Anxiety and Depression in Metastatic Cancer: A Critical Review of Negative Impacts on Advance Care Planning and End-of-Life Decision Making With Practical Recommendations
Open accessAbstract
PURPOSE: Providers treating adults with advanced cancer increasingly seek to engage patients and surrogates in advance care planning (ACP) and end-of-life (EOL) decision making; however, anxiety and depression may interfere with engagement. The intersection of these two key phenomena is examined among patients with metastatic cancer and their surrogates: the need to prepare for and engage in ACP and EOL decision making and the high prevalence of anxiety and depression. METHODS: Using a critical review framework, we examine the specific ways that anxiety and depression are likely to affect both ACP and EOL decision making. RESULTS: The review indicates that depression is associated with reduced compliance with treatment recommendations, and high anxiety may result in avoidance of difficult discussions involved in ACP and EOL decision making. Depression and anxiety are associated with increased decisional regret in the context of cancer treatment decision making, as well as a preference for passive (not active) decision making in an intensive care unit setting. Anxiety about death in patients with advanced cancer is associated with lower rates of completion of an advance directive or discussion of EOL wishes with the oncologist. Patients with advanced cancer and elevated anxiety report higher discordance between wanted versus received life-sustaining treatments, less trust in their physicians, and less comprehension of the information communicated by their physicians. CONCLUSION: Anxiety and depression are commonly elevated among adults with advanced cancer and health care surrogates, and can result in less engagement and satisfaction with ACP, cancer treatment, and EOL decisions. We offer practical strategies and sample scripts for oncology care providers to use to reduce the effects of anxiety and depression in these contexts.
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Anxiety and depression in people with advanced cancer can negatively affect end-of-life decision-making and Advance Care Planning.
“Arch et al. (15) describen incluso cómo la ansiedad y depresión en estas personas pueden afectar negativamente a la toma de decisiones al final de la vida y a la Planificación Anticipada de los Cuidados (PAC).”
From AVANZACT: protocolo e intervención psicoterapéutica en cáncer avanzado basados en Terapia de Aceptación y Compromiso. (2025) · cites this paper as Arch et al. (15)
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- Authors
- Arch, J. J., Bright, E. E., Finkelstein, L. B., Fink, R. M., Mitchell, J. L., Andorsky, D. J., & Kutner, J. S.
- Affiliations
- University of Colorado Boulder (US)
- University of Colorado Anschutz (US)
- Rocky Mountain Cancer Centers (US)
- ORCID
- Venue
- JCO Oncology Practice
- Published
- 2023-12
- Volume
- 19
- Issue
- 12
- Pages
- 1097-1108
- ISSN
- 2688-1527 (ISSN-L)
- 2688-1535
- PMC
- PMC10732500
- OpenAlex
- W4387608827
- Cited by
- 25
- References
- 135
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 4
- FWCI
- 1.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JCO Oncology Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- AstraZeneca
- Celgene
- National Comprehensive Cancer Network
- National Institutes of Health
- Genentech
- National Institute of Nursing Research (R01NR018479)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- anxiety, depression, metastatic cancer, advance care planning, end-of-life decisions, advance directives, decision regret, treatment decision-making, life-sustaining treatment, trust in physicians, intensive care unit, patient engagement
- MeSH terms
- Adult, Anxiety, Death, Decision Making, Depression, Humans, Neoplasms, Terminal Care, Advance Care Planning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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