Temporal trends in self-reported general and mental health status among colorectal cancer patients: racial/ethnic disparities in a population-based analysis

Purpose: Patient-reported outcomes are essential to patient-centered cancer care. We sought to determine the relationships between colorectal cancer (CRC) diagnosis and trends in self-reported general health status (GHS) and mental health status (MHS) among racial/ethnic groups.

Methods: We used population-based Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify CRC patients diagnosed from 1996 to 2011 who reported GHS and/or MHS on a CAHPS survey within 6 years before or after diagnosis and were 65 or older at survey completion. Multivariable logistic regression assessed relationships of patient race/ethnicity and CRC diagnosis with the odds of reporting fair or poor GHS or MHS.

Results: Five thousand five hundred forty-five patients reported GHS and/or MHS within 6 years before CRC diagnosis and 4,604 reported GHS and/or MHS within 6 years after diagnosis. 80.9% were non-Hispanic white (NHW), 7.1% were non-Hispanic black (NHB), 6.7% were Hispanic, and 5.3% were non-Hispanic Asian. Being diagnosed with CRC was associated with increased odds of reporting fair or poor GHS (OR = 1.55, 95% CI = 1.40-1.72) and MHS (OR = 1.33, 95% CI = 1.13-1.58). For GHS, this trend held for all race/ethnicities except NHBs, and for MHS, this trend held for NHWs and Hispanics only.

Conclusion: CRC diagnosis is an important driver of increased likelihood of fair and poor GHS and MHS, but the relationship is complicated by effect modification by race/ethnicity. Efforts to further understand the race/ethnicity-specific relationships between CRC diagnosis and declines in GHS and MHS are necessary to promote equitable care for all patients.