Abstract
Background/Aims Consequences of surgery for rectal cancer (permanent ostomy (PO), anastomosis (AN), or temporary ostomy (TO) followed by anastomosis) can affect survivors’ psychological and financial well-being. We investigated depression and its association with perceived financial burden resulting from their illness/treatment among long-term (≥5 years post-diagnosis) survivors.
Methods A mail survey of 574 long-term rectal cancer survivors from Kaiser Permanente Northern California and Northwest was conducted in 2010–2011. The survey included questions on current depression and perceived financial burden from the City of Hope Quality of Life questionnaire. Responses were indicated on a scale where 0 = ‘none’ and 10 = ‘severe’. Scores ≥4 were classified as depressed and ≥5 as high financial burden. ANOVA was used to contrast mean scores among surgery types. Linear regression models evaluated depression and perceived financial burden scores with co-variates.
Results Mean current depression level was 2.09 (SD = 2.40), with 23% (134 of 574) classified as depressed. PO survivors (N = 182) had the highest current depression levels (M = 2.46, SD = 2.61) compared to AN (N = 326, M = 1.96, SD = 2.37) and TO (N = 66, M = 1.68, SD = 1.81) (P = 0.02). These differences in depression by surgery type were significant after adjusting for age, sex, and race (P = 0.015). Survivors reported average perceived financial burden of 1.94 (SD = 2.72), with 18% (103 of 572) perceiving high financial burdens. PO survivors perceived highest burden (M = 2.5, SD = 2.92) compared to AN (M = 1.60, SD = 2.57) and TO (M = 2.12, SD = 2.65) (P = 0.001). After confounding adjustment, level of perceived financial burden was positively associated with higher current depression levels (P <0.001). Surgery type did not modify this relationship, but it was stronger among those also reporting depression after surgery (P = 0.04).
Conclusions Current depression was frequent among these long-term survivors of rectal cancer and was highest among those with permanent ostomy. While current depression and perceived financial burden due to their illness/treatment were statistically associated, there were no differences by surgery type. Research is needed to identify factors influencing high depression and financial pressures among these rectal cancer survivors. Clinicians should be aware that long-term survivors, particularly with permanent ostomy, can have depression and financial burdens resulting from their illness or treatment. Encouraging these survivors to receive psychosocial services may improve their well-being.
