Disease stage predicts post-diagnosis anxiety and depression only in some types of cancer

We hypothesised that patients with advanced disease or a cancer type that has a poor prognosis may be more likely to report anxiety and depressive symptoms after diagnosis; younger age and female gender may moderate these effects.

Patients (n=3850) were consecutively assessed with PSSCAN, a standardised, validated tool, at two large cancer centres between 2004 and 2009.

Female patients reported more anxiety and depressive symptoms (P=0.003 to P<0.001) compared with men and a healthy comparison group. Older age was associated with fewer anxiety (P=0.033 to P<0.001) and fewer depressive symptoms (P<0.001), but this was not true for lung cancer. Presence of metastases was associated with more anxiety symptoms in patients with gastrointestinal (P=0.044; R(2)Δ=0.001), lung (P=0.011; R(2)Δ=0.016), and prostate (P=0.032; R(2)Δ=0.008) cancer, but this was not true for breast cancer. Furthermore, early disease stage was associated with fewer depressive symptoms among older prostate cancer patients (P=0.021; R(2)Δ=0.008). Men with early lung cancer reported fewer anxiety (P=0.020; R(2)Δ=0.013) and depressive (P=0.017; R(2)Δ=0.016) symptoms than men with advanced disease or women.

As hypothesised, disease stage was directly associated with emotional distress, except for patients with breast cancer. Furthermore, age and gender moderated some of these effects.