title: A cohort study on the evolution of psychosocial problems in older patients with breast or colorectal cancer: comparison with younger cancer patients and older primary care patients without cancer.
abstract: BACKGROUND
  Although older cancer survivors commonly report psychosocial problems, the impact of both cancer and ageing on the occurrence of these problems remains largely unknown. The evolution of depression, cognitive functioning, and fatigue was evaluated in a group of older cancer patients in comparison with a group of younger cancer patients and older persons without cancer.
  
  
  METHODS
  Older (≥70 years) and younger cancer patients (50-69 years) with breast or colorectal cancer stage I-III, and older persons without cancer (≥70 years) were included. Data were collected at baseline and one year follow-up and were available for 536 persons. Depression was evaluated with the 15-item Geriatric Depression Scale. Cognitive functioning was measured with the cognitive functioning subscale of the European Organization for Research and Treatment of Cancer. Fatigue was measured with a Visual Analogue Scale. Risk factors for depression, cognitive functioning, and fatigue were analysed using multivariate logistic regression analyses. Risk factors included cancer- and ageing-related factors such as functional status, cancer treatment, and comorbidities.
  
  
  RESULTS
  The evolution of psychosocial problems was similar for the group of older (N = 125) and younger cancer patients (N = 196): an increase in depression (p < 0.01), slight worsening in cognitive functioning (p = 0.01), and no clear change in fatigue. Also, compared to the group of people without cancer (N = 215), the differences were small and after one year of follow-up only depression was more frequent in older cancer patients compared to older persons without cancer (18% versus 9%, p = 0.04). In multivariate analyses the main risk factors for psychosocial problems after one year follow-up were changes in functional status and presence of baseline depression, fatigue, or cognitive impairment.
  
  
  CONCLUSIONS
  Over the course of one year after a diagnosis of cancer, cancer patients face increasing levels of depression and increasing difficulties in cognitive functioning. The main risk factor for psychosocial problems was presence of the problem at baseline. This calls for regular screening for psychosocial problems and exchange of information on psychosocial functioning between different health care providers and settings during the treatment and follow-up trajectory of cancer patients.
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Laura.deckx@med.kuleuven.be.
authors.forename: Laura
authors.initials: L
authors.lastname: Deckx
authors.affiliation: Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands. doris.van.abbema@mumc.nl.
authors.forename: Doris L
authors.initials: DL
authors.lastname: van Abbema
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Marjan.vandenakker@maastrichtuniversity.nl.|Department of Family Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. Marjan.vandenakker@maastrichtuniversity.nl.
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. carine.vandenbroeke@med.kuleuven.be.
authors.forename: Carine
authors.initials: C
authors.lastname: van den Broeke
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Building 16/910, Royal Brisbane and Women's Hospital, Brisbane, 4029, QLD, Australia. m.vandriel@uq.edu.au.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Driel
authors.affiliation: Limburgs Oncologisch Centrum, Stadsomvaart 11, 3500, Hasselt, Belgium. paul.bulens@jessazh.be.
authors.forename: Paul
authors.initials: P
authors.lastname: Bulens
authors.affiliation: Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands. vcg.tjan.heijnen@mumc.nl.
authors.forename: Vivianne C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.affiliation: Department of General Medical Oncology, University Hospitals Leuven, UZ Herestraat 49 - box 815, 3000, Leuven, Belgium. cindy.kenis@uzleuven.be.
authors.forename: Cindy
authors.initials: C
authors.lastname: Kenis
authors.affiliation: Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. eric.dejonge@zol.be.
authors.forename: Eric T
authors.initials: ET
authors.lastname: de Jonge
authors.affiliation: Department of Abdominal and Oncological Surgery, Jessa Hospital - Campus Salvator, Salvatorstraat 20, 3500, Hasselt, Belgium. bert.houben@jessazh.be.
authors.forename: Bert
authors.initials: B
authors.lastname: Houben
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Frank.buntinx@med.kuleuven.be.|Department of Family Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. Frank.buntinx@med.kuleuven.be.
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D000367:Age Factors; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011584:Psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data