Hope, optimism and survival in a randomized trial of chemotherapy for metastatic colorectal cancer

Abstract

Purpose: Psychological responses to cancer are widely believed to affect survival. We investigated associations between hope, optimism, anxiety, depression, health utility and survival in patients starting first line chemotherapy for metastatic colorectal cancer. Methods: 429 subjects with metastatic colorectal cancer in a randomised controlled trial of chemotherapy, completed baseline questionnaires assessing: hopefulness, optimism, anxiety and depression and health utility. Hazard ratios (HR) and P-values were calculated with Cox models for overall survival (OS) and progression-free survival (PFS) in univariable and multivariable analyses. Results: Median follow-up was 31 months. Univariable analyses showed that OS was associated negatively with depression (HR 2.04, P<0.001), and positively with health utility (HR 0.56, P<0.001) and hopefulness (HR 0.75, P=0.013). In multivariable analysis, OS was also associated negatively with depression (HR 1.72, P<0.001), and positively with health utility (HR 0.73, P=0.014), but not with optimism, anxiety or hopefulness. PFS was not associated with hope, optimism, anxiety or depression in any analyses. Conclusions: Depression and health utility, but not optimism, hope, or anxiety were associated with survival after controlling for known prognostic factors in patients with advanced colorectal cancer. Further research is required to understand the nature of the relationship between depression and survival. If a causal mechanism is identified, this may lead to interventional possibilities.