Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis.
Lonneke A van Tuijl, Maartje Basten, Kuan-Yu Pan, Roel Vermeulen, Lützen Portengen, Alexander de Graeff, Joost Dekker, Mirjam I Geerlings, Adriaan Hoogendoorn, Femke Lamers, Adri C Voogd, Jessica Abell, Philip Awadalla, Aartjan T F Beekman, Ottar Bjerkeset, Andy Boyd, Yunsong Cui, Philipp Frank 15 , Henrike Galenkamp 23 , Bert Garssen, Sean Hellingman, Martijn Huisman, Anke Huss, Trynke R de Jong, Melanie R Keats, Almar A L Kok, Steinar Krokstad, Flora E van Leeuwen, Annemarie I Luik, Nolwenn Noisel, N Charlotte Onland-Moret, Yves Payette, Brenda W J H Penninx, Ina Rissanen, Annelieke M Roest, Rikje Ruiter, Robert A Schoevers, David Soave, Mandy Spaan, Andrew Steptoe, Karien Stronks, Erik R Sund, Ellen Sweeney, Emma L Twait, Alison Teyhan, W M Monique Verschuren, Kimberly D van der Willik, Judith G M Rosmalen, Adelita V Ranchor.
Abstract: Meta-Analysis. 2023 Oct 15;129(20):3287-3299. doi: 10.1002/cncr.34853. Epub 2023 Aug 7.
Background: Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium.
Methods: The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2).
Results: No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23).
Conclusions: Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER:
Annotation (unstructured)
The finding:
The authors evaluated data from 18 longitudinal studies with follow up ranging from 8 to 26 years examining the association between depression and anxiety on cancer incidence. Majority were smoking related cancers (36%) followed by alcohol related cancers (30%). No association was found between depression, anxiety, and all cancers, but there was an association with lung and smoking related cancers. With further adjustment of various factors, the association diminished.
Strength and weaknesses:
Analysis was done via individual participant data analyses, which allowed evaluation of original data from different studies and testing of more hypothesis. This study was conducted by an internal committee, so its results could help develop guidelines. Other strengths were large sample size, heterogeneity assessed by two tools and information about cancer diagnoses obtained from cancer registries. Weakness included that only current depressive and anxiety diagnoses or symptoms were assessed, not those with history of depression or anxiety.
Relevance:
The study helps to understand psychological factors and cancer outcomes in more detail and may help with further research in this area. Certainly, the study also indicates the importance of smoking cessation counselling/support in oncology setting.
PUBLICATION #2 — Psychooncology
Incidence of delirium in older people with cancer: Systematic review and meta-analysis.
Francisco Miguel Martínez-Arnau, Cristina Buigues, Pilar Pérez-Ros.
Purpose:
Delirium is a prevalent neuropsychiatric syndrome in older people with cancer. However, there are no meta-analyses assessing its incidence exclusively in this population. This study aims to assess the incidence proportion of delirium in older people with cancer in the hospital area.
Methods:
A systematic review and meta-analysis were carried out. MEDLINE, Scopus, and EBSCO were searched from inception to December 2021. PRISMA guidelines were followed. Inclusion criteria were original peer-reviewed studies with experimental (randomised controlled trials), observational, and cross-sectional designs assessing delirium older inpatients (≥65 years) with oncological diseases in medical and post-surgical hospital areas and using validated screening or diagnostic methods. A web-based system was used to manage the screening process. Study quality was assessed with Joanna Briggs Institute Critical Appraisal tools. The statistical analysis was performed in RevMan v5.4.0 (Cochrane Collaboration, Oxford, UK), using a random-effects model to calculate incidence and 95% confidence intervals (CIs).
Results:
Based on 37 included articles, the incidence proportion of delirium ranged from 3.8% to 61.4%, in a total of 11,847 older patients with cancer. Meta-analysis showed a pooled incidence of 22.6% (95% confidence interval 18.5%, 26.7%; I2 = 97%, p < 0.001). The main tools for detection were the Diagnostic Statistical Manual criteria and the Confusion Assessment Methods scale.
Conclusions:
The incidence proportion of delirium in older inpatients with cancer is 22.6%. Incidence in the medical setting was higher than in the post-surgical areas. There is a need for high-quality studies examining delirium in older people with cancer.
Annotation (unstructured)
The finding:
The incidence of delirium in older inpatients with cancer is 22.6%. The incidence is higher in medical delirium at 36% compared to postoperative delirium at 17%. The main tools for detection were the DSM criteria and the CAM (Confusion Assessment Method) scale. There is no significant heterogeneity statistically in subgroup analysis by person performing assessment, number of patients per study or type of cancer.
Strength and weaknesses:
This systematic review used the registered study in PROSPERO and utilized the PRISMA statement to guide their methodology. Weaknesses included that the PROSPERO registration did not have updated past data extraction. Although they mentioned utilizing PRISMA, there was not included as a checklist in the supplementary material for review.
Relevance:
Delirium is a condition commonly encountered in the practice of psychosomatic medicine. Internalizing that approximately one out of every five older adult cancer patients in the hospital setting may be experiencing delirium, will help us sharpen our sensitivity to identifying delirium during clinical encounters.
PUBLICATION #3 — Psychooncology
Trauma-Informed Approaches in the Context of Cancer Care in Canada and the United States: A Scoping Review .
Cancer is predominantly understood as a physical condition, but the experience of cancer is often psychologically challenging and has potential to be traumatic. Some people also experience re-traumatization during cancer because of previous, non-cancer-related trauma, such as intimate partner violence or adverse childhood experiences. A trauma-informed approach to care (TIC) has potential to enhance care and outcomes; however, literature regarding cancer-related TIC is limited. Accordingly, the objective of this scoping review was to identify what is known from existing literature about trauma-informed approaches to cancer care in Canada and the United States. A scoping review (using Arksey and O’Malley’s (2005) framework) was conducted. The PsycINFO, CINAHL, MEDLINE (Ovid), Embase (Ovid), and Scopus databases, key journals, organizations, and reference lists were searched in February 2022. In total, 124 sources met the review criteria and 13 were included in the final review. Analysis included a basic descriptive summary and deductive thematic analysis using conceptual categories. Theorizations, applications, effectiveness, and feasibility of TIC were compiled, and gaps in TIC and recommendations for TIC were identified. TIC appeared to be growing in popularity and promising for improving cancer outcomes; however, gaps in the theorization, effectiveness, and feasibility of TIC persisted. Many recommendations for the application of TIC were not issued based on a strong body of evidence due to a lack of available literature. Further research is required to develop evidence-based recommendations regarding TIC related to cancer. A systematic review and meta-analysis would be warranted upon literature proliferation.
Annotation (unstructured)
The finding:
This scoping review, limited to studies from the United States and Canada, identifying large gaps in the application of trauma informed care (TIC) into the cancer setting. Thirteen out of 124 studies were ultimately included in the review. The review found examples where TIC was operationalized mostly in the context of eliciting patient preferences (e.g., provider gender, facilitating safety and trust) and clinician education regarding trauma. The authors identified that recommendations were variable and inconsistent.
Strength and weaknesses:
The review highlighted several important issues in how TIC is described and some of the inherent challenges that will be forthcoming in future studies that will incorporate TIC. There was not a clear reason why studies were limited to the United States and Canada. It may also be seen as a limitation that several studies were included that were trial designs only, but this inclusion fit their criteria for a scoping review and was in line that this is an evolving area of study.
Relevance:
This review is helpful in describing the landscape of incorporating TIC into the cancer setting. As more information becomes available, reviews on this topic will be able to consolidate findings and provide recommendations in the field.
You must be logged in to view this page
Please login below or register as a new user
Thank you for visiting our website.
The Academy of Consultation-Liaison Psychiatry is a professional organization of physicians who provide psychiatric care to people with coexisting psychiatric and medical illnesses, both in hospitals and in primary care. Our specialty is called consultation-liaison psychiatry because we consult with patients and liaise with their other clinicians about their care.
With nearly 2,000 members, the Academy is the voice of consultation-liaison psychiatry in the US with international reach.
Please browse our website, read our journal, Psychosomatics, and come to our annual meeting which is in November each year. In 2020 it will be a virtual event – see www.CLP2020.org for more details.
If you are a C-L Psychiatrist and not yet a member please join our great organization and welcoming, inclusive community. Please visit this page for details on joining.
