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

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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

Four hundred twenty-nine subjects with metastatic colorectal cancer in a randomised controlled trial of chemotherapy completed baseline questionnaires assessing the following: hopefulness, optimism, anxiety and depression and health utility. Hazard ratios (HRs) 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.

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Acknowledgments

The MAX trial is an Australasian Gastro-Intestinal Trials Group (AGITG) study: Clinical trial registration number ACTRN12605000025639. Assoc. Prof. Schofield is supported by National Health and Medical Research Council Research Fellowship (CDA Level 2). This work was supported by an unrestricted educational grant from Roche Products Pty Ltd., Australia, and an additional unrestricted educational grant from Roche Products Ltd., UK.

Conflict of interest

None of the authors has any conflict of interest with respect to this study. The study sponsors had no involvement in any aspect of the conduct of this research. The authors had full control of all primary data and agree to allow the journal to review the data if requested.

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Authors and Affiliations

  1. Department of Psychology, Swinburne University of Technology, John Road, Hawthorn, Australia

    Penelope E. Schofield

  2. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Australia

    Penelope E. Schofield & M. Jefford

  3. Sir Peter MacCallum Department of Oncology, and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia

    Penelope E. Schofield & M. Jefford

  4. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia

    M. R. Stockler, R. J. Simes & N. Wong

  5. Ludwig Institute Oncology Unit, Ludwig Institute for Cancer Research, Melbourne, Australia

    D. Zannino & N. C. Tebbutt

  6. Department of Oncology, Queen Elizabeth Hospital, Adelaide, Australia

    T. J. Price

  7. Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia

    N. Pavlakis

  8. Department of Medical Oncology, St John of God Hospital, Subiaco, Australia

    D. Ransom

  9. Department of Medical Oncology, Liverpool Hospital, Sydney, Australia

    E. Moylan

  10. Border Medical Oncology, Wodonga, Australia

    C. Underhill

  11. Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Herston, Australia

    D. Wyld

  12. School of Medicine, University of Queensland, Brisbane, Australia

    D. Wyld

  13. Department of Oncology, St Vincent’s Hospital, Melbourne, Australia

    I. Burns

  14. Prince of Wales Clinical School and Lowy Cancer Research Centre, Faculty of Medicine, UNSW, Sydney, Australia

    R. Ward

  15. Department of Medical Oncology, Westmead Hospital, Sydney, Australia

    N. Wilcken

Authors
  1. Penelope E. Schofield
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  2. M. R. Stockler
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  3. D. Zannino
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  4. N. C. Tebbutt
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  5. T. J. Price
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  6. R. J. Simes
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  7. N. Wong
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  8. N. Pavlakis
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  9. D. Ransom
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  10. E. Moylan
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  11. C. Underhill
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  12. D. Wyld
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  13. I. Burns
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  14. R. Ward
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  15. N. Wilcken
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  16. M. Jefford
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Correspondence to Penelope E. Schofield.

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Schofield, P.E., Stockler, M.R., Zannino, D. et al. Hope, optimism and survival in a randomised trial of chemotherapy for metastatic colorectal cancer. Support Care Cancer 24, 401–408 (2016). https://doi.org/10.1007/s00520-015-2792-8

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  • DOI: https://doi.org/10.1007/s00520-015-2792-8

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