title: Psychosocial predictors of health outcomes in colorectal cancer: a comprehensive review.
abstract: BACKGROUND
  A diagnosis of colorectal cancer (CRC) and its long-term treatment may lead to significant psychological distress and impaired health-related quality of life (HRQoL) for a significant proportion of patients.
  
  
  METHODS
  We searched the PubMed/MEDLINE electronic database for available literature on the associations between personality characteristics, depression, psychological distress and HRQoL in CRC. Additional references were identified through the citation tracking of the included articles.
  
  
  RESULTS
  Recent evidence indicates that Type-D (distressed) personality may predict distress among CRC patients. Additionally, other personality traits, such as specific ego defense mechanisms, influence the coping responses and HRQoL. Although the presence of a stoma has been linked to the development of depressive symptoms and impairment in HRQoL in CRC patients, more prospective studies are necessary to confirm these associations. Sense of coherence (SOC) has both a moderating and mediating effect on health (especially mental health and HRQoL), and preliminary data indicate that SOC may be an independent predictor of CRC survival.
  
  
  CONCLUSIONS
  The interplay between personality variables during the elaboration of "the impaired role" is complex, and the assessment of personality traits may be incorporated into a comprehensive psychosomatic evaluation of CRC patients. More well-designed prospective investigations are necessary to establish the contributory role of personality dimensions for the development of and protection from distress and impairment in the HRQoL of CRC patients, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population (for example, manual-based psychotherapies).
authors.affiliation: Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Paulo M G
authors.initials: PM
authors.lastname: Sales
authors.affiliation: Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Mood Disorders Psychopharmacology Unit (MDPU) and Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Department of Medical Oncology, Medical School, University of Ioannina, Greece.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pavlidis
authors.affiliation: Department of Psychiatry, Medical School, University of Ioannina, Greece. Electronic address: tyfantis@cc.uoi.gr.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Hyphantis
mesh_terms: D000223:Adaptation, Psychological; D000339:Affect; D000342:Affective Symptoms / Q000150:complications; D001007:Anxiety / Q000209:etiology; D001828:Body Image; D015179:Colorectal Neoplasms / Q000473:pathology / Q000523:psychology*; D015897:Comorbidity; D003674:Defense Mechanisms; D003863:Depression / Q000209:etiology; D018450:Disease Progression; D004766:Enterostomy / Q000523:psychology*; D006304:Health Status; D006801:Humans; D010551:Personality; D011237:Predictive Value of Tests; D039781:PubMed; D011788:Quality of Life; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: Alexithymia; Colorectal cancer; Coping strategies; Depression; Ego defense mechanisms; Oncology; Personality; Psychological distress; Quality of Life; Sense of coherence