Correlation of anxiety/depression status with stress-related markers and cancer-related fatigue in patients with colon cancer

Abstract

BACKGROUND

Anxiety and depression are significant contributors to adverse outcomes in patients with colon cancer (CC). Therefore, investigating the key determinants of this psychological distress in such patients is essential.

AIM

To examine the correlation of anxiety/depression status with stress-related markers and cancer-related fatigue (CRF), along with associated risk factors in patients with CC.

METHODS

The study enrolled 120 patients with CC treated at the Affiliated Yongchuan Hospital of Chongqing Medical University between February 2022 and February 2025. Initially, patients’ anxiety [Self-Rating Anxiety Scale (SAS)] and depression [Self-Rating Depression Scale (SDS)] status were assessed first and then stratified into the anxiety/depression group (n = 62, SAS ≥ 50 or SDS ≥ 53) and control group (n = 58). Comparative assessments were conducted for stress-related markers [heat shock protein 70 (HSP70) and C-reactive protein (CRP)] and CRF [Brief Fatigue Inventory-Chinese version (BFI-C)] at three measurement time points: Preoperative (T0), postoperative day 3 (T1), and postoperative day 7 (T2). Correlations between anxiety/depression status and HSP70, CRP, and BFI-C in patients with CC were analyzed using Pearson’s method, whereas univariate and multivariate regression identified independent predictors of anxiety or depressive symptoms in such patients.

RESULTS

The analysis revealed prevalence rates of 30.00% for anxiety and 38.33% for depression among the 120 patients with CC, of whom 51.67% exhibited either condition, and 16.67% showed comorbidity. Both groups showed an initial increase in HSP70, CRP, and BFI-C followed by a decrease compared with those at T0, with the anxiety/depression group exhibiting markedly higher levels of HSP70, CRP, and BFI-C at T1 and T2. Subsequent correlation analysis revealed strong positive correlations between SAS and SDS scores and HSP70, CRP, and BFI-C concentrations. Univariate analysis identified sex, age, marital status, monthly household income, tumor stage, and comorbidities as factors closely associated with anxiety or depression. Multivariate analysis further established female sex [odds ratio (OR) = 2.755], age ≥ 60 years (OR = 2.649), and advanced tumor stage (III-IV, OR = 2.349) as independent predictors of anxiety or depression in patients with CC.

CONCLUSION

A subset of patients with CC exhibits anxiety and depressive symptoms, which are significantly positively correlated with stress-related markers and CRF. Moreover, patients with CC, female patients, those aged 60 years or older, and patients diagnosed with stage III-IV tumors are more prone to anxiety or depression.

Keywords: Colon cancer; Anxiety; Depression; Stress-related markers; Cancer-related fatigue

Core Tip: Focusing on patients with colon cancer (CC; n = 120), this study comprehensively explored psychological and clinical correlates. Results indicated anxiety/depression in over 50% of patients with CC, with symptoms primarily falling into the mild category. Notably, anxiety and depression correlated significantly and positively with stress-related factors (heat shock protein 70 and C-reactive protein) and cancer-induced fatigue. Moreover, certain clinical features—specifically being female, being 60 years old or older, and having a stage III or IV tumor—were confirmed to increase the risk of patients with CC to developing anxiety or depression. These results offer valuable evidence-based support for clinical practice, such as screening for psychological distress, classifying patients by risk level, and implementing tailored psychological support for patients with CC.