Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors

  • Joanna J. ArchEmail author
  • Sarah R. Genung
  • Michelle C. Ferris
  • Alex Kirk
  • Elizabeth T. Slivjak
  • Joel N. Fishbein
  • Rebecca L. Schneider
  • Annette L. Stanton
Original Article



Despite cancer survivors’ frequent endorsement of anxiety symptoms, assessing the full range of anxiety disorders (AD), their timing of onset relative to cancer diagnosis, co-morbidity with mood disorder, and predictors of post-cancer onset, is rare or absent to date. This study provides a step toward addressing these gaps.


Cancer survivors at re-entry after primary treatment completion who screened positively for anxiety symptoms (N = 133) and sought care through an intervention trial completed standardized diagnostic interviews, dimensional assessment of disorder severity, and timing of disorder onset relative to cancer diagnosis. We evaluated sociodemographic and medical predictors of developing a first AD after cancer diagnosis.


Most ADs began after cancer diagnosis (58%); for 68% of affected patients, this represented their first AD episode. The most common was generalized anxiety disorder (GAD; 41%), where “cancer-focused GAD” was distinguished from “typical GAD”; the next most common were specific phobia (14%) and social anxiety disorder (13%). A minority (31%) of ADs were comorbid with major depression. Relative to having no AD, experiencing more lingering treatment side effects predicted developing a first AD after cancer diagnosis. Relative to having an AD that began before cancer diagnosis, reporting a higher cancer stage predicted developing a first AD after diagnosis.


Cancer survivors at re-entry seeking care for anxiety symptoms manifested a broad range of ADs which most commonly developed after cancer diagnosis and were prompted by the experience of cancer. Such disorders represent an unusually late-life, cancer-linked etiology that warrants further investigation and clinical attention.


Cancer survivors Cancer Anxiety Anxiety disorders Phobia disorders Mental health 


Funding information

J.J.A. was supported by the American Cancer Society Research Scholar Grant (Arch, RSG-15-020-01–CPPB); A.L.S. was supported by the Breast Cancer Research Foundation (Stanton, BCRF-20184915).

Compliance with ethical standards

The University of Colorado Boulder Institutional Review Board (#15-0313) and University of Colorado Cancer Center approved the study and all participants provided written informed consent.

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

520_2020_5297_MOESM1_ESM.docx (30 kb)
ESM 1 (DOCX 30 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Psychology and NeuroscienceUniversity of Colorado BoulderBoulderUSA
  2. 2.Division of Cancer Prevention and ControlUniversity of Colorado Cancer CenterAuroraUSA
  3. 3.Department of PsychologyUniversity of California Los AngelesLos AngelesUSA
  4. 4.Jonsson Comprehensive Cancer CenterUniversity of California Los AngelesLos AngelesUSA

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