Life after cancer diagnosis and treatment is full of uncertainties for the patients and their caregivers. The possibility of cancer returning is hard to dismiss at least in the first few years after the end of treatment. Life has often changed in many imperceptible and subtle ways for people who have undergone cancer treatment, as well as their loved ones.
The research on psychological health of long-term cancer survivors gives us a mixed picture. While some studies show high rates of cancer-related intrusive thoughts, others find low rates of depression and good quality of life. Psychological distress experienced by carers is also of concern as that can be even higher than the issues faced by patients.
Mitchell et al (2013) have recently completed a systematic review and meta-analysis that aims to answer the following questions:
- Is the prevalence of mood disorders significantly different in long-term cancer patients compared to their spouses?
- Do the high rates of distress return to a similar rate as in the general population for cancer patients in the long-term?
The authors carried out an extensive search for studies that reported depression and anxiety prevalence in adults with cancer two years after the treatment. They excluded studies that used the same sample (duplicate publications) and also studies conducted on patients in palliative settings. They found high heterogeneity so they used random-effects rather than fixed-effect meta-analysis.
Out of 1886 results that the systematic review found, they included 43 studies (26 long-term comparisons with healthy controls and 17 long-term comparisons with spouses). They found no publication bias in terms of depression or anxiety in the literature.
The prevalence of depression was 11.6% among cancer survivors compared with 10.2% among healthy people – the difference was not statistically significant. However, the results differed depending on the depression scale used (the relative risk of depression was significantly higher for studies that used the Center for Epidemiologic Studies Depression Scale and not significantly lower for those that used the Hospital Anxiety and Depression Scale).
The prevalence of depression was 26.7% among cancer survivors whereas among their spouses it was 26.3% showing that the risk of depression is not different in spouses of long-term cancer survivors as in the survivors themselves.
Results for anxiety, on the other hand, presented a different picture. The prevalence for anxiety was 17.9% among cancer survivors compared to 13.9% among healthy people. The relative risk of anxiety was higher in cancer survivors than healthy controls. However, a significant difference emerged when it comes to comparing anxiety prevalence between cancer survivors and their spouses: 28% vs 40.1%, respectively.
In addition, the relative risk for depression was significantly higher for cancer survivors who were diagnosed within the past 2 years (1.74) compared with those diagnosed 2-10 years or 10 years ago or more (2.09). In the case of anxiety, relative risks for less than 2 years versus 2-10 years and less than 2 years versus more than 10 years did not differ significantly.
The authors conclude that
…after diagnosis of cancer, increased rates of anxiety tend to persist compared with healthy controls, whereas increased rates of depression are less long-lasting (p. 9).
They highlight that anxiety can impact quality of life negatively and that screening for anxiety has not received the same attention as screening for depression and distress.
It is important to note the drawbacks of this meta-analysis. As they indicate, the studies had high heterogeneity and the quality varied. However, a bigger problem is that they ignored a very important factor in their analyses: the importance of gender. As Hagedoorn et al (2008) clearly showed in their meta-analysis of distress in couples coping with cancer, women reported more distress than men, regardless of whether they were the patient or the partners. So, it is surprising that Mitchell et al. did not take gender into account or even cite this work. Given this caveat, we end up wondering what the results would be like if gender was accounted for in the analyses.
Mitchell, AJ et al Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis (PDF). The Lancet Oncology – 5 June 2013. DOI: 10.1016/S1470-2045(13)70244-4
Hagedoorn, M., R. Sanderman, et al. (2008). Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull 134(1): 1-30. [PubMed abstract] [PowerPoint presentation from lead author PDF]
Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: what about th… http://t.co/OEjXdvJSR0
Check out my latest blog piece MT @Mental_Elf: Depression and anxiety in long-term #cancer.. http://t.co/hGC7FpYQkN @CoyneoftheRealm
RT @Gozde786: Check out my latest blog piece MT @Mental_Elf: Depression and anxiety in long-term #cancer.. http://t.co/YLC22jJ92k
#Depression and #anxiety in long-term #cancer survivors compared with spouses and healthy controls http://t.co/RsWRfHBZEB via @Mental_Elf
Check out my latest blog piece on the recent @TheLancet article on #depression and anxiety in long-term #cancer.. http://t.co/hGC7FpYQkN
@TheLancet SR finds that cancer survivors experienced less anxiety than their spouses, 28% v 40% respectively http://t.co/7lZ0NL3xEl
@Mental_Elf @TheLancet @Gozde786 Gender aside, results make sense. Caregivers manage personal stress & empathize w/loved ones’ hardships.
@drseanmullen @Mental_Elf @TheLancet I agree Sean. but gender needs to be taken into account given its importance in distress.
@Mental_Elf @Gozde786 Are depress./anx scales gender invariant? Mean diffs (levels) cant be interpreted if meaning of items is nonequivalent
@drseanmullen @Mental_Elf check this out. it will answer ur q’s better than i can! http://t.co/7SSZiCx3vR @CoyneoftheRealm
.@Gozde786 @drseanmullen @Mental_Elf Can access full text comprehensive review of distress, gender in cancer pts here http://t.co/zrTCIKMKE1
.@Mental_Elf @TheLancet But @Gozde786 catches glaring omission in review of distress in cancer patients, spouses. http://t.co/LOOsr7sbvX
.@CoyneoftheRealm @Mental_Elf @TheLancet @Gozde786 @drseanmullen Thanks we looked at gender post-hoc for NY times see
.@_alexjmitchell @Mental_Elf @TheLancet @Gozde786 @drseanmulle Review misleading in indicating patient v spouse more important than gender.
@CoyneoftheRealm @_alexjmitchell @Mental_Elf @TheLancet great to see you joining disc Alex! was there a reason not to account for gender?
@Gozde786 @CoyneoftheRealm @Mental_Elf @TheLancet Sadly, gender data unavailable in all but 2 key *comparative* studies examined; see NYblog
.@_alexjmitchell @Gozde786 @Mental_Elf @TheLancet RE Gender data missing. Dismissed our extensive previous review with lots of references
@_alexjmitchell @CoyneoftheRealm @Mental_Elf @TheLancet yes that’s a prb. but surely Hagedoorn et al’s piece could’ve bn cited.
.@CoyneoftheRealm @Mental_Elf @TheLancet @Gozde786 I don’t believe we made any such claims re:gender effect due to lack of comparative data.
@_alexjmitchell @CoyneoftheRealm @Mental_Elf @TheLancet that’s the point. given gender-distress rel, shldn’t be at least mentnd in article?
.@_alexjmitchell @Mental_Elf @TheLancet @Gozde786 Ignored wealth of relevant gender data. Not reviewing anxiety, depression, but self-report
.@Mental_Elf @TheLancet RE cancer survivors experience less anxiety than spouses. Not true, ignores gender effects http://t.co/zrTCIKMKE1
[…] Here is the link to the blog piece: http://www.thementalelf.net/mental-health-conditions/anxiety-disorders/depression-and-anxiety-in-lon… […]
Pls RT @CR_UK Systematic review of how #depression & #anxiety affect #cancer survivors & their spouses http://t.co/7lZ0NL3xEl
Gender differences excluded in meta-analysis of anxiety in long-term cancer survivors http://t.co/2Tmuptxqwk
.@Gozde786 Uncovered important flaw in Lancet Oncology review. Too bad journal limits post publication commentary http://t.co/LOOsr7sbvX
What role does gender play in relation to depression and anxiety in cancer survivors and their spouses? http://t.co/7lZ0NL3xEl
My latest blog piece on the recent Lancet meta analysis on #Depression and anxiety in long-term #cancer survivors http://t.co/hGC7FpYQkN
Don’t miss: #Depression & #anxiety in long-term #cancer survivors compared with spouses & healthy controls http://t.co/7lZ0NL3xEl
@Mental_Elf excellent piece …
Mental Elf: Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: what… http://t.co/rZxTGrOFZm