Depression and Anxiety in Tunisian Patients with Colorectal Cancer: Specificities and Width

Background: Cancer causes psychological distress that impairs patient's morbidity. Colorectal cancer is a public health problem because of its severity and impact, in addition to its psychological consequences on patients and their entourage. The aim of this work is to determine the prevalence of depression and anxiety in a group of Tunisian patients with colorectal cancer, and its correlations with clinical factors. Patients and methods: We have conducted a prospective longitudinal observational study for 6 months (from March to August 2017) collecting all patients with colorectal cancer that were treated and followed up in the medical oncology consultation at CHU Farhat Hached in Sousse (Tunisia). Assessment was based on a grid to be completed by the investigator. It contains epidemiological and clinical data based on medical records and a validated self-questionnaire measuring depression and anxiety (Hospital Anxiety and Depression Scale (HADS)). Data entry and analysis were performed by SPSS V20.0 software. Results: Fifty-two patients were enrolled into the study. They were divided into 28 women and 24 men; their mean age was 57 +/- 13 years, the mean disease's duration was 3.2 +/- 1 year. Metastatic stage (stage IV) was found in 27% of cases. Fifty-four percent of our patients had curative treatment, 88.6% had surgery of their primary tumor, 94.3% had chemotherapy, 34.6% had radiotherapy, and 15.5% had received cetuximab. Doubtful depression concerned 17.3% of patients and 13.5% of them had a sure depression, 13.5% scored a doubtful anxiety and 7.5% had a sure anxiety. A significant positive correlation was noted between depression and metastatic stage (r = 0.741, P = 0.042), presence of ostomy (r = 0.811; P = 0.005), fatigue (r = 0.720; P = 0.005) and adverse events like nausea and vomiting (r = 0.653; P = 0.045). Conclusion: There is a high prevalence of depression and anxiety in patients with colorectal cancer in our study. These disorders should be systematically screened in order to provide comprehensive care for patients.