First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study
Open accessAbstract
Background The diagnosis of cancer is strongly associated with the risk of mental disorders even in patients with no previous history of mental disorders. Accumulating data suggest that mental distress may accelerate tumor progression. We hypothesized therefore that mental disorders after a cancer diagnosis may increase the risk of cancer-specific mortality.Patients and methods We conducted a nationwide cohort study including 244 261 cancer patients diagnosed in Sweden during 2004-2009 and followed them through 2010. Through the Swedish Patient Register, we obtained clinical diagnoses of all mental disorders and focused on mood-, anxiety-, and substance abuse disorders (ICD10: F10-F16, F18-F19, F32-F33, F40-F41, and F43-45) that are commonly diagnosed among patients with cancer. We further classified the studied mental disorders into first-onset or recurrent mental disorders. We used Cox regression to estimate multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) as a measure of the association between mental disorders after cancer diagnosis and cancer-specific mortality, adjusting for age, sex, calendar period, educational level, cancer stage, and cancer type at diagnosis.Results After cancer diagnosis, 11 457 patients were diagnosed with mood-, anxiety-, and substance abuse disorders; of which 7236 were first-onset mental disorders. Patients with a first-onset mental disorder were at increased risk of cancer-specific mortality (HR: 1.82, 95% CI: 1.71-1.92) while patients with a recurrent mental disorder had much lower risk elevation (HR: 1.14, 95% CI: 1.05-1.24). The increased cancer-specific mortality by first-onset mental disorders was observed for almost all cancer sites/groups and the association was stronger for localized cancers (HR: 2.00, 95% CI: 1.73-2.31) than for advanced cancers (HR: 1.49, 95% CI: 1.32-1.69).Conclusions Patients with a first-onset common mood-, anxiety-, or substance abuse disorder after cancer diagnosis may be at increased risk of cancer-specific death.
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The point prevalence of MDD in people with cancer is around 21%.
“Large meta-analyses have estimated the point prevalence of MDD in people with cancer to be around 21%4,74,75.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [74]
The prevalence of MDD in cancer is highly variable depending on disease course, treatment time point, and assessment method.
“However, this estimate is highly variable depending on a range of factors related to disease course (e.g., early vs. advanced stages), treatment time point (acute treatment vs. survivorship), and assessment method (self-reported or clinical diagnosis)4,74,75.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [74]
Cites
External review and validation of the Swedish national inpatient register
Ludvigsson, J. F., Andersson, E., Ekbom, A., Feychting, M., Kim, J.-L., Reuterwall, C., Heurgren, M., & Olausson, P. O. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-450 · Cited by 5,055 · see citing works
Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70002-x · Cited by 2,449 · see citing works
Stress, depression, the immune system, and cancer
Reiche, E. M. V., Nunes, S. O. V., & Morimoto, H. K. (2004) · The Lancet Oncology · doi:10.1016/s1470-2045(04)01597-9 · Cited by 1,364 · see citing works
The completeness of the Swedish Cancer Register – a sample survey for year 1998
Barlow, L., Westergren, K., Holmberg, L., & Talbäck, M. (2008) · Acta Oncologica · doi:10.1080/02841860802247664 · Cited by 1,240 · see citing works
Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Sephton, S. E. (2000) · Journal of the National Cancer Institute · doi:10.1093/jnci/92.12.994 · Cited by 1,082 · see citing works
Do stress-related psychosocial factors contribute to cancer incidence and survival?
Chida, Y., Hamer, M., Wardle, J., & Steptoe, A. (2008) · Nature Clinical Practice Oncology · doi:10.1038/ncponc1134 · Cited by 1,072 · see citing works
Influence of psychological response on survival in breast cancer: a population-based cohort study
Watson, M., Haviland, J., Greer, S., Davidson, J., & Bliss, J. (1999) · The Lancet · doi:10.1016/s0140-6736(98)11392-2 · Cited by 705 · see citing works
Suicide and Cardiovascular Death after a Cancer Diagnosis
Fang, F., Fall, K., Mittleman, M. A., Sparén, P., Ye, W., Adami, H.-O., & Valdimarsdóttir, U. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1110307 · Cited by 455 · see citing works
Self-citationHost Circadian Clock as a Control Point in Tumor Progression
Filipski, E. (2002) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/94.9.690 · Cited by 413 · see citing works
Batty, G. D., Russ, T. C., Stamatakis, E., & Kivimäki, M. (2017) · BMJ · doi:10.1136/bmj.j108 · Cited by 377 · see citing works
Epigenetics of Stress-Related Psychiatric Disorders and Gene × Environment Interactions
Klengel, T., & Binder, E. B. (2015) · Neuron · doi:10.1016/j.neuron.2015.05.036 · Cited by 353 · see citing works
Diurnal cortisol rhythm as a predictor of lung cancer survival
Sephton, S. E., Cash, E. D., Dedert, E. A., Floyd, A. R., Rebholz, W. N., Dhabhar, F. S., Spiegel, D., & Salmon, P. M. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.07.019 · Cited by 312 · see citing works
Depression and Survival in Metastatic Non–Small-Cell Lung Cancer: Effects of Early Palliative Care
Pirl, W. F., Greer, J. A., Traeger, L., Jackson, V., Lennes, I. T., Gallagher, E. R., Perez-Cruz, P., Heist, R. S., & Temel, J. S. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.38.3166 · Cited by 228 · see citing works
Clinical Diagnosis of Mental Disorders Immediately Before and After Cancer Diagnosis
Lu, D., Andersson, T., Fall, K., Hultman, C. M., Czene, K., Valdimarsdóttir, U. A., & Fang, F. (2016) · JAMA Oncology · doi:10.1001/jamaoncol.2016.0483 · Cited by 225 · see citing works
Self-citationQuality of Life After Breast Cancer Diagnosis and Survival
Epplein, M., Zheng, Y. F., Zheng, W., Chen, Z. J., Gu, K., Penson, D. F., Lu, W., & Shu, X. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2010.30.6951 · Cited by 187 · see citing works
Cancer incidence and survival following bereavement
Levav, I., Kohn, R., Iscovich, J., Abramson, J. H., Tsai, W., & Vigdorovich, D. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.10.1601 · Cited by 124 · see citing works
Prasad, S. M., Eggener, S., Lipsitz, S., Irwin, M. R., Ganz, P., & Hu, J. C. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.51.1048 · Cited by 123 · see citing works
Ranjan, A., Gupta, P., & Srivastava, S. (2015) · Cancer Research · doi:10.1158/0008-5472.can-15-1233 · Cited by 105 · see citing works
Vin‐Raviv, N., Hillyer, G. C., Hershman, D. L., Galea, S., Leoce, N., Bovbjerg, D. H., Kushi, L. H., Kroenke, C. H., Lamerato, L. E., Ambrosone, C. B., et al. (2013) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djt024 · Cited by 90 · see citing works
Breast cancer recurrence risk in relation to antidepressant use after diagnosis
Chubak, J., Buist, D. S. M., Boudreau, D. M., Rossing, M. A., Lumley, T., & Weiss, N. S. (2007) · Breast Cancer Research and Treatment · doi:10.1007/s10549-007-9828-9 · Cited by 63 · see citing works
Wikman, A., Ljung, R., Johar, A., Hellstadius, Y., Lagergren, J., & Lagergren, P. (2015) · Journal of Clinical Oncology · doi:10.1200/jco.2014.57.1893 · Cited by 53 · see citing works
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Wang, Y.-H., Li, J.-Q., Shi, J.-F., Que, J.-Y., Liu, J.-J., Lappin, J. M., Leung, J., Ravindran, A. V., Chen, W.-Q., Qiao, Y.-L., et al. (2020) · Molecular Psychiatry · doi:10.1038/s41380-019-0595-x · Cited by 885 · see citing works
Niedzwiedz, C. L., Knifton, L., Robb, K. A., Katikireddi, S. V., & Smith, D. J. (2019) · BMC Cancer · doi:10.1186/s12885-019-6181-4 · Cited by 756 · see citing works
Berk, M., Köhler‐Forsberg, O., Turner, M., Penninx, B. W. J. H., Wrobel, A., Firth, J., Loughman, A., Reavley, N. J., McGrath, J. J., Momen, N. C., et al. (2023) · World Psychiatry · doi:10.1002/wps.21110 · Cited by 336 · see citing works
Almeida, M., Ramos, C., Maciel, L., Basto-Pereira, M., & Leal, I. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.995981 · Cited by 81 · see citing works
Riedl, D., & Schüßler, G. (2022) · Translational Oncology · doi:10.1016/j.tranon.2021.101328 · Cited by 77 · see citing works
Vehling, S., Mehnert-Theuerkauf, A., Philipp, R., Härter, M., Kraywinkel, K., Kuhnert, R., & Koch, U. (2022) · Acta Oncologica · doi:10.1080/0284186x.2021.1992008 · Cited by 55 · see citing works
- Authors
- Zhu, J., Fang, F., Sjölander, A., Fall, K., Adami, H. O., & Valdimarsdóttir, U.
- Affiliations
- Karolinska Institutet (SE)
- Örebro University (SE)
- Harvard University (US)
- Corresponding author
- Zhu, J.
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 28
- Issue
- 8
- Pages
- 1964-1969
- ISSN
- 0923-7534 (ISSN-L)
- OpenAlex
- W2616243737
- Cited by
- 168
- References
- 21
- Citations by year
- 2026: 14 · 2025: 24 · 2024: 34 · 2023: 28 · 2022: 29 · 2021: 17 · 2020: 12 · 2019: 3 · 2018: 6 · 2017: 1
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Swedish Cancer Society (CAN 2014/417)
- Swedish Research Council for Health, Working Life and Welfare (2012-0498)
- China Scholarship Council (201309370015)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- cancer-specific mortality, mood disorders, anxiety disorders, substance use disorders, cancer patients, tumor stage
- MeSH terms
- Aged, Mental Disorders, Female, Humans, Male, Middle Aged, Neoplasms, Registries, Sweden, Cohort Studies
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