The impact of anxiety and depression on hematologic malignancy outcomes: a systematic review and meta-analysis

Hematologic malignancies (HMs) are associated with high morbidity and mortality. Depression and anxiety, prevalent in patients with HM, may adversely impact survival, but their prognostic role remains unclear.

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD42024568789). We searched PubMed, SCOPUS, and Web of Science for studies examining the association between depression or anxiety and survival outcomes in patients with HMs. Data extraction and quality assessment (using the Newcastle-Ottawa Scale and RoB2) were conducted independently by multiple reviewers. Random-effects meta-analyses were performed, with subgroup, sensitivity, and publication bias analyses. Additionally, meta-regression analyses were used to explore the impact of study-level factors on the observed associations.

Twenty-nine studies (31 cohorts) comprising 419,054 patients with various HMs were included. Depression was significantly associated with poorer OS (HR = 1.17, 95% CI: 1.09-1.27), while anxiety showed a non-significant association (HR = 1.20, 95% CI: 1.00-1.44). Depression was not significantly associated with EFS or CSS, however, anxiety was linked to poor EFS. Publication bias was detected, and adjustment attenuated the associations. Subgroup and sensitivity analyses confirmed the robustness of the main findings. Meta-regression indicated that heterogeneity in effect sizes was partially explained by sample size.

Depression is associated with reduced overall survival in patients with HMs, underscoring the importance of psychological assessment and early intervention in this population. Further research is needed to clarify the impact of anxiety and to inform targeted supportive care strategies.