New research calls into question relationship between cancer risk and depression, anxiety
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Key takeaways:
- Results showed no association between depression or anxiety and overall cancer risk.
- Other risk factors may explain the slightly elevated risk observed for smoking-related cancers.
A meta-analysis performed by an international group of researchers revealed no association between depression or anxiety and increased overall cancer risk.
Results showed elevated risk for smoking-related cancers among those with depression or anxiety. However, the association weakened considerably when researchers performed multivariate analysis adjusted for other risk factors.
“We found very little evidence to support an association between depression and anxiety and several forms of cancer,” researcher Lonneke A. van Tuijl, PhD, assistant professor in the department of clinical psychology at Utrecht University, told Healio. “There was some evidence of an association with lung cancer, but this weakened considerably when accounting for several known risk factors such as smoking, BMI and alcohol consumption.”
Background
Previous meta-analyses examining the relationship between depression/anxiety and overall cancer risk have yielded mixed results, according to van Tuijl.
“We wanted to conduct a meta-analysis [that] adjust[ed] for a number of known risk factors across all included studies, where depression and anxiety were measured with validated measures, where cancer diagnosis was based on relatively objective data and we had powered adequately enough to consider several types of cancer,” she told Healio. “In other words, we were aiming for more harmony across the included studies in our meta-analyses, with sufficient statistical power to detect small effects.”
Methodology
Van Tuijl and colleagues used data from the international Psychosocial Factors and Cancer Incidence (PSY‐CA) consortium to conduct a two-stage individual participant data meta-analysis to evaluate any association between depression or anxiety and cancer incidence.
Researchers assessed overall cancer incidence, plus risk for breast, lung, prostate or colorectal cancers. They also evaluated risk for malignancies with established common lifestyle risk factors, such as smoking or alcohol use.
The analysis included anxiety and depression measurement data from 18 cohorts across four countries, comprising a combined 319,613 patients.
Investigators observed 25,803 cancer cases during more than 3.25 million person-years of follow-up.
Key findings
Results showed no association between depression or anxiety and overall cancer incidence or the risk for breast, prostate, colorectal or alcohol-related cancers.
Minimally adjusted analyses showed increased risk for lung cancer (HR range = 1.12-1.6) and smoking-related cancers (HR range = 1.06-1.24).
However, analyses adjusted for known risk factors — including smoking status, alcohol use and BMI — yielded less robust associations between depression or anxiety and risk for lung cancer (HR range = 1.07-1.23) or smoking-related malignancies(HR range = 1.04-1.08).
Clinical implications
The study findings do not support the hypothesis that depression or anxiety are related to elevated risk for cancer overall, nor for prostate, breast, colorectal or alcohol-related cancers, according to van Tuijl.
“Our results may come as a relief to many patients with cancer who believe their diagnosis is attributed to previous anxiety or depression,” van Tuijl said in a press release. “However, further research is needed to understand exactly how depression, anxiety, health behaviors and lung cancer are related.”
References:
- van Tuijl LA, et al. Cancer. 2023;doi:10.1002/cncr.34853.
- Wiley. Robust analysis challenges theory that depression and anxiety increase cancer risk (press release). Published Aug. 7, 2023. Accessed Aug. 7, 2023.
For more information:
Lonneke A. van Tuijl, PhD, can be reached at l.a.van.tuijl@umcg.nl.
Perspective
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Mary Moeller, PhD
With the prevalence of mental health diagnoses rising worldwide, it is of increasing importance to study the causes and consequences of such conditions. Psychological contributors to cancer risk are, understandably, an area of great concern for people with cancer and providers alike. I have spoken with many patients who have wondered if their stress, depression or anxiety caused their cancer, or if they made themselves sick somehow by having untreated or undertreated mental health symptoms.As van Tuijl pointed out, the results of this meta-analysis may be a relief to patients presenting with those concerns, particularly given that the relationship between depression and anxiety and lung cancer weakened when researchers adjusted for health-related behavioral variables (eg, smoking or alcohol use).
Consistent with these results, we know behavioral factors can play a role in cancer risk. The results on the relationship between anxiety and depression and lung cancer in particular highlight the importance of addressing the way that mental health symptoms can impact behaviors and suggest that the emotions themselves are not innately harmful, but that the significance lies in what we do with those emotions.
It also is important to note that this does not negate the reverse relationship: We know cancer can be a cause of anxiety and depression for many patients. It remains important for providers to screen patients for clinically significant symptoms of anxiety and depression so these symptoms can be addressed. We also must continue to explore the ways in which psychological symptoms influence behaviors related to cancer risk, and how they impact the cancer journey and treatment outcomes.
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van Tuijl LA, et al. Cancer. 2023;doi:10.1002/cncr.34853.
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