Abstract LB330: Psychological distress, functional impairment, and survival: A retrospective study of cancer survivors in Mexico
Authors: Heidy N. Medina, Patricia I. Moreno, Frank J. Penedo, Matthew P. Schlumbrecht, Johis Ortega, Erika Ruiz-García, Oscar Galindo Vázquez
Journal: Cancer Research (2025)

Abstract Background: Functional impairment is associated with worse quality of life, symptom burden, and clinical outcomes among individuals with cancer. In Mexico, a middle-income country with a rapidly aging population and rise in cancer cases, there is a lack of research on cancer survivorship challenges, including functional impairment and psychological distress. This study examines the association between functional status, psychological distress (i.e., anxiety and depression), and survival among cancer survivors in Mexico. Methods: A retrospective analysis of cancer patients (N = 967) at the Instituto Nacional de Cancerología in Mexico during 2017 to 2023 was conducted. Cancer-related variables were extracted from the electronic medical record. Patients were administered the Hospital Anxiety and Depression Scale (HADS), and functional status was determined by the Eastern Cooperative Oncology Group (ECOG) performance scale. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Exploratory all-cause Cox proportional hazards regression analyses were performed. Results: The median age was 61 (IQR: 52-69), 70% were women, 44% were married, and 30% had only a basic elementary school education. Patients had breast (35%), lung (24%), prostate (21%), and cervical (20%) cancer with 34% presenting at Stage IV. More than half had ECOG 0 status (61%), 34% ECOG 1 status, 3% ECOG 2 status, and less than 1% ECOG 3 status. After adjusting for age, sex, education level, marital status, cancer type, stage, treatment type, comorbidities, and alcohol use, patients with ECOG 1 status (limitations in strenuous activity only) had a higher likelihood of experiencing symptoms of anxiety (OR 1.72, 95% CI: 1.06-2.78) compared to those with ECOG 0 (no restrictions). Patients with ECOG 2 status (unable to carry out work activities, restricted to self-care only) had a higher likelihood of experiencing depression symptoms (OR 3.66, 95% CI: 1.23-10.88) compared to those with ECOG 0 status, adjusting for the same covariates. There were no differences between ECOG 1 and 2 status patients. Exploratory survival analyses showed that cancer survivors with symptoms of depression had a 3.5-fold higher risk of death (HR 3.50, 95% CI: 1.64-7.45) than those with no symptoms, after taking into account functional status and all covariates listed above. Symptoms of anxiety were not associated with risk of all-cause death. Conclusions: Psychological distress is linked with functional impairments among Mexican cancer survivors. Symptoms of depression also predict worse survival outcomes. Findings highlight the importance of timely screening and identification of psychological distress and functional impairment to optimize clinical management. Future research should investigate the underlying mechanisms via which depressive symptomology may impact survival. Citation Format: Heidy N. Medina, Patricia I. Moreno, Frank J. Penedo, Matthew P. Schlumbrecht, Johis Ortega, Erika Ruiz-García, Oscar Galindo Vázquez. Psychological distress, functional impairment, and survival: A retrospective study of cancer survivors in Mexico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr LB330.