Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis

<b>Background</b> Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.<p></p> <b>Methods</b> We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.<p></p> <b>Findings</b> Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11•6% (95% CI 7•7—16•2) in the pooled sample of 51 381 cancer survivors and 10•2% (8•0—12•6) in 217 630 healthy controls (pooled relative risk [RR] 1•11, 95% CI 0•96—1•27; p=0•17). The prevalence of anxiety was 17•9% (95% CI 12•8—23•6) in 48 964 cancer survivors and 13•9% (9•8—18•5) in 226 467 healthy controls (RR 1•27, 95% CI 1•08—1•50; p=0•0039). Neither the prevalence of depression (26•7% vs 26•3%; RR 1•01, 95% CI 0•86—1•20; p=0•88) nor the prevalence of anxiety (28•0%vs 40•1%; RR 0•71, 95% CI 0•44—1•14; p=0•16) differed significantly between cancer patients and their spouses.<p></p> <b>Interpretation</b> Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.<p></p&gt