New research shows colorectal cancer patients who have depression when they are diagnosed are significantly less likely to make a good recovery following surgery than patients without depression. The researchers say the groundbreaking study shows the important role mental health plays in cancer recovery and the need to cater for each patient's individual needs before, during, and long after their treatment has finished.

The new research is part of the largest study of its kind, by Macmillan Cancer Support and the University of Southampton - both in the United Kingdom - that is following the lives of over 1,000 colorectal cancerpatients treated at 29 UK hospitals. The study covers the period from before surgery in 2010-2012 to at least 5 years afterward.

Prof. Jane Maher, joint chief medical officer of Macmillan Cancer Support, says people can live well after cancer, but only if they get the right support, and mental health can be a barrier to a good recovery. She notes:

"We know that depression and anxiety often go hand in hand with cancer, but now we can see the extent to which people are struggling to live with these illnesses."

Prof. Maher says the study shows depression affects patients' recovery more than whether or not their cancer is diagnosed early.

In a paper published in the journal PLOS One, the researchers described how they used health, quality of life, and well-being indicators to assess post-treatment recovery in the 2 years following colorectal cancer surgery.

Depression affects 1 in 5 colorectal cancer patients

The analysis shows that 1 in 5 colorectal cancer patients are depressed at the time of diagnosis.

It also shows that patients depressed at time of diagnosis are seven times more likely to be in very poor health 2 years after treatment has ended, compared with patients without depression. Indicators of this include, for instance, finding it very difficult to walk around, or being confined to bed.

Patients with depression are also 13 times more likely to have very poor quality of life, including, for example, experiencing problems with thinking and memory, or with sexual functioning, report the authors.

First author Claire Foster, professor of psychosocial oncology and director of the Macmillan Survivorship Research Group at Southampton, says:

"We have shown that self-reported depression before cancer treatment starts predicts quality of life and health status during treatment and up to 2 years later."

Cancer doctors should ask about other illnesses

In their analysis, the researchers found that the patients fell into four different groups, each with its own recovery "journey." Groups one and two fared "consistently well" and showed quality of health, quality of life, and well-being scores above or within normal range.

Group three had some problems, and Group four fared consistently poorly. The team notes that "higher pre-surgery depression and lower self-efficacy were significantly associated with poorer trajectories" for health, quality of life and well-being after adjusting for other factors that could affect the outcomes such as "disease characteristics, stoma, anxiety and social support."

Macmillan warn that unless doctors ask cancer patients about other illnesses, concerns and worries, important mental health issues may get overlooked and they could miss out on vital support that affects their chances of making a good recovery.

The researchers note that worldwide, there are currently 17 million people living with or beyond cancer, and this number is expected to triple by 2050.

Cancer care is also changing from a one-size-fits-all approach to care that is tailored to individual need, including a growing emphasis on self-management. Yet our knowledge of how equipped cancer survivors might be to cope with such changes is quite poor.

Prof. Foster says their findings are just the beginning. She says there is now a need to assess how they apply to patients with different types of cancer and to make it easier for patients with depression to get help and access services.

"These results have the potential to revolutionize patient assessment and care-planning to enhance patient care and improve recovery experiences after cancer."

Prof. Claire Foster