Perioperative Depressive Symptoms in Surgical Cancer Patients: a Systematic Review and Meta-analysis

Patients with cancer requiring surgery are at increased risk for depressive symptoms. However, prevalence and severity during the perioperative period are poorly characterized. This study systematically reviewed the perioperative prevalence of clinically significant depression and depressive symptom severity in patients with cancer, as measured by self-reported tools.

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, EMBASE, and Scopus databases (searched to 15 December 2023). Clinical studies of patients with cancer undergoing surgery that measured depressive symptoms using a self-reported instrument were included. Study quality and bias were assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and Joanna Briggs Institute Critical Appraisal Checklist. Data extracted included study characteristics, as well as prevalence and severity of depression pre- and postoperatively.

Data from 526 studies involving 103,075 surgical patients were included. The most common cancers were breast (32%), colorectal (10%), and head and neck (8%). The most frequently used tools were the Hamilton Anxiety and Depression Scale Depression Subscale (HADS-D, 52%), Beck's Depression Inventory (BDI, 10%), and the Center for Epidemiological Studies Depression Scale (10%). On average, 24% of patients reported clinically significant depressive symptoms, with higher prevalence preoperatively (P < 0.0001). This perioperative difference shifted to higher prevalence postoperatively for patients with other solid tumors when compared with those with breast or prostate cancer.

A fourth of surgical cancer patients report clinically significant depressive symptoms in their perioperative course, with the preoperative timepoint presenting the greatest risk, extending to the immediately postoperative timepoint. This can inform mental health screening timing while considering cancer type.