Onset of Depression Among Gastrointestinal Cancer Survivors: An "All of Us" Research Program Study.

Abstract

Background: Depression is common among individuals with cancer and has been associated with impaired quality of life, reduced treatment adherence, and increased morbidity and mortality. We sought to characterize the timing and predictors of early- and late-onset depression among adults with gastrointestinal (GI) cancer.

Methods: Adults aged ≥18 years with a diagnosis of GI cancer were identified from the "All of Us" Research Program V8. Incident depression was defined as new clinical diagnosis following cancer diagnosis and its onset was categorized as early (<5 years) or late (≥5 years). Multinomial logistic regression and Cox proportional hazards models were used to evaluate association with sociodemographic factors, cancer subtype, baseline anxiety, and treatment.

Results: Among 4,349 individuals, 68.2% (n=2,964) patients developed incident depression with 54.3% (n=2,360) of patients classified as having early-onset depression. On multivariable analysis, younger age was associated with lower odds of both early- (aOR 0.99, 95%CI 0.98-0.99) and late-onset depression (aOR 0.97, 95%CI 0.96-0.98), whereas female sex was associated with higher odds of early- (aOR 1.20, 95%CI 1.01-1.44) and late-onset depression (aOR 1.31, 95%CI 1.01-1.70). Compared with colorectal cancer, esophageal (aOR 1.74, 95%CI 1.19-2.56), pancreatic (aOR 1.59, 95%CI 1.25-2.02) and liver/hepatic bile duct (aOR 1.51, 95%CI 1.23-1.86) cancer were associated with higher odds of early-onset depression.

Discussion: Depression was common among GI cancer survivors and frequently emerged years after diagnosis. These findings underscore the importance of longitudinal, risk-stratified mental health screening throughout GI cancer survivorship, extending beyond periods of active treatment.