Association Between Psychological Distress and Site-Specific Cancer Incidence: A Systematic Review and Meta-Analysis

Depression and anxiety are hypothesized to increase the risk for the development of chronic disease(s), including cancer. Several published observational studies and meta-analyses have investigated the link between depression and anxiety in cancer but have reported conflicting results. To clarify this relationship, a meta-analysis of observational studies reporting an association between depression, anxiety, and cancer incidence was performed.

Prospective and retrospective cohort studies investigating the relationship between depression, anxiety, and cancer incidence were included. A literature search of the PubMed was performed, with the final search conducted in March 2026. Egger's test and funnel plots were used to evaluate publication bias. Meta-analysis was performed using a random-effects model because high heterogeneity among the studies was expected.

In the analysis including both retrospective and prospective studies, patients with depression or anxiety exhibited an elevated risk for lung, hepatobiliary-pancreatic (HBP), hematological, and kidney, ureter, and bladder (KUB) cancers. In the analysis including only prospective studies, patients with depression or anxiety exhibited an elevated risk for female reproductive organ and lung cancer. Finally, in the analysis including only retrospective studies, patients with depression or anxiety exhibited an elevated risk for lung, HBP, hematological, KUB, and oral cancers, and a notably lower risk for female reproductive organ cancer.

Results of this study revealed that depression and anxiety were associated with an elevated risk for specific cancers. A future meta-analysis including only prospective cohort studies with the same measures of depression or anxiety may further clarify this relationship.