A systematic review of risk factors associated with depression and anxiety in cancer patients
Open accessAbstract
Depression and anxiety are common comorbid conditions associated with cancer, however the risk factors responsible for the onset of depression and anxiety in cancer patients are not fully understood. Also, there is little clarity on how these factors may vary across the cancer phases: diagnosis, treatment and depression. We aimed to systematically understand and synthesise the risk factors associated with depression and anxiety during cancer diagnosis, treatment and survivorship. We focused our review on primary and community settings as these are likely settings where longer term cancer care is provided. We conducted a systematic search on PubMed, PsychInfo, Scopus, and EThOS following the PRISMA guidelines. We included cross-sectional and longitudinal studies which assessed the risk factors for depression and anxiety in adult cancer patients. Quality assessment was undertaken using the Newcastle-Ottawa assessment checklists. The quality of each study was further rated using the Agency for Healthcare Research and Quality Standards. Our search yielded 2645 papers, 21 of these were eligible for inclusion. Studies were heterogenous in terms of their characteristics, risk factors and outcomes measured. A total of 32 risk factors were associated with depression and anxiety. We clustered these risk factors into four domains using an expanded biopsychosocial model of health: cancer-specific, biological, psychological and social risk factors. The cancer-specific risk factors domain was associated with the diagnosis, treatment and survivorship phases. Multifactorial risk factors are associated with the onset of depression and anxiety in cancer patients. These risk factors vary across cancer journey and depend on factors such as type of cancer and individual profile of the patients. Our findings have potential applications for risk stratification in primary care and highlight the need for a personalised approach to psychological care provision, as part of cancer care.
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Depression in cancer patients is associated with a higher risk of suicide and systemic inflammation, which may worsen long-term health outcomes.
“Depression, in particular, has been associated with a higher risk of suicide and systemic infammation, which may worsen long-term health outcomes [4,7].”
From Internet‐Based Telecare and Bibliotherapy Delivery of Acceptance and Commitment Therapy for Reducing Anxiety and Depression in Breast Cancer Patients: A Randomized Controlled Trial. (2026) · cites this paper as [4]
The Introduction links depression in cancer patients to increased suicide risk and says patients with comorbid depression or anxiety have a poorer prognosis. It does not link depression to systemic inflammation or say that inflammation may worsen long-term health outcomes; searches for those terms found no supporting passage. (LLM, conf=0.87)
Experimental — accuracy not yet measuredUp to 25% of cancer patients experience depression after diagnosis, though this figure is likely underestimated due to symptom overlap with cancer-related fatigue.
“Studies indicate that up to 25% of cancer patients experience depression after diagnosis; however, this fgure is likely underestimated due to symptom overlap with cancer-related fatigue [4].”
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Cites
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Risk Screening of Neuro-Cognitive Disorders via AI-Based Multimodal Transformers
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Modifiable psychosocial risk factors for depression among cancer survivors in the United States
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- Authors
- Ikhile, D., Ford, E., Glass, D., Gremesty, G., & van Marwijk, H.
- Affiliations
- Brighton and Sussex Medical School (GB)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Ford, Elizabeth
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2024-03-29
- Volume
- 19
- Issue
- 3
- Pages
- e0296892
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC10980245
- OpenAlex
- W4393305779
- Cited by
- 59
- References
- 60
- Citations by year
- 2026: 29 · 2025: 24 · 2024: 5 · 2021: 1
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NIHR200179 ARC KSS)
- 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 › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- depression, anxiety, cancer patients, risk factors, biopsychosocial model, cancer diagnosis, cancer therapy, cancer survivorship, psychological comorbidity, risk stratification, primary care, psychological care
- MeSH terms
- Anxiety, Depression, Humans, Neoplasms, Risk Factors
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