Register TodayEarn Free CME Credits by reading the latest medical newsin your specialty.Sign Up
By John Gever, Deputy Managing Editor, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse PlannerAnxiety, not depression, is the most common mental health issue facing long-term cancer survivors and their spouses.Note that the study suggests that efforts should be made to improve the identification and treatment of anxiety in long-term cancer survivors and their spouses.Anxiety, not depression, is the most common mental health issue facing long-term cancer survivors and their spouses, a large meta-analysis found.
With data pooled from 26 studies, rates of depression in people surviving at least 2 years after a cancer diagnosis did not differ significantly from those seen in controls (relative risk 1.11, 95% 0.96-1.27, P=0.17), whereas anxiety was significantly more frequent in the survivors (RR 1.27, 95% CI 1.08-1.50, P=0.0039), according to Alex J. Mitchell, MD, of Leicester Partnership Trust in Leicester, England, and colleagues.
Rates of both depression and anxiety were similar among long-term survivors and their spouses included in 17 studies, although the data from those analyses suggested that women worried more than men irrespective of whether they were survivors or spouses.
"Our findings underline the importance of detection and treatment of anxiety disorders, not only depression," Mitchell and colleagues wrote in Lancet Oncology, adding that future research should address these conditions among patients receiving noncurative, palliative care.
In an accompanying commentary, Julia Addington-Hall, MD, of the University of Southampton in England, said the study sheds light on an under-recognized psychological effect of cancer survivorship.
"Much of this [past] research has been focused on depression, with anxiety being neglected by comparison," she wrote.
"The increased risk of anxiety [shown in the current analysis] in long-term cancer survivors justifies taking a fresh look at anxiety in these patients, including methods for identification of those at high risk, and provision of appropriate care and treatment."
Another cancer specialist, Ashley Sumrall, MD, of Carolinas Healthcare's Levine Cancer Institute in Charlotte, N.C., said anxiety needs to be addressed in cancer patients.
"Most of our cancer patients suffer from anxiety and depression that impact their quality of life," she told MedPage Today. "In the past, we tended to lump these two together, when, in fact, anxiety can impact the patient's care more than depression can. Anxiety increases levels of stress in the body and can also correlate with poorer outcomes. We've seen that time and time again."
In the study, Mitchell and colleagues searched the published literature for studies on prevalence of mood disorders among spouses and patients who had survived at least 2 years with a cancer diagnosis. They found a total of 16 that compared prevalences of depression and/or anxiety in cancer survivors versus healthy controls, and another 12 assessing these conditions in survivors and their spouses.
Some of these studies were based on national registry data and were quite large -- one drew on the U.K. General Practice Research Database and included data on more than 26,000 patients and 104,000 matched controls.
Pooled data from the studies on survivors versus controls yielded the following results: Depression prevalence: 11.6% in survivors (95% CI 7.7%-16.2%), 10.2% in controls (95% CI 8.0%-12.6%)Anxiety prevalence: 17.9% in survivors (95% CI 12.8%-23.6%), 13.9% in controls (95% CI 9.8%-18.5%)
For both calculations, excluding one study that Mitchell and colleagues considered to be a "methodological outlier" did not change the findings.
However, when the researchers included data from the component studies on patients diagnosed with cancer less than 2 years previously, they found that depression was significantly increased in that group relative to those with less recent diagnoses (RR 1.74 relative to diagnoses 2 to 10 years previously, P=0.0009).
The comparisons of depression and anxiety in survivors versus their spouses yielded the following: Depression prevalence: 26.7% in survivors (95% CI 19.8%-34.2%), 26·3% in spouses (95% CI 18.4%-35.0%)Anxiety prevalence: 28.0% in survivors (95% CI 22.3%-33.9%), 40.1% in spouses (95% CI 25.4%-55.9%)
Neither the prevalence of depression nor the prevalence of anxiety differed significantly between cancer patients and their spouses
The difference in anxiety prevalence did not reach statistical significance (RR 0.71, 95% CI 0.44 to 1.14), but that appeared to be because one of the five studies contributing to the analysis was sharply at odds with the other four.
That one study -- involving gynecologic cancer survivors -- showed a tripled rate of anxiety in the patients versus their spouses (RR 3.26, 95% CI 1.64-6.78), whereas the other four all showed reduced rates of anxiety in the patients relative to their spouses.
When the outlier study was excluded, the analysis of the remaining four showed significantly less anxiety among the cancer survivors (RR 0.54, 95% CI 0.42-0.69).
And of those four studies, the one with the largest patient-spouse imbalance in anxiety prevalence, with a relative risk of 0.36, involved prostate cancer survivors -- suggesting that wives may suffer from cancer-related anxiety more than their husbands, regardless of which one of them is the cancer patient.
Limitations to the study cited by Mitchell and colleagues included the usual caveats attached to meta-analyses, as well as a frequent lack of detail in the original studies on patients' mental status or on recruitment methods for healthy controls. Matching of controls to patients was variable in the studies, the researchers also noted. Overall, heterogeneity among studies was high, but there was no evidence of publication bias and excluding methodological outliers had no impact on most results.
The study had no external funding.
Study authors and the editorialist declared they had no relevant financial interests.
John Gever
Senior Editor
John Gever, Senior Editor, has covered biomedicine and medical technology for 30 years. He holds a B.S. from the University of Michigan and an M.S. from Boston University. Now based in Pittsburgh, he is the daily assignment editor for MedPage Today as well as general factotum on the reporting side. Go Pirates/Penguins/Steelers!
0 comments:
Post a Comment