Anxiety

• 24% higher all-cause and cancer-specific mortality within 10 years among people with cancer who have anxiety and depression in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 51 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies¹Wang YH, Li JQ et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Molecular Psychiatry. 2020 Jul;25(7):1487-1499.
• 13% higher all-cause mortality but not cancer-specific mortality among women with breast cancer who have anxiety compared to others, and 34% higher mortality among those with both anxiety and depression in a very large meta-analysis of 17 observational studies²Wang X, Wang N et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Molecular Psychiatry. 2020 Dec;25(12):3186-3197.

• 17% higher risk of recurrence among women with breast cancer who have anxiety compared to others in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 17 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies³Wang X, Wang N et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Molecular Psychiatry. 2020 Dec;25(12):3186-3197.

• 13% higher risk of cancer and 21% higher risk of cancer mortality among people with anxiety and depression compared to others in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 51 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies⁴Wang YH, Li JQ et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Molecular Psychiatry. 2020 Jul;25(7):1487-1499.

• A link between greater anxiety and obesity in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 16 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies not specific to cancer⁵Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. International Journal of Obesity (London). 2010 Mar;34(3):407-19.
• Increased frequency of anxiety among people with increasing body weight in a meta-analysis of 25 observational studies not specific to cancer⁶Amiri S, Behnezhad S. Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatrie. 2019 Jun;33(2):72-89. English.

• Slightly higher markers of inflammation among people with generalized anxiety disorder compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 14 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies⁷Costello H, Gould RL, Abrol E, Howard R. Systematic review and meta-analysis of the association between peripheral inflammatory cytokines and generalised anxiety disorder. BMJ Open. 2019 Jul 19;9(7):e027925.
• Slightly lower anxiety among people with chronic physical illness with a treatment blocking a pro-inflammatory cytokine compared to controls in a meta-analysis of 6 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁸Abbott R, Whear R et al. Tumour necrosis factor-α inhibitor therapy in chronic physical illness: a systematic review and meta-analysis of the effect on depression and anxiety. Journal of Psychosomatic Research. 2015 Sep;79(3):175-84.

• More fear of cancer recurrence among women with invasive breast cancer with a higher relative abundance of the Bacteroides genus, and higher fear among women with a history of chemotherapy and lower microbial diversity and lower relative abundance of Firmicutes and higher relative abundance of Bacteroidetes at the phylum level, and higher relative abundance of Bacteroides and lower relative abundance of Lachnospiraceae and Ruminococcus at the genus level in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study⁹Okubo R, Kinoshita T et al. Impact of chemotherapy on the association between fear of cancer recurrence and the gut microbiota in breast cancer survivors. Brain, Behavior, and Immunity. 2020 Mar;85:186-191.
• More anxiety among people with breast cancer with changes in frequency of certain gut bacteria genera (Faecalibacterium, Prevotella, Bacteroides) compared to baseline in a small observational study¹⁰Paulsen JA, Ptacek TS et al. Gut microbiota composition associated with alterations in cardiorespiratory fitness and psychosocial outcomes among breast cancer survivors. Supportive Care in Cancer. 2017 May;25(5):1563-1570.

• Lower cognitive performance and self-perception of worse memory and attention before surgery, mostly for brain tumors, among people with clinically relevant anxiety compared to people with less anxiety in a review of 27 studies (7 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects and 20 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies)¹¹Oteri V, Martinelli A, Crivellaro E, Gigli F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurgical Review. 2021 Feb 19.

• More depressive symptoms after surgery among people with clinically relevant anxiety before surgery, mostly for brain tumors, compared to people with less anxiety in a review of 27 studies (7 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects and 20 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies)¹²Oteri V, Martinelli A, Crivellaro E, Gigli F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurgical Review. 2021 Feb 19.

The relationship between pain and anxiety is bidirectional—each can trigger and impact the other.¹³Thielking PD. Cancer pain and anxiety. Current Pain and Headache Reports. 2003 Aug;7(4):249-61; Theobald DE. Cancer pain, fatigue, distress, and insomnia in cancer patients. Clinical Cornerstone. 2004;6 Suppl 1D:S15-21.

• Higher levels of anxiety among people with breast or prostate cancer with increased pain compared to other people in an observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods analysis within a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹⁴Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer. BMJ Open. 2019 Jan 24;9(1):e026809.
• Higher levels of anxiety among people with cancer of unknown primary with physical symptoms comprising pain, fatigue, and sleep disturbance compared to other people in a mid-sized observational study¹⁵Wolyniec K, Sharp J et al. Psychological distress, understanding of cancer and illness uncertainty in patients with cancer of unknown primary. Psycho-Oncology. 2022 Jun 28.
• Higher risk of anxiety or depression among people with newly diagnosed metastatic solid tumors and with pain compared to people without pain in a secondary analysis of a mid-sized observational study¹⁶de la O Murillo A, Torres AC et al. Association of pain with the presence of additional supportive care (SC) needs in patients with advanced cancer. Journal of Clinical Oncology. 2022 Jun 1;40(16_suppl):e24071-e24071.
• Higher anxiety scores among older people with cancer living at home with high pain scores compared to people with lower pain scores in a mid-sized observational study¹⁷Solvik E, Ytrehus S, Utne I, Grov EK. Pain, fatigue, anxiety and depression in older home‐dwelling people with cancer. Nursing Open. 2019 Nov 5;7(1):430-438.
• Higher anxiety before surgery among people (not exclusive to cancer) with worse pain and function compared to other people, and higher anxiety after surgery among people with higher pain compared to other people in an observational study¹⁸Tarrasch J, England P, Hurst VT, McDonald D, O’Keefe R, Cipriano C. Patients with metastatic disease are at highest risk for anxiety and depression in an orthopedic oncology patient population. JCO Oncology Practice. 2022 Jun 1:OP2100905.
• A link between chronic pain and anxiety among elderly people in a mid-sized observational study¹⁹McCarthy LH, Bigal ME, Katz M, Derby C, Lipton RB. Chronic pain and obesity in the elderly: results from the Einstein aging study. Journal of the American Geriatrics Society. 2009 Jan;57(1):115-9.
• More anxiety among people with cancer with cancer-related breakthrough pain compared to those without breakthrough pain in a mid-sized observational study²⁰Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999 May;81(1-2):129-34.
• More fear about the future, worries about pain progression, and higher general anxiety that hampered daily living among people with insufficient control of cancer-related pain compared to those with sufficient pain control in a small observational study²¹Strang P. Existential consequences of unrelieved cancer pain. Palliative Medicine. 1997 Jul;11(4):299-305.
• Higher rates of anxiety during treatment among people with lung cancer reporting higher pain intensity compared to other people in a mid-sized observational study²²Lekka D, Pachi A et al. Pain and anxiety versus sense of family support in lung cancer patients. Pain Research and Treatment. 2014;2014:312941.
• Higher prevalence of anxiety among people with cancer reporting high pain levels compared to low pain levels in a small observational study²³Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994 Nov 1;74(9):2570-8.

• Lower health-related quality of life before surgery among people with clinically relevant anxiety before surgery, mostly for brain tumors, compared to people with less anxiety in a review of 27 studies (7 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects and 20 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods
  studies)²⁴Oteri V, Martinelli A, Crivellaro E, Gigli F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurgical Review. 2021 Feb 19.
• Lower quality of life and higher physical disability after surgery among people with clinically relevant anxiety before surgery, mostly for brain tumors, compared to people with less anxiety in a review of 27 studies (7 RCTs and 20 observational studies)²⁵Oteri V, Martinelli A, Crivellaro E, Gigli F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurgical Review. 2021 Feb 19.

• More sleep disturbance in the first year after mastectomy among people with breast cancer with anxiety at baseline compared to no anxiety in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study²⁶Azizoddin DR, Soens MA et al. Perioperative sleep disturbance following mastectomy: a longitudinal investigation of the relationship to pain, opioid use, treatment, and psychosocial symptoms. Journal of Clinical Oncology. 2021 Oct 1;39(28_suppl:192.

• Lower Quality of Recovery Scale scores among people with higher anxiety before and/or after elective abdominal surgery (not specific to cancer) compared to lower anxiety in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study²⁷Gümüs K. The effects of preoperative and postoperative anxiety on the quality of recovery in patients undergoing abdominal surgery. Journal of PeriAnesthesia Nursing. 2021 Apr;36(2):174-178.