Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies - Wang 2020

The link between depression, anxiety, and the outcome of cancer has been studied a lot, but it is still not clear. We looked at the link between depression and anxiety, as measured by symptom scales or clinical diagnoses, and the risk of getting cancer, dying from cancer, and dying from any cause in cancer patients. In a meta-analysis, random effects or fixed effects models were used, as needed, to get pooled estimates of the relative risks (RRs) of getting cancer and dying from it. Associations were tested in smaller groups based on different aspects of the study and the people who took part in it. We found 51 eligible cohort studies that had a total of 2,611,907 participants and a mean follow-up time of 10.3 years. Overall, depression and anxiety were linked to a significantly higher risk of getting cancer (adjusted RR: 1.13, 95% CI: 1.06–1.19), dying from cancer (1.21, 1.16–1.26), and dying from any cause in cancer patients (all-cause mortality) (1.24, 1.13-1.35). The estimated absolute risk increases (ARIs) for cancer incidence due to depression and anxiety were 34.3 events/100,000 person years (15.8-50.2) and 28.2 events/100,000 person years (21.5-34.9). Subgroup analyses showed that clinically diagnosed depression and anxiety were linked to a higher risk of getting cancer, a shorter time of living with cancer, and a higher death rate from cancer. Psychological distress, like depression and anxiety symptoms, was linked to higher cancer-specific mortality and shorter cancer survival times, but not to more cancers. Site-specific analyses showed that depression and anxiety were linked to a higher risk of getting lung, oral cavity, prostate, and skin cancers, as well as a higher risk of dying from lung, bladder, breast, colorectum, hematopoietic system, kidney, and prostate cancers. Lung cancer patients also had a higher risk of dying from any cause. These analyses suggest that depression and anxiety may play a role in the cause and prognosis of cancer, though there is a chance of reverse causation. There was also a lot of variation between the studies, so the results should be taken with a grain of salt. Depression and anxiety are common in the general population and in people with cancer, so it's important to find them early and treat them well.

Wang, Y. H., Li, J. Q., Shi, J. F., Que, J. Y., Liu, J. J., Lappin, J. M., Leung, J., Ravindran, A. V., Chen, W. Q., Qiao, Y. L., Shi, J., Lu, L., & Bao, Y. P. (2020). Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Molecular psychiatry, 25(7), 1487–1499. https://doi.org/10.1038/s41380-019-0595-x