Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review

Table 1 Assessment tools

Assessment tool		Used in study (No. of occurrences)
EDS	Edinburgh Depression Scale	1 (1)
HADS	Hospital Anxiety and Depression Scale	1, 3, 5, 6, 8, 9, 15, 19, 21, 22, 23 (11)
SCID	Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders	1, 22, 23, 26 (4)
PTSD-(inventory) scale	Self-report scale based on DSM-III-R criteria with items corresponding to PTSD symptoms	2, 16 (2)
SCL-90	Symptom Checklist 90	2 (1)
PCL-C/PCL-S	Posttraumatic Stress Disorder Checklist-Civilian Version/Posttraumatic Stress Disorder Checklist-Specific	3, 5, 13, 14 (4)
UW-QOL	The University of Washington Quality of Life instrument - brief, self-administered questionnaire to analyze rates of depression	11 (1)
IES	Impact of Event Scale	7, 20 (2)
BDI	Beck Depression Inventory	4, 18, 20 (3)
PHQ-9	Patient Health Questionaire-9	10, 17 (2)
GAD-7	Generalized Anxiety Disorder 7	10, 17, 24 (3)
GDS-SF/GDS-15	Geriatric Depression Scale-Short Form/Geriatric Depression Scale-15	12, 25 (2)
DASS	Depression-Anxiety-Stress-Scale	24 (1)
MINI	Mini International Neuropsychiatric Interview	4 (1)
SAI	Spielberger State Anxiety Inventory	20 (1)

EDS: Edinburgh Depression Scale; HADS: Hospital Anxiety and Depression Scale; SCID: Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders; PTSD: Posttraumatic stress disorder; SCL-90: Symptom Checklist 90; PCL-C: Posttraumatic Stress Disorder Checklist-Civilian Version; PCL-S: Posttraumatic Stress Disorder Checklist-Specific; UW-QOL: The University of Washington Quality of Life; IES: Impact of Event Scale; BDI: Beck Depression Inventory; PHQ-9: Patient Health Questionaire-9; GAD-7: Generalized Anxiety Disorder 7; GDS-SF: Geriatric Depression Scale-Short Form; GDS-15: Geriatric Depression Scale-15; DASS: Depression-Anxiety-Stress-Scale; MINI: Mini International Neuropsychiatric Interview; SAI: Spielberger State Anxiety Inventory.

Table 2 Summary of findings for included articles, organized by tumor subtypes

No.	Ref./country	Tumor site	Number of participants/gender/age in years	Time since diagnosis	Parameters and tests (related to psychiatric disorders)	Key results: Prevalence of clinical levels of: Anxiety/depression/PTSD/comorbid anxiety-depression	Possible bias
1	Alexander et al[26], 2010; United Kingdom	Breast	n = 200; 100% female; mean: 58.1, range: 29-89	Mean time since last treatment: 10.1 mo	EDS; HADS; SCID	Depression: 9%; anxiety: 3.5%; comorbid: 1.5	Selection bias; response bias
2	Amir et al[28], 2002; Israel	Breast	n = 39; 100% female; range: 37-60	≥ 5 yr	PTSD-scale; SCL-90	Full PTSD: 18%; partial PTSD: 56% (additional)	Selection bias; response bias
3	Mehnert et al[25], 2008; Germany	Breast	n = 1083; 100% female; mean: 61.8, range: 31-81	Average: 47 mo	HADS; PCL-C	Moderate to high anxiety: 38% (high: 20.1%); moderate to high depression: 22% (high: 11.3%); PTSD: 12%	Selection bias; response bias
4	Qiu et al[42], 2012; China	Breast	n = 505; 100% female; mean: 52.02	Mean time after surgery: 17.6 mo	BDI; MINI	Depression: 20.59%	Response bias; performance bias
5	Vazquez et al[16], 2020; United States	Breast	n = 700; 100% female; median: 37, range: 17-40	144 d: HADS; 30 mo (PCL-S)	PCL-S; HADS	PTSS: 6.3%; depression: 8%; anxiety: 23%	Selection bias; response bias
6	Dahl et al[24], 2005; Norway	Testicular	n = 1408; 100% male; mean: 44.6	Mean: 11.3 yr	HADS	Anxiety: 19.2%; depression: 9.7%; comorbid: 6.8%	Selection bias; response bias
7	Dahl et al[17], 2016; Norway	Testicular	n = 1418; 100% male; mean: 44.6	Mean: 11 yr	IES	Full PTSD: 4.5%; partial PTSD: 6.4%; probable PTSD (combination of the 2): 10.9%	Selection bias; response bias
8	Fosså et al[43], 2003; Norway	Testicular	n = 791; 100% male; median: 44, range: 23-75	Median: 12 yr	HADS	Anxiety: 19%; depression: 9%	Selection bias; response bias
9	Thorsen et al[15], 2005; Norway	Testicular	n = 1260; 100% male; median: 42	Mean: 11 years	HADS	Anxiety: 20.2%; depression 9.7%	Selection bias; response bias
10	Vehling et al[19], 2016; Germany	Testicular	n = 164; 100% male; mean: 44.4	Mean: 11.6 yr	GAD-7; PHQ-9	Anxiety: 6.1%; depression: 7.9%	Selection bias; response bias
11	Chen et al[33], 2013; United States	Head and neck	n = 211; 58% male; median: 57, range: 21-93	Disease free at least 1 yr	UW-QOL	Depression: 17%	Response bias
12	Lambert et al[21], 2005; United States	Head and neck	n = 694; 84.6% male; mean: 61.8	At least 6 mo	GDS-SF	Depression: 44.1%	Selection bias; response bias
13	Moschopoulou et al[44], 2018; United Kingdom	Head and neck	n = 93; 58.1% male; mean: 66	Mean: 6 yr	PCL-C	PTSD: 11.8%	Selection bias; response bias
14	Black et al[45], 2005; United Kingdom	Hodgkin’s lymphoma non- Hodgkin’s lymphoma; acute leukemia	n = 36; 50% female; adults	? - complete remission	PCL-C	PTSD: 17%	Selection bias; response bias
15	Daniëls et al[46], 2014; The Netherlands	Hodgkin’s lymphoma	n = 180; 55% male; median: 46	Mean: 4.6 yr	HADS	Anxiety: 23%; depression: 18%	Selection bias; response bias
16	Geffen et al[35], 2003; Israel	Hodgkin’s lymphoma; non-Hodgkin’s lymphoma	HD: n = 8; nHL: n = 36; 46% male; median: 51; range: 27-80	At least 2 yr after treatment completion	PTSD-inventory scale	Full or partial PTSD: 32%; full PTSD: 18%; partial PTSD: 13% (additional)	Selection bias; response bias
17	Kuba et al[47], 2019; Germany	Hematological	n = 922; 57% male; range: 18-85	3 yr	PHQ-9; GAD-7	Anxiety: 9%; depression: 15%	Selection bias; response bias
18	Han et al[22], 2013; Korea	Stomach	n = 391; 72.9% male; mean: 54.5	Mean (time since operation): 27.4 mo	BDI	Depression: 43.9%	Selection bias; response bias
19	Hanprasertpong et al[48], 2017; Thailand	Cervical	n = 700; 100% female; mean: 53	Completion of treatment 3 mo - 10 yr before study	HADS	Anxiety: 20.46%; depression: 9.44%	Selection bias; response bias
20	Urbaniec et al[18], 2011; Australia	Gynecological	n = 45; 100% female; mean: 56.7, range: 23-83	Mean: 4 yr; range: 0.9-11.6 yr	BDI-II; SAI; IES-Revised	Anxiety: 28.9%; depression: 20%; probable PTSD: 15.6	Selection bias; response bias
21	Krajewski et al[49], 2018; Germany	Melanoma	n = 561; 51.2% male; mean: 62.1	4 yr	HADS	Anxiety: 10.2%; depression: 10.3%	Selection bias; response bias
22	Rogiers et al[27], 2020; Belgium	Melanoma	n =25; 28% male; median: 58, range: 28-86	Median: 30 mo	SCID-IV-CV; HADS	HADS: Anxiety: 32%; depression: 20%; comorbid: 12%. SCID: PTSD: 48%; depression: 0%	Selection bias; response bias; performance bias
23	Rogiers et al[14], 2020; Belgium	Melanoma	n = 17; 29% male; median: 57, range: 33-86	Median: 5.6 yr	SCID-IV-CV; HADS	HADS: Anxiety: 35%; depression: 41%; comorbid: 30%. Interview: PTSD: 35%; depression: 11.76%	Selection bias; response bias; performance bias
24	Nicol et al[23], 2019; Australia	Brain	n = 65; 35.4% male; mean: 49.97; range: 22-75	Mean: 5.29 yr	DASS-Depression; GAD-7	Anxiety: 58.5%; depression: 43.1%	Selection bias; response bias
25	Recklitis et al[50], 2014; United States	Prostate	n = 693; 100% male; mean: 67.1	Range: 3-8 yr	GDS-15	Depression: 15%	Selection bias; response bias
26	Uchitomi et al[51], 2003; Japan	Lung	n = 212; 60.4% male; mean: 62.1, range: 22-83	1 mo after surgery	SCID, Revised; POMS scale	Depression: 8%	Selection bias; performance bias

EDS: Edinburgh Depression Scale; HADS: Hospital Anxiety and Depression Scale; SCID: Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders; POMS: Profiles of Mood States; GDS-15: Geriatric Depression Scale-15; GAD-7: Generalized Anxiety Disorder 7; SCID-IV-CV: Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Clinical Version; BDI: Beck Depression Inventory; SAI: Spielberger State Anxiety Inventory; IES: Impact of Event Scale; PHQ-9: Patient Health Questionaire-9; PTSD: Posttraumatic stress disorder; UW-QOL: The University of Washington Quality of Life; GDS-SF: Geriatric Depression Scale-Short Form; PCL-C: Posttraumatic Stress Disorder Checklist-Civilian Version; MINI: Mini International Neuropsychiatric Interview; PCL-S: Posttraumatic Stress Disorder Checklist-Specific.

Table 3 Prevalence of psychiatric comorbidities in % sorted by tumor site

No	Tumor site	Key result in %				Ref.
		Depression	Anxiety	Comorbid anxiety-depression	PTSD
1	Breast	9	3.5	1.5	-	Alexander et al[26], 2010
2		-	-	-	18	Amir et al[28], 2002
3		22	38	-	12	Mehnert et al[25], 2008
4		20.6	-	-	-	Qiu et al[42], 2012
5		8	23	-	6.3	Vazquez et al[16], 2020
6	Testicular	9.7	19.2	6.8	-	Dahl et al[24], 2005
7		-	-	-	4.5	Dahl et al[17], 2016
8		9	19	-	-	Fosså et al[43], 2003
9		9.7	20.2	-	-	Thorsen et al[15], 2005
10		7.9	6.2	-	-	Vehling et al[19], 2016
11	Head and neck	17	-	-	-	Chen et al[33], 2013
12		44.1	-	--	-	Lambert et al[21], 2005
13		-	-		11.8	Moschopoulou et al[44], 2018
14	Hematological	-	-	-	17	Black et al[45], 2005
15		18	23	-	-	Daniels et al[21], 1976
16		-	-	-	18	Geffen et al[35], 2003
17		15	9	-	-	Kuba et al[47], 2019
18	Stomach	43.9	-	-	-	Han et al[22], 2013
19	Cervical, gynecological	9.4	20.5	-	-	Hanprasertpong et al[48], 2017
20		20	28.9	-	15.6	Urbaniec et al[18], 2011
21	Melanoma	10.3	10.2	-	-	Krajewski et al[49], 2018
22		20	32	12	48	Rogiers et al[27], 2020
23		41	35	30	35	Rogiers et al[14], 2020
24	Brain	43.1	58.5	-	-	Nicol et al[23], 2019
25	Prostate	15	-	-	-	Recklitis et al[50], 2014
26	Lung	8	-	-	-	Uchitomi et al[51], 2003

PTSD: Posttraumatic stress disorder.