Abstract C059: Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality
Authors: Nair Mrudula , Patel Pranali , Dagli Chaitali S , Al-Antary Nada , Babatunde Oluwole A , Osazuwa-Peters Nosayaba , Boakye Eric Adjei 
Published: September 2024

Abstract
Introduction: Cancer survivorship often entails considerable psychological distress. Colorectal cancer (CRC) presents distinct stressors including the use of colostomy and multimodality treatments resulting in side effects for many patients. These factors increases the likelihood of social isolation, body image issues, intimacy problems, and marital strain which affect mental health of CRC survivors. However, information about the prevalence of psychological distress in this population and its association with clinical outcomes are lacking. We examined the prevalence of psychological distress and its association with emergency room usage (ER) and all-cause mortality among CRC survivors. Methods: We utilized data from the 2000-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files. The NHIS is an annual cross-sectional, nationally representative, in-person survey of the civilian, noninstitutionalized population in the United States. The main exposure was psychological distress, assessed with the six-item Kessler Psychological Distress Scale (K6) and classified as (no/low, moderate, severe). The outcomes were ER usage during the past 12 months and all-cause mortality. Multivariable logistic and Cox proportional hazards models were used to examine the associations between psychological distress, and ER usage and all-cause mortality, respectively. The models were adjusted for age, gender, survey year, race/ethnicity, marital status, education, smoking, geographic region, visit to mental professionals, general health status, comorbidities, and time since cancer diagnosis. Results: A total of 3198 CRC survivors were included in the study, of whom 4.1% and 19.6% reported severe and moderate psychological distress, respectively. In the 12 months preceding the survey, 29.8% of CRC survivors had ER usage and 41.5% deaths occurred with a median follow-up of 84 months. In the adjusted model, compared to CRC survivors with low/no psychological distress, those with severe (aOR=1.86; 95% CI, 1.11–3.10) or moderate (aOR=1.60; 95% CI, 1.22–2.11) psychological distress had high odds of reporting ER use. Similarly, after adjusting for covariates, CRC survivors with severe (aHR =1.32; 95% CI, 1.30–1.34) or moderate (aHR =1.02; 95% CI, 1.01–1.02) psychological distress had higher risk of all-cause mortality compared with survivors experiencing low/no psychological distress. Conclusion: CRC survivors with severe or moderate psychological distress have higher ER usage and all-cause mortality. This finding emphasizes the significance of timely identifying and addressing psychological distress to improve quality of life and clinical outcomes of patients diagnosed with CRC. Integrating mental health support into routine cancer care may reduce distress levels, potentially leading to fewer ER usage and lower mortality rates among CRC survivors.
Citation Format: Mrudula Nair, Pranali Patel, Chaitali S Dagli, Nada Al-Antary, Oluwole A Babatunde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C059.