Anxiety and Depression After Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes

Objective: Anxiety and depression commonly afflict colorectal cancer (CRC) surgery patients, but their impact on survival remains uncertain. Methods: We systematically reviewed three databases for relevant articles. Data included study and patient characteristics, cancer type, anxiety/depression measures, timing, and prevalence. Meta-analyses, using common- or random-effects models, assessed associations. Subgroup analyses based on follow-up duration and publication bias assessment were performed. Results: We analyzed seven cohort studies, examining anxiety and depression's impact on mortality in colorectal cancer patients. Samples ranged from 215 to 567 for anxiety and 215 to 46 710 for depression. Using common- or random-effects models based on heterogeneity, anxiety and depression showed increased mortality risk. Pooled odds ratio (OR) for anxiety was 1.07 (95% CI [confidence interval] 1.05-1.10), depression's OR was 2.76 (95% CI 1.25-6.11; random-effects). Pooled hazard ratio (HR) for anxiety was 1.33 (95% CI 1.28-1.37; common-effects) and 1.30 (95% CI 1.19-1.43; random-effects). HRs for depression were 1.45 (95% CI 1.30-1.61; random-effects) and 1.28 (95% CI 1.25-1.32; common- effects). Subgroup analyses revealed stronger effects on mortality in a shorter follow-up (0-5 years) compared to a longer follow-up (5-28 years). Conclusion: This meta-analysis shows that anxiety and depression are linked to increased mortality in patients with CRC. The findings suggested that screening and treating mental distress improve survival and quality of life in this population.