Disease stage predicts post-diagnosis anxiety and depression only in some types of cancer

Background:

We hypothesised that patients with advanced disease or a cancer type that has a poor prognosis may be more likely to report anxiety and depressive symptoms after diagnosis; younger age and female gender may moderate these effects.

Methods:

Patients (n=3850) were consecutively assessed with PSSCAN, a standardised, validated tool, at two large cancer centres between 2004 and 2009.

Results:

Female patients reported more anxiety and depressive symptoms (P=0.003 to P<0.001) compared with men and a healthy comparison group. Older age was associated with fewer anxiety (P=0.033 to P<0.001) and fewer depressive symptoms (P<0.001), but this was not true for lung cancer. Presence of metastases was associated with more anxiety symptoms in patients with gastrointestinal (P=0.044; R²Δ=0.001), lung (P=0.011; R²Δ=0.016), and prostate (P=0.032; R²Δ=0.008) cancer, but this was not true for breast cancer. Furthermore, early disease stage was associated with fewer depressive symptoms among older prostate cancer patients (P=0.021; R²Δ=0.008). Men with early lung cancer reported fewer anxiety (P=0.020; R²Δ=0.013) and depressive (P=0.017; R²Δ=0.016) symptoms than men with advanced disease or women.

Conclusion:

As hypothesised, disease stage was directly associated with emotional distress, except for patients with breast cancer. Furthermore, age and gender moderated some of these effects.