an important way to identify and treat symptoms related to both cancer and therapy by establishing a holistic care plan and implementing measures to increase the quality of life.
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Tang WSW, Chiang LLC, Kwang KW, Zhang MWB. Prevalence of depression and its potential contributing factors in patients with enterostomy: A meta-analytical review. Front Psychiatry 2022; 13:1001232. [PMID: 36532192 PMCID: PMC9756805 DOI: 10.3389/fpsyt.2022.1001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE In patients with intestinal pathologies, the placement of a stoma bag affects multiple aspects of their perceived quality of life. This meta-analysis aims to evaluate the prevalence of depression among patients with enterostomy and to determine the underlying factors that could explain the potential heterogeneity of this prevalence. METHODS Relevant published studies were identified by searching PubMed, Embase, PsycINFO, Cochrane, CINAHL, Scopus, and Web of Science until May 2022. The random-effects model was used to determine the pooled prevalence of depression among patients with enterostomy using cross-sectional studies from various countries. Meta-regression and subgroup analysis were performed to identify factors contributing to heterogeneity. Quality assessment of the included studies was conducted using the Newcastle-Ottawa scale for nonrandomized studies. RESULTS The pooled prevalence of depressive symptoms among patients with enterostomy, as calculated using the random-effects model, was 41.6% (95% confidence interval [CI]: 25.4-59.7%, Q-value = 145.794, df = 8, p < 0.001, tau∧2 = 1.124, I∧2 = 94.513). The meta-regression found that mean age and gender were not significant moderators for the observed heterogeneity in prevalence. Subgroup analysis according to the indications for enterostomy formation showed that the prevalence of depression was highest in patients with colorectal cancer, at 34.4% (95% CI: 27.2-42.4%). Subgroup analysis by region showed that patients in Africa had the highest prevalence of depression, at 88.2% (95% CI: 76.1-94.6%), compared to other regions. Subgroup analysis by stoma indication was not significant. CONCLUSION This meta-analysis reports that the pooled prevalence of depression among patients with enterostomy is 41.6%. Indications for enterostomy formation, as well as geographical region, were identified as potential sources of heterogeneity. These findings highlight the need for appropriate psychosocial support and interventions at different stages of enterostomy placement.
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Affiliation(s)
- Wymann Shao Wen Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Kay Wee Kwang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melvyn Wei Bin Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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