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Do depression and anxiety affect cancer prognosis?

Depression and anxiety are associated with breast cancer recurrence and mortality. However, anxiety is less associated with these outcomes compared to depression.

Image Credit: Kulli Kittus on Unsplash

Almost everyone knows somebody that has been affected by cancer, and maybe even breast cancer specifically. This is because breast cancer is a very common type of cancer and contributes to many of the deaths of women across the world. The high death rate from breast cancer is partially due to the fact that the cancer often returns after being gone for a while, which is called recurrence. Breast cancer frequently spreads from the original tumor to other parts of the body, a process known as metastasis. This contributes to the high death rate as well. 

Depression and anxiety are also very common illnesses. However, there is still much research to be done into how mental disorders can affect physical diseases. Getting diagnosed with breast cancer and going through the necessary treatment can impact a patient’s physical appearance, how they interact with others, and their outlook on life. All of this combined can take a toll on a patient’s mental health, which could explain why they are more likely to develop a mental illness. Researchers have looked at the idea that psychological factors might be a future indicator of whether a patient will die from breast cancer, but none of the results were consistent. 

A recent study examined the question of whether mental disorders, specifically depression and anxiety, are associated with breast cancer coming back or the patient dying from breast cancer. The scientists performed a meta-analysis, which is when they analyze data from multiple independent studies examining the same question and try to find trends in this compiled data using statistics. This gives the scientists a larger dataset to use to answer their research question.

The researchers searched electronic databases for studies that examined their research question or a part of the question. They then filtered the studies based on quality control criteria, which rates the studies based on how they picked the patients and controls, what factors were controlled for, and how they got the results. They only included studies that were rated as “good” or “fair.” The researchers ended up with 17 cohort studies in their meta-analysis. 

The team performed statistical analyses to determine if there were links between clinical outcomes, like surviving and remaining cancer-free. The statistical analyses performed also looked at how many patients died from breast cancer and from any cause.

The statistical analyses indicated that depression increases the likelihood of breast cancer coming back by around 24% and the likelihood of the patient dying from any cause by 30%. Depression also increases the likelihood by 29% that the patient will die from their breast cancer specifically. Analyzing the studies showed that anxiety increased the risk of breast cancer coming back by 17% and the risk for death from any cause by 13% but did not increase the risk of death from breast cancer specifically. In addition, when patients had both depression and anxiety, risk of death from any cause and risk of breast cancer coming back increased.

The results from this study suggest that depression is more strongly associated with breast cancer progressing faster and breast cancer-specific deaths than anxiety. A patient that has both depression and anxiety at the same time has the highest risk. There may be factors that are more common in people with anxiety or depression, such as smoking, obesity, or insomnia, which are also associated with an increased risk of death, and this could blur the true impact of individual factors. The effects of anxiety and depression can also cause higher death rates in breast cancer patients because they can cause patients to skip treatments and cause stress, which can accelerate tumor growth. 

This study shows that treating mental health issues, such as depression and anxiety, can potentially have positive effects on the recovery from difficult and deadly diseases, such as breast cancer. The treatment of breast cancer patients should include more attention and resources dedicated to the mental stress and disorders that can come along with battling cancer. 

These results emphasize the importance of educating all healthcare workers and patients on how poor mental health can affect recovery so that they can keep an eye out for any issues and work on them as soon as possible. Researchers should look further into how depression and anxiety affect the outcomes of other cancer types to potentially improve recovery rates for more people. 

Study Information

Original study: Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients

Study was published on: August 20, 2020

Study author(s): Xuan Wang, Neng Wang, Lidan Zhong, Shengqi Wang, Yifeng Zheng, Bowen Yang, Juping Zhang, Yi Lin, and Zhiyu Wang

The study was done at: The Second Clinical College of Guangzhou University of Chinese Medicine (China), Guangdong Provincial Hospital of Chinese Medicine (China), Guangzhou University of Chinese Medicine (China), Hong Kong Baptist University (Hong Kong, China)

The study was funded by: The National Natural Science Foundation Of China, Guangdong Science And Technology Department, Guangdong High-Level Personnel Of Special Support Program, Department Of Education Of Guangdong Province, Guangdong Traditional Chinese Medicine Bureau Project, The Ph.D. Start-Up Fund Of Natural Science Foundation Of Guangdong Province, Science And Technology Planning Project Of Guangdong Province, Guangzhou Science And Technology Project, The Specific Research Fund For TCM Science And Technology Of Guangdong Provincial Hospital Of Chinese Medicine , And The Foundation For Young Scholars Of Guangzhou University Of Chinese Medicine

Raw data availability: Not supplied.

Featured image credit: Kulli Kittus on Unsplash

This summary was edited by: Erica Curles