Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Apr 19, 2022; 12(4): 623-635
Published online Apr 19, 2022. doi: 10.5498/wjp.v12.i4.623
Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review
Anne Bach, Klara Knauer, Johanna Graf, Norbert Schäffeler, Andreas Stengel
Anne Bach, Klara Knauer, Johanna Graf, Norbert Schäffeler, Andreas Stengel, Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
Andreas Stengel, Germany & Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin 10117, Germany
Author contributions: Bach A wrote the paper; Bach A, Knauer K and Graf J screened the literature; Graf J and Stengel A planned and supervised the project and thoroughly revised the paper; Schäffeler N thoroughly revised the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andreas Stengel, MD, PhD, Professor, Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr 5, Tübingen 72076, Germany. andreas.stengel@med.uni-tuebingen.de
Received: August 31, 2021
Peer-review started: August 31, 2021
First decision: December 12, 2021
Revised: December 20, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 19, 2022
Processing time: 224 Days and 11 Hours
Abstract
BACKGROUND

Psychiatric disorders are common but underdiagnosed in cancer survivors. Research suggests that tumor type has an effect on the prevalence of clinically relevant depression, anxiety, comorbid anxiety-depression and posttraumatic stress disorder (PTSD).

AIM

To identify studies that examined the prevalence of clinically relevant levels of depression, anxiety, comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.

METHODS

Four databases (PubMed, PsycInfo, PubPsych and the Cochrane Database) were searched and resulted in a total of 2387 articles to be screened. To be included, a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities. All articles were screened by two authors with a third author reviewing debated articles.

RESULTS

Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review. The studies showed heterogeneity regarding the study characteristics, number of participants, time since diagnosis, and assessment tools. Generally, all four comorbidities show higher prevalences in cancer survivors than the general population. Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety. Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities. Regarding comorbidities, a wide range in prevalence existed across the tumor types. Within one cancer site, the prevalence also varied considerably among the studies.

CONCLUSION

Psychiatric comorbidities are more frequent in cancer survivors than in the general population, as reflected by the prevalence of depression, anxiety, comorbid anxiety-depression and PTSD across all tumor subtypes. Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.

Keywords: Cancer survivor; Cancer type; Prevalence; Psychiatric disorder; Psychiatric comorbidity; Survivorship; Tumor site

Core Tip: Psychiatric disorders are a common comorbidity in cancer survivors, even years after diagnosis. Studies have found that tumor type has an effect on the prevalence of clinically relevant depression, anxiety, comorbid anxiety-depression and posttraumatic stress disorder. This systematic review compared the prevalence of these four psychiatric disorders in cancer survivors among tumor types. The results suggest that there are variations in the prevalence of all comorbidities across and within cancer types. A future direction should be the development of a screening tool to regularly assess cancer survivors’ psychological distress for at least 10 years after the initial disease.