Objective: This study aimed to evaluate the association between distress at initial diagnosis and disease-free survival in patients with resectable colon cancer.

Summary background data: Considerable research has examined the psychological impact of having a confirmed diagnosis of cancer, but relatively limited research has examined the impact of distress during diagnostic phase on oncological outcomes.

Methods: This is a retrospective cohort study. We included newly diagnosed colon cancer patients who had resectable surgery and underwent distress screening between July 2014 and July 2021 (N=1,362). The Korean versions of the Distress Thermometer (DT) were used to assess distress and related problems. Patients were categorized into three groups based on distress score: low (<4), moderate (4-7), and severe (≥8). The primary outcome was disease free survival (DFS).

Results: The mean distress was 5.1 (SD=2.4) and 61%, and 15% patients had moderate and severe distress at diagnosis, respectively. The severe distress group was more likely to report fear, sadness, and concerns regarding insurance/finance, work, and childcare than low distress group. Compared to the low distress group, the severe distress group had worse DFS (HR=1.84, 95% CI=1.03, 3.29). The association was more evident in patients with stage IV disease (HR=2.53, 95% CI=1.02, 6.25).

Conclusions: A substantial number of patients with colon cancer experience distress at diagnosis, and severe distress has a negative impact on oncologic outcomes. Active monitoring and appropriate management of distress at diagnosis should be adopted at clinical settings.