Journal de la dépression et de l'anxiété
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Emotional Distress in Newly Diagnosed Cancer Outpatients: Do Depression and Anxiety Predict Mortality and Psychosocial Outcomes After 1 Year?

Jianlin Liu, Chao-Xu Peh, Shi Min Chua and Rathi Mahendran

Background and Objective: Metastatic progression predicts cancer mortality but there are conflicting findings on the effects of emotional distress (depression and anxiety) on mortality. Although survival time continues to be an important outcome in cancer care, psychosocial wellbeing is recognized to be a clinically significant and meaningful subjective outcome. This prospective study examined the effects of depression and anxiety on cancer mortality and psychosocial wellbeing across the first year of diagnosis. Methods: Participants were 221 newly diagnosed adult cancer patients who were assessed on depression, anxiety, and life satisfaction. Mortality was formulated as cancer deaths occurring between baseline and December 2014 (timescale in months). Cox proportional-hazards models were conducted to examine if baseline depression and anxiety predict cancer mortality with adjustments for cancer stage at diagnosis (early/advanced), metastatic cancer, cancer site, medical comorbidities, and demographic variables age, gender, and ethnicity. Logistic regressions were conducted to examine if the baseline depression and anxiety predict depression, anxiety, and poor life satisfaction at 12-month follow-up. Results: There were 31 incident cancer deaths within the study period (14% mortality). Cancer mortality was predicted by metastatic cancer, female gender, and Hepatitis B diagnosis. Depression at 12-month follow-up was predicted only by baseline depression. Anxiety was predicted by baseline depression and anxiety. Additionally, poor life satisfaction was predicted by baseline depression. Conclusion: The present study adds to existing research by examining the role of depression and anxiety on cancer mortality and psychosocial outcomes early in the course of cancer, with considerations for potential confounding medical variables. Potential implications from the study include the importance of screening and supportive inventions for depression and anxiety post cancer diagnosis so as to prevent or reduce the risk of persistent emotional distress and improve patients’ quality of life.