Anxiety in patients with cancer and emergency department use: a systematic review

Anxiety is common among patients with cancer, with up to 30% of patients experiencing clinically significant symptoms at some point following their cancer diagnosis. Although patients with cancer frequently use the emergency department (ED), the relationship between anxiety and ED use in this population remains unclear. The objective of this systematic review was to synthesize the existing literature examining the association between anxiety in adults with cancer and subsequent ED use.

We conducted a systematic review comparing ED use among adult cancer patients with and without anxiety. Electronic searches of CINAHL, Cochrane, Medline, PsychInfo, PubMed, and Web of Science were conducted. Two reviewers independently screened titles and abstracts, followed by full text review, data extraction and quality assessment using the Newcastle-Ottawa scale for cohort studies. Due to substantial heterogeneity across studies, including differences in cancer populations, anxiety measurement, timing of assessment, ED outcome definitions, and analytic approaches, a meta-analysis was not performed. Findings were summarized and synthesized narratively.

Seven studies met inclusion criteria, including single-center, multicenter and population-based retrospective designs. Anxiety was identified using either diagnostic codes or patient-reported measures. Four studies found no statistically significant association between anxiety and ED use in multivariable analyses, although three reported small effect sizes with odds or hazard ratios near 1.0. In contrast, three studies reported a significant positive association between anxiety and increased ED use, with effect estimates ranging from 1.23 to 3.87. Variability in findings may be related to differences in anxiety measurement, timing of outcomes, and covariate adjustment.

Evidence of the association between anxiety and ED use among patients with cancer is mixed. However, when significant differences were observed, anxiety was consistently linked to increased ED use. Given the heterogeneity of existing studies, prospective longitudinal research using standardized anxiety measures across the cancer continuum is needed to better understand this relationship.