title: Hope, optimism and survival in a randomised trial of chemotherapy for metastatic colorectal cancer.
abstract: OBJECTIVE
  Psychological responses to cancer are widely believed to affect survival. We investigated associations between hope, optimism, anxiety, depression, health utility and survival in patients starting first-line chemotherapy for metastatic colorectal cancer.
  
  
  METHODS
  Four hundred twenty-nine subjects with metastatic colorectal cancer in a randomised controlled trial of chemotherapy completed baseline questionnaires assessing the following: hopefulness, optimism, anxiety and depression and health utility. Hazard ratios (HRs) and P values were calculated with Cox models for overall survival (OS) and progression-free survival (PFS) in univariable and multivariable analyses.
  
  
  RESULTS
  Median follow-up was 31 months. Univariable analyses showed that OS was associated negatively with depression (HR 2.04, P < 0.001) and positively with health utility (HR 0.56, P < 0.001) and hopefulness (HR 0.75, P = 0.013). In multivariable analysis, OS was also associated negatively with depression (HR 1.72, P < 0.001) and positively with health utility (HR 0.73, P = 0.014), but not with optimism, anxiety or hopefulness. PFS was not associated with hope, optimism, anxiety or depression in any analyses.
  
  
  CONCLUSIONS
  Depression and health utility, but not optimism, hope or anxiety, were associated with survival after controlling for known prognostic factors in patients with advanced colorectal cancer. Further research is required to understand the nature of the relationship between depression and survival. If a causal mechanism is identified, this may lead to interventional possibilities.
authors.affiliation: Department of Psychology, Swinburne University of Technology, John Road, Hawthorn, Australia. pschofield@swin.edu.au.|Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Australia. pschofield@swin.edu.au.|Sir Peter MacCallum Department of Oncology, and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. pschofield@swin.edu.au.
authors.forename: Penelope E
authors.initials: PE
authors.lastname: Schofield
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: M R
authors.initials: MR
authors.lastname: Stockler
authors.affiliation: Ludwig Institute Oncology Unit, Ludwig Institute for Cancer Research, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Zannino
authors.affiliation: Ludwig Institute Oncology Unit, Ludwig Institute for Cancer Research, Melbourne, Australia.
authors.forename: N C
authors.initials: NC
authors.lastname: Tebbutt
authors.affiliation: Department of Oncology, Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: T J
authors.initials: TJ
authors.lastname: Price
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Simes
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Pavlakis
authors.affiliation: Department of Medical Oncology, St John of God Hospital, Subiaco, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Ransom
authors.affiliation: Department of Medical Oncology, Liverpool Hospital, Sydney, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Moylan
authors.affiliation: Border Medical Oncology, Wodonga, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Underhill
authors.affiliation: Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia.|School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Wyld
authors.affiliation: Department of Oncology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Burns
authors.affiliation: Prince of Wales Clinical School and Lowy Cancer Research Centre, Faculty of Medicine, UNSW, Sydney, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Ward
authors.affiliation: Department of Medical Oncology, Westmead Hospital, Sydney, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Wilcken
authors.affiliation: Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Australia.|Sir Peter MacCallum Department of Oncology, and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Jefford
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000209:etiology; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000523:psychology; D003866:Depressive Disorder / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D000067656:Optimism; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires
keywords: Colorectal cancer; Depression; Health utility; Hope; Optimism; Survival