Confidence Levels May Affect Recovery From Surgery for Colorectal Cancer

“Mind over matter” is taking shape for patients facing surgery to treat colorectal cancer. Self-efficacy has been determined to be an accurate predictor for recovery after colorectal cancer surgery, independent from type of disease or treatment for it. Patients with higher levels of self-efficacy — a personal confidence that they can manage illness-related problems — were found to have a better recovery, whereas those with depression and anxiety did not recover as well, according to findings of a new study published in the online journal PLOS One.

Findings of the study, led by Clare Foster of the University of Southampton in the United Kingdom, were based on questionnaire responses from 857 patients aged 18 years or older, who were awaiting initial surgery to cure their colorectal cancer and recruited between November 2010 and March 2012.

Questionnaires were administered before surgery, and at three, nine, 15 and 24 months after, assessing the patient’s quality of life (QOL), health status and wellbeing, and included measurements of the patient’s depression, anxiety and self-efficacy.

After analyzing the responses, the researchers detected four distinct groups of patients depending on how well they recovered from colorectal cancer and its treatment. From this information, the authors identified how many patients fit into each of the four groups and what factors were associated with them.

Groups one and two recovered generally well, with results on each of the three indicators either above or within the normal range (QOL 70 percent, health status 33.3 percent and wellbeing 77.6 percent). Group three had some problems (QOL 24.2 percent, health status 59.3 percent and wellbeing 18.2 percent), whereas group four scored consistently poorly on QOL (5.3 percent, health 7.4 percent and wellbeing 4.2 percent).

Approximately one in five participants were found to be depressed at baseline. Of these 147 patients, 21 percent of those with depression were in the group having the worst health two years after treatment, compared with 2.9 percent of those without depression, and 18.4 percent were in the group with the worst quality of life two years after treatment, compared with 1.4 percent of patients who were not depressed.

Overall, the researchers found that higher levels of depression before surgery and lower feelings of self-efficacy were significantly linked to poorer outcomes in the areas of QOL, health and wellbeing.

“Most people [treated with curative intent] have good quality of life and personal wellbeing in the first two years following colorectal cancer surgery in spite of reporting problems with their health,” explained Foster, a professor of psychosocial oncology and director of the Macmillan Survivorship Research Group at the University of Southampton. “However, around a third of patients report poorer quality of life and personal wellbeing over the first two years of treatment.”

Foster said that patients who reported depression and low confidence to manage illness-related problems before their treatment began were most likely to report poorer quality of life, health status and personal wellbeing in the first two years following surgery, when compared with those who were not depressed or had high confidence in their ability to manage illness-related problems.

For clinicians, these findings suggest that they should assess each patient’s self-efficacy beginning at the time of diagnosis to help determine which patients are more at risk of experiencing a poorer recovery. Those with depression and anxiety have the opportunity to receive the psychological and emotional support they need, hopefully helping them achieve a more positive trajectory in recovery.

“This is significant, because gaining support to manage depression and increase confidence to manage may make a significant difference to these people’s recovery experiences,” Foster said. “We want this study to raise the profile of these psychosocial issues which are very important in how people manage during and following their treatment and may be improved by appropriate support.”

Foster and her team are planning to continue their study, furthering their research with their group of patients with colorectal cancer, as well as branching out to study more cancer types.

Foster C, Haviland J, Winter J, et al. Pre-surgery depression and confidence to manage problems predict recovery trajectories of health and wellbeing in the first two years following colorectal cancer: results from the CREW cohort study. PLOS One. 2016 May 12;11(5):e0155434.