Study Finds Inadequate Emotional Support, Lower Health-Related Quality of Life, Increased Odds of Depression in Adults With Gastrointestinal Cancers

Compared to those without cancer, older adults with cancer are more likely to experience depression, anxiety, and poor quality of life, according to study authors at the University of Alabama at Birmingham who recently published their research in Cancer Medicine. An important component of health-related quality of life (HRQoL) is social support, particularly emotional support (ES), which is defined as the perception that an individual has in an intrapersonal relationship in which they can effectively share their emotions and be understood.

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This cross-sectional study examined older adults with gastrointestinal (GI) malignancies and ES and its associations with HRQoL, mental health, and survival. Investigators measured ES using an adaptation of the Medical Outcomes Study (dichotomized adequate ES versus inadequate ES). Outcomes included physical and mental HRQoL, anxiety, depression, and survival. Multivariable linear regression evaluated the link between ES and HRQoL scores, and multivariable logistic regression evaluated the association of ES with anxiety and depression. If necessary, adjustments were made for age at geriatric assessments (GA), race, sex, and cancer stage and type.

The study authors examined 795 adults aged 60 years or older who were newly diagnosed with GI cancer and undergoing geriatric assessment at their first clinic visit. The most common malignancies in the study were colorectal (37.9%, n = 274) and pancreatic cancer (30.8%, n = 223), with 72.1% (n = 564) diagnosed as stage III or IV disease. Further, most participants were married (61.9%) and retired (61.2%). Patients were selected from the Cancer & Aging Resilience Evaluation (CARE) registry, which is an ongoing prospective study of older adults with cancer that combines self-reported GA (also called CARE tool) and follow-up outcomes.

Results indicated that in older adults with GI cancers, inadequate ES was associated with lower physical and mental HRQoL and increased odds of depression. Patients with inadequate ES were more likely to be non-White, disabled, or not married (eg, single, divorced, or widowed). However, inadequate ES was not found to be linked with worse overall survival.

Approximately 77.6% of patients had adequate ES, and more than 80% had noted they had each type of emotional support “most” or “all of the time”. Those with inadequate ES were more likely to be Black (31.5% versus 20.8%, p = 0.005) or another race (3.4% vs. 1.9% p = 0.005), and less likely to be White (65.2% vs. 77.3%, p = 0.005). Patients with inadequate ES were more likely to have a disability (24.1% vs. 10.4%, p < 0.001) and less likely to be retired (56.0% vs. 62.6%, p < 0.001), employed part-time (3.0% vs. 3.5%, p < 0.001) or employed full time (8.4% vs. 13.1%, p < 0.001). Further, more patients with insufficient ES were less likely to be married (32.7% vs. 70.1%, p < 0.001), and more likely to be widowed, divorced, or separated (54.2% vs. 24.8%, p < 0.001) or single (13.1% vs. 5.2%, p < 0.001). Additionally, those with insufficient ES were shown to have higher odds of depression (aOR: 2.22, CI: 1.34–3.69).

The median follow-up time during the study period was 14 months (IQR: 8 to 31 months) and 36.7% (n = 292) of participants died during the study period; 24.3% of participants who died were deceased within 1 year of diagnosis, and 32.6% were deceased within 2 years of diagnosis. However, there were no differences between those with adequate ES and those without adequate ES in the proportion of deaths during the study period (36.6% vs. 37.1%, p = 0.913) within 1 year of diagnosis (24.3% vs. 24.2%, p = 0.966) and within 2 years of diagnosis (32.4% vs. 33.2%, p = 0.126). Further, there was no significant variance in survival probability between patients who had adequate ES versus those without (1-year survival: p = 0.940; 2-year survival: p = 0.544; overall survival: p = 0.506).

The authors noted that study limitations included the inability to generalize results (the study was conducted in one medical center), HRQoL and ES were measured at one point in time which can affect the established connection, and the data was self-reported by patients which could introduce information bias or misinformation. Similarly, the measures of anxiety and depression were solely patient reported which may not correlate with clinical diagnoses made by health care professionals. Further, >80% of patients had reported adequate ES in each survey question; therefore, the frequency of inadequate ES was rather low. Unlike previous research, the current study did not measure differences between received and perceived ES.

Reference

Clausing, D, Fowler, ME, Harmon, C, et al. Association of emotional support with quality of life, mental health, and survival in older adults with gastrointestinal malignancies–Results from the CARE registry. Cancer Med. 2023; 00: 1-10. doi:10.1002/cam4.6477