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Cited by 117Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeGlobal Cancer Incidence and Screening

Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses

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Getie, Addisu, Ayalneh, Manay, Bimerew, Melaku·2025·BMC Psychiatry
DOI 10.1186/s12888-025-06599-5PMC PMC11841195
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Abstract

INTRODUCTION: Depression and anxiety are prevalent psychological disorders that significantly affect physical, emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especially challenging for cancer survivors, complicating treatment management, affecting adherence, and potentially impacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, and anxiety, as well as their determinants among cancer patients. METHOD: An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants of pain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses. The review involved a thorough search of multiple databases and included studies published in English up to July 2024 that reported on these symptoms. The process involved screening and selecting studies based on specific criteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determine overall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understanding of these psychological issues in cancer survivors and guide future research and interventions. RESULT: The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59-38.74), while anxiety had a prevalence of 30.55% (95% CI 24.04-37.06). Pain prevalence after treatment was 39.77% (95% CI 31.84-47.70). Before treatment, 65.22% (95% CI 62.86-67.57) of cancer patients reported pain, which persisted in 51.34% (95% CI 40.01-62.67) during treatment. The analysis also found that during the COVID-19 pandemic, depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI 41.25-45.26) and 52.93% (95% CI 50.91-54.96), respectively. CONCLUSION: The umbrella review found that depression and anxiety prevalence among cancer survivors was 33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factors contributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxiety was significantly linked to advanced cancer stage and poor sleep quality. CLINICAL TRIAL NUMBER: Not applicable.

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  1. [1]Yang Y-L, Liu L, Wang Y, Wu H, Yang X-S, Wang J-N, et al. The prevalence of depression and anxiety among Chinese adults with cancer: a systematic review and meta-analysis. BMC Cancer. 2013;13:1–15. 23967823 PMC3765872 · DOI
  2. [2]Naser AY, Hameed AN, Mustafa N, Alwafi H, Dahmash EZ, Alyami HS, et al. Depression and anxiety in patients with cancer: a cross-sectional study. Front Psychol. 2021;12:585534. 33935849 PMC8081978 · DOI
  3. [3]Obispo-Portero B, Cruz-Castellanos P, Jiménez-Fonseca P, Rogado J, Hernandez R, Castillo-Trujillo OA, et al. Anxiety and depression in patients with advanced cancer during the COVID-19 pandemic. Support Care Cancer. 2022;30(4):3363–70. 34993652 PMC8735888 · DOI
  4. [4]Greco MT, Corli O, Montanari M, Deandrea S, Zagonel V, Apolone G. Epidemiology and pattern of care of breakthrough cancer pain in a longitudinal sample of cancer patients: results from the Cancer Pain Outcome Research Study Group. Clin J Pain. 2014;30(3):221–8. 20842024
  5. [5]Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Sjölund K. Cancer-related pain: a pan-european survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33. 19244085 · DOI
  6. [6]Kouhestani M, Gharaei HA, Fararouei M, Ghahremanloo HH, Ghaiasvand R, Dianatinasab M. Global and regional geographical prevalence of depression in gastric cancer: a systematic review and meta-analysis. BMJ Supportive Palliat Care. 2022;12(e4):e526–36. 32434923 · DOI
  7. [7]Mejareh ZN, Abdollahi B, Hoseinipalangi Z, Jeze MS, Hosseinifard H, Rafiei S, et al. Global, regional, and national prevalence of depression among cancer patients: a systematic review and meta-analysis. Indian J Psychiatry. 2021;63(6):527–35. 35136248 PMC8793718 · DOI
  8. [8]Aggeli P, Fasoi G, Zartaloudi A, Kontzoglou K, Kontos M, Konstantinidis T, et al. Posttreatment anxiety, depression, sleep disorders, and associated factors in women who survive breast cancer. Asia-Pacific J Oncol Nurs. 2021;8(2):147–55. PMC7934591 33688563 · DOI
  9. [9]Li J, Kuang X, Zhang Y, Hu D, Liu K. Global burden of gastric cancer in adolescents and young adults: estimates from GLOBOCAN 2020. Public Health. 2022;210:58–64. 35870322 · DOI
  10. [10]Poletti V, Pagnini F, Banfi P, Volpato E. The role of Depression on Treatment Adherence in patients with Heart Failure–a systematic review of the literature. Curr Cardiol Rep. 2022;24(12):1995–2008. 36327056 PMC9747824 · DOI
  11. [11]Ayalew M, Deribe B, Duko B, Geleta D, Bogale N, Gemechu L, et al. Prevalence of depression and anxiety symptoms and their determinant factors among patients with cancer in southern Ethiopia: a cross-sectional study. BMJ open. 2022;12(1):e051317. 35063957 PMC8785168 · DOI
  12. [12]Endeshaw D, Walle TA, Yohannes S. Depression, anxiety and their associated factors among patients with cancer receiving treatment at oncology units in Amhara Region, Ethiopia: a cross-sectional study. BMJ open. 2022;12(11):e063965. 36396311 PMC9677016 · DOI
  13. [13]Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development. 2015. 26360830
  14. [14]Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate, or severe? Grading pain severity by its interference with function. Pain. 1995;61(2):277–84. 7659438 · DOI
  15. [15]Degefa M, Dubale B, Bayouh F, Ayele B, Zewde Y. Validation of the PHQ-9 depression scale in Ethiopian cancer patients attending the oncology clinic at Tikur Anbessa specialized hospital. BMC Psychiatry. 2020;20:1–7. 32912183 PMC7488004 · DOI
  16. [16]Abraham Y, G/Tsadik M, Gebeyehu A, Fanta T, Ashegu T. Depression and anxiety prevalence and correlations among cancer patients at Tikur Anbesa Hospital in Addis Ababa, Ethiopia, 2018: cross-sectional study. Front Psychiatry. 2022;13:939043. 36213926 PMC9537762 · DOI
  17. [17]Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:1–7. 17302989 PMC1810543 · DOI · Paper page
  18. [18]Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. 12111919 · DOI · Paper page
  19. [19]DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88. 3802833 · DOI · Paper page
  20. [21]Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Res ed). 1997;315(7109):629–34. PMC2127453 9310563 · DOI · Paper page
  21. [22]Zamani M, Alizadeh-Tabari S. Anxiety and depression prevalence in digestive cancers: a systematic review and meta-analysis. BMJ Supportive Palliat Care. 2023;13(e2):e235–43. 34417285 · DOI
  22. [25]Brunckhorst O, Hashemi S, Martin A, George G, Van Hemelrijck M, Dasgupta P, et al. Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis. 2021;24(2):281–9. 32978524 · DOI · Paper page
  23. [26]Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ open. 2014;4(3):e003901. 24625637 PMC3963074 · DOI
  24. [27]Watts S, Prescott P, Mason J, McLeod N, Lewith G. Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates. BMJ open. 2015;5(11):e007618. 26621509 PMC4679843 · DOI
  25. [28]Tao F, Xu M, Zou Q, Tang L, Feng J, Li Z. Prevalence and severity of anxiety and depression in Chinese patients with breast cancer: a systematic review and meta-analysis. Front Psychiatry. 2023;14:1080413. 37448492 PMC10336240 · DOI
  26. [29]Geremew H, Abdisa S, Mazengia EM, Tilahun WM, Haimanot AB, Tesfie TK, et al. Anxiety and depression among cancer patients in Ethiopia: a systematic review and meta-analysis. Front Psychiatry. 2024;15:1341448. 38455516 PMC10917887 · DOI
  27. [30]Tan DJH, Quek SXZ, Yong JN, Suresh A, Koh KXM, Lim WH, et al. Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: systematic review and meta-analysis. Clin Mol Hepatol. 2022;28(4):864. 36263668 PMC9597225 · DOI
  28. [31]Osmani V, Hörner L, Klug SJ, Tanaka LF. Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: a systematic review and meta-analysis. Cancer Med. 2023;12(17):18354–67. 37559504 PMC10523984 · DOI
  29. [32]Yu H, Zhou Z, Mo Q, Zhou X, Liu Y, Feng S. Prevalence of anxiety and depression among cancer patients during the COVID-19 pandemic: a systematic review and meta-analysis. 2020.
  30. [33]Darvishi N, Ghasemi H, Rahbaralam Z, Shahrjerdi P, Akbari H, Mohammadi M. The prevalence of depression and anxiety in patients with cancer in Iran: a systematic review and meta-analysis. Support Care Cancer. 2022;30(12):10273–84. 36222976 · DOI
  31. [34]Ghamari D, Dehghanbanadaki H, Khateri S, Nouri E, Baiezeedi S, Azami M, et al. The prevalence of depression and anxiety in women with ovarian cancer: an updated systematic review and meta-analysis of cross-sectional studies. Asian Pac J Cancer Prevention: APJCP. 2023;24(10):3315. PMC10770678 37898834 · DOI
  32. [35]Rezaianzadeh A, Mousave M, Hassanipour S, Maghsoudi A, Mokhtari AM, Dehghani SL. Prevalence of depression among Iranian women with breast cancer: a systematic review and meta-analysis. Health Scope. 2019;8(2).
  33. [36]Rezagholi P, Abdi K, Barzanji A, Ghanei-Gheshlagh R, Eghbali T, Dehkordi AH et al. Prevalence of depression in Iranian women with breast cancer: a systematic review and meta-analysis. Epidemiol Review/Przegląd Epidemiologiczny. 2022;76(1). 35860943
  34. [37]Mohammed A, Melak D, Demeke Bayou F, Yasin H, Zerga AA, Wagaye B, et al. Prevalence and associated factors of depression among breast cancer patients in Sub-saharan Africa: a systematic review and meta-analysis. SAGE Open Med. 2024;12:20503121241226897. 38292418 PMC10826378 · DOI
  35. [38]Javan Biparva A, Raoofi S, Rafiei S, Masoumi M, Doustmehraban M, Bagheribayati F, et al. Global depression in breast cancer patients: systematic review and meta-analysis. PLoS ONE. 2023;18(7):e0287372. 37494393 PMC10370744 · DOI
  36. [39]Pilevarzadeh M, Amirshahi M, Afsargharehbagh R, Rafiemanesh H, Hashemi S-M, Balouchi A. Global prevalence of depression among breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat. 2019;176:519–33. 31087199 · DOI · Paper page
  37. [40]Gharaei HA, Dianatinasab M, Kouhestani SM, Fararouei M, Moameri H, Pakzad R et al. Meta-analysis of the prevalence of depression among breast cancer survivors in Iran: an urgent need for community supportive care programs. Epidemiol Health. 2019;41. PMC6791826 31319657
  38. [41]Van Den Beuken-Van MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51(6):1070–90. e9. 27112310 · DOI
  39. [42]Van den Beuken-van Everdingen M, De Rijke J, Kessels A, Schouten H, Van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49. 17355955 · DOI · Paper page
  40. [43]Haenen V, Evenepoel M, De Baerdemaecker T, Meeus M, Devoogdt N, Morlion B, et al. Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Support Care Cancer. 2023;31(1):85. 36574040 · DOI
  41. [44]Evenepoel M, Haenen V, De Baerdemaecker T, Meeus M, Devoogdt N, Dams L, et al. Pain prevalence during cancer treatment: a systematic review and meta-analysis. J Pain Symptom Manag. 2022;63(3):e317–35. 34563628 · DOI
  42. [47]Walker J, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry. 2013;1(5):343–50. 26360998 · DOI · Paper page
  43. [48]Zabora J, et al. The prevalence of psychological distress by cancer site. Psycho-oncology. 2001;10(1):19–28. 11180574 · DOI · Paper page
  44. [50]Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Ramirez A, et al. Prevalence of depression in adults with cancer: a systematic review. Ann Oncol. 2013;24(4):895–900. 23175625 · DOI
  45. [51]Caruso R, Nanni MG, Riba M, Sabato S, Mitchell AJ, Grassi L. Depressive spectrum disorders in cancer: diagnostic issues and intervention. A critical review. Curr Psychiatry Rep. 2022;24(4):91–102. PMC5423924 28488207
  46. [52]Jean CY, Syrjala KL. Anxiety and depression in cancer survivors. Med Clin. 2017;101(6):1099–113. PMC5915316 28992857
  47. [54]Haller H, Waller A. Anxiety and depression in cancer patients: a systematic review. Eur J Cancer Care. 2018;27(5):e12857. 10.1111/ecc.12857 · DOI
  48. [55]Smith L, et al. Cultural determinants of mental health in cancer patients. J Psycho-Oncology. 2020;25(4):123–35.
  49. [56]Chowdhury R, et al. Community and family support in cancer care. Asian Pac J Cancer Prev. 2019;20(6):1523–9.
  50. [57]Knaul FM, et al. Closing the cancer divide: global equity in cancer care. Lancet Oncol Comm. 2021;12(11):1103–22.
  51. [58]Zafar SY, Abernethy AP. Financial toxicity and implications for cancer care. Oncol J. 2013;27(12):1752–9.
  52. [59]Andersen BL, et al. Socioeconomic disparities in mental health outcomes among cancer survivors. J Clin Oncol. 2022;40(5):325–34.
  53. [60]Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, hematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. 21251875 · DOI · Paper page
  54. [61]Grassi L, Riba M, Caruso R, Nanni MG, Mitchell AJ. Managing depression and anxiety in cancer patients: a comprehensive review. J Clin Oncol. 2017;35(7):799–808.28113030
  55. [62]Van den Beuken-van Everdingen MHJ, de Rijke J, et al. Pain in patients with Cancer: prevalence, understanding, and treatment. Lancet Oncol. 2016;17(12):e858–72. 10.1016/S1470-2045(16)30367-4 · DOI
  56. [63]Olesen F, Sokolowski I. Prevalence of Cancer Pain and its impact on quality of life. Cancer Med. 2017;6(6):1358–65. 10.1002/cam4.1071 · DOI
  57. [64]Mestdagh F, Steyaert A, Lavand’homme P. Cancer pain management: a narrative review of current concepts, strategies, and techniques. Curr Oncol. 2023;30(7):6838–58. 37504360 PMC10378332 · DOI
  58. [65]Tolia M, Symvoulakis EK, Matalliotakis E, Kamekis A, Adamou M, Kountourakis P, et al. COVID-19 emotional and mental impact on cancer patients receiving radiotherapy: an interpretation of potential explaining descriptors. Curr Oncol. 2023;30(1):586–97. 36661695 PMC9857784 · DOI
  59. [66]Koca S, Koca E, Okten IN, Orengül FF, Oztürk A, Ozçelik M et al. Psychological impacts of COVID-19 pandemic in cancer patients on active treatment. Heliyon. 2022;8(8). PMC9385601 35996550
  60. [67]Chuang S-C, Lee Y-CA, Wu G-J, Straif K, Hashibe M. Alcohol consumption and liver cancer risk: a meta-analysis. Cancer Causes Control. 2015;26:1205–31. 26134046 · DOI

Cited by

Sorted by citations

Authors
Getie, A., Ayalneh, M., & Bimerew, M.
Affiliations
  • Debre Markos University (ET)
  • Injibara University (ET)
Corresponding author
Getie, Addisu
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2025-02-19
Volume
25
Issue
1
Pages
156-156
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-025-06599-5
PMC
PMC11841195
OpenAlex
W4407741262
Cited by
117
References
6
Citations by year
2026: 90 · 2025: 27
FWCI
13.73
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cancer pain, depression, anxiety, cancer survivors, prevalence, risk factors, COVID-19 pandemic, social support, advanced cancer, medication adherence, quality of life, psychological distress, cancer-related fatigue, cancer-related cognitive impairment, cancer-related sexual dysfunction, cancer-related dyspnea, cancer-related constipation, cancer-related nausea and vomiting
MeSH terms
Cancer Survivors, Systematic Reviews as Topic, COVID-19, Anxiety, Depression, Humans, Neoplasms, Pain, Global Health, Meta-Analysis as Topic, Prevalence

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