Depression and Functional Status in Colorectal Cancer Patients Awaiting Surgery; Impact of a Multimodal Prehabilitation Program

Abstract

Depression and functional impairment frequently co-occur. Though both predict complications and mortality following surgery, there is a paucity of research examining functional status (FS) in depressed cancer patients awaiting surgery. Prehabilitation, a preoperative intervention including exercise, nutrition, and stress-reducing strategies, may help to improve FS; however, the extent to which depressed individuals can benefit from this intervention has not yet been explored. The primary objectives were to assess whether preoperative depression is associated with poor FS and whether prehabilitation can improve FS in depressed individuals. A secondary analysis was conducted on 172 colorectal cancer (CRC) patients enrolled in three studies comparing prehabilitation with a control group (rehabilitation). FS was assessed at baseline with the Six-Minute Walk Test, measuring distance walked during 6-minutes (6MWD), and the Hospital Anxiety and Depression Scale (HADS) was used to assess psychological symptoms. Measures were collected twice preoperatively, at 4-weeks and 48 hours before surgery, and at 4- and 8-weeks postoperatively. Subjects were divided into 3 groups: depression (HADS-D), anxiety (HADS-A), or no psychological symptoms (HADS-N). Main hypotheses were tested using analysis of variance, Chi-Square tests, and multivariate logistic regression. At baseline, depressed individuals had lower 6MWD (p=0.003), and a higher proportion walked <400m (45%; p<0.001). Prehabilitation was associated with significant improvements in 6MWD in HADS-D group (OR=2.36, 95% CI:1.53-3.66), but not in HADS-N (OR=0.97 95% CI:0.44-2.16) or --A groups (OR=1.47 95% CI:0.69-3.16). CRC patients with depressive symptoms had poorer FS, and these individuals benefited most from prehabilitation intervention.