Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis
Background: Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls. Methods: We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls. Findings: Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11�6% (95% CI 7�7�16�2) in the pooled sample of 51 381 cancer survivors and 10�2% (8�0�12�6) in 217 630 healthy controls (pooled relative risk [RR] 1�11, 95% CI 0�96�1�27; p=0�17). The prevalence of anxiety was 17�9% (95% CI 12�8�23�6) in 48 964 cancer survivors and 13�9% (9�8�18�5) in 226 467 healthy controls (RR 1�27, 95% CI 1�08�1�50; p=0�0039). Neither the prevalence of depression (26�7% vs 26�3%; RR 1�01, 95% CI 0�86�1�20; p=0�88) nor the prevalence of anxiety (28�0% vs 40�1%; RR 0�71, 95% CI 0�44�1�14; p=0�16) differed significantly between cancer patients and their spouses. Interpretation: Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses. Funding: None.