Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Apr 19, 2022; 12(4): 623-635
Published online Apr 19, 2022. doi: 10.5498/wjp.v12.i4.623
Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review
Anne Bach, Klara Knauer, Johanna Graf, Norbert Schäffeler, Andreas Stengel
Anne Bach, Klara Knauer, Johanna Graf, Norbert Schäffeler, Andreas Stengel, Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen 72076, Germany
Andreas Stengel, Germany & Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin 10117, Germany
Author contributions: Bach A wrote the paper; Bach A, Knauer K and Graf J screened the literature; Graf J and Stengel A planned and supervised the project and thoroughly revised the paper; Schäffeler N thoroughly revised the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andreas Stengel, MD, PhD, Professor, Section Psychooncology, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr 5, Tübingen 72076, Germany. andreas.stengel@med.uni-tuebingen.de
Received: August 31, 2021
Peer-review started: August 31, 2021
First decision: December 12, 2021
Revised: December 20, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 19, 2022
ARTICLE HIGHLIGHTS
Research background

Psychiatric disorders are common but underdiagnosed in cancer survivors. Research suggests that tumor type has an effect on the prevalence of clinically relevant depression, anxiety, comorbid anxiety-depression and posttraumatic stress disorder (PTSD) symptoms.

Research motivation

Detecting differences in the prevalence of four common mental disorders that can occur as a comorbidity in cancer survivors might lead to a better understanding of cancer survivors’ psychological distress. This might help to address the psychological concerns of cancer survivors more effectively.

Research objectives

The aim of this review was to identify studies in which clinically relevant levels of common mental disorders in cancer survivors were examined. The prevalence rates were compared among different cancer types.

Research methods

Four databases were searched for studies that investigated cancer-free, posttreatment survivors with screening tools that assess clinically relevant levels of four common mental disorders. Two authors screened all articles, with a third author reviewing debated articles.

Research results

Twenty-six studies were included in the article and indicated the prevalence of one or more of the four mental disorders. Ten different tumor types were examined in the included papers. Generally, all four comorbidities show higher prevalences in cancer survivors than in the general population. The studies showed heterogeneity regarding the study characteristics, number of participants, time since diagnosis, and assessment tools. Each comorbid disorder had a variable prevalence across tumor subtypes. Within one cancer site, the prevalence also varied considerably among the studies.

Research conclusions

Psychiatric comorbidities are high in cancer survivors relative to the general population, as reflected by the prevalences of depression, anxiety, comorbid anxiety-depression and PTSD across all tumor types. This enhanced distress is clinically relevant even years after a cancer diagnosis. The lack of a concise definition of cancer survivorship likely contributes to the high heterogeneity among studies focusing on cancer survivors’ psychological distress, which might hinder significant comparisons among studies.

Research perspectives

Developing generalized screening tools that examine psychological distress in cancer survivors for at least ten years after diagnosis could help to understand and address the psychological burdens of the survivors.