Anxiety and depression disorders in cancer patients: incidence, diagnosis and therapy

Short review


Psycho-oncologist research in recent years has focused on assessment of distress and mental disorders in cancer patients. Primary objective has been the implementation of individually tailored psychosocial support during routine medical care. This review shows that based on validly structured clinical interviews, 30–40% of the studied patient population had a mental disorder in accordance with the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Most common diagnoses were depression, adjustment and anxiety disorders. Risk factors included among others younger age, previous history of mental disorders and lack of social support. Screening instruments are useful, easy to complete and allow early detection of high distress in patients, enabling appropriate interventions in affected patients. Established methods in psycho-oncology are cognitive behavioural therapy, psycho-educational groups and relaxation trainings. A positive influence of early palliative care intervention on cancer patients' mood has been shown. Adequate resources in acute and outpatient routine care shall be offered.


Distress Psycho-oncology Quality of life Supportive care Underestimation 


  1. Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety and adjustment disorder in oncological, haematological and palliative-care settings: A meta-analysis of 94 interview-based studies. Lancet Oncol, 12(2): 160–74, 2011PubMedCrossRefGoogle Scholar
  2. Fallowfield L, Ratcliffe D, Jenkins V, Saul J. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer, 84(8): 1011–5, 2001PubMedCrossRefGoogle Scholar
  3. Hjerl K, Anderson EW, Keiding N, et al. Depression as a prognostic factor for breast cancer mortality. Psychosomat, 44(1): 24–30, 2003CrossRefGoogle Scholar
  4. Pelletier G, Verhoef M, Khatri N, Hagen N. Quality of life in brain tumor patients: The relative contributions of depression, fatigue, emotional distress and existential issues. J Neuro-Oncol, 57: 41–49, 2002CrossRefGoogle Scholar
  5. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment. Arch Int Med, 160: 2101–7, 2000CrossRefGoogle Scholar
  6. Prieto JM, Blanch J, Atala J, Carreras E, Rovira M, Cirera E. Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. J Clin Oncol, 20: 1907–17, 2002PubMedCrossRefGoogle Scholar
  7. Mitchell AJ, Vahabzadeh A, Magruder K. Screening for distress and depression in cancer settings: 10 lessons from 49 years of primary-care research. Psycho-Oncol, 20: 572–84, 2011CrossRefGoogle Scholar
  8. Pollak KI, Arnold RM, Jeffreys AS, et al. Oncologist communication about emotion during visits with patients with advances cancer. J Clin Oncol, 25: 5748–52, 2007PubMedCrossRefGoogle Scholar
  9. Hickie IB, Davenport TA, Scott EM, Hadzi-Pavlovic D, Naismith SL, Koschera A. Unmet need for recognition of common mental disorders in Australian general practice. Med J Aust, 175: 18–24, 2001Google Scholar
  10. Maerckert I, Libert Y, Messin S, Milani M, Slachmuylder J-L, Razavi D. Cancer patients' desire for psychological support: Prevalence and implications for screening patients' psychological needs. Psycho-Oncol, 19: 141–9, 2009Google Scholar
  11. Singer S, Bringmann H, Hauss J, et al. Häufigkeit psychischer Begleiterscheinungen und der Wunsch nach psychosozialer Unterstützung bei Tumorpatienten im Aktkrankenhaus. Dtsch Med Wochensch, 132: 2071–6, 2007CrossRefGoogle Scholar
  12. Irwin MR. Depression and risk of cancer progression: An elusive link. J Clin Oncol, 25: 2343–4, 2007PubMedCrossRefGoogle Scholar
  13. Jacobi F, Wittchen H-U, Hölting C, et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: Results from the German Health Interview and Examination Survey (GHS). Psychol Med, 34: 1–15, 2004CrossRefGoogle Scholar
  14. Andrykowsky MA, Kangas M. Posttraumatic stress disorder associated with cancer diagnosis and treatment. In: Holland JC, et al., editors. Psycho-Oncology. 2nd ed. Oxford University Press, New York, pp. 348–57, 2010Google Scholar
  15. Li M, Hales S, Rodin G. Adjustment Disorders. In: Holland JC, et al., editors. Psycho-Oncology. 2nd ed. Oxford University Press, New York, pp. 303–10, 2010Google Scholar
  16. Brown MS, Kroenke MD. Cancer-related fatigue and its associations with depression and anxiety: A systematic review. Psychosomat, 50: 440–7, 2009Google Scholar
  17. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: Inflammation and the pathogenesis of depression. Trends Immunol, 27(1): 24–31, 2006PubMedCrossRefGoogle Scholar
  18. Miller K, Massie MJ. Depressive Disorders. In: Holland JC, et al., editors. Psycho-Oncology. 2nd ed. Oxford University Press, New York, pp. 311–8, 2010Google Scholar
  19. Massie MJ. Prevalence of Depression in patients with cancer. J Nat Cancer Inst Monogr, 32: 57–71, 2004CrossRefGoogle Scholar
  20. Carlson LE, Bultz BD. Benefits of psychosocial oncology care: Improved quality of life and medical cost offset. Health Qual Life Outcomes, 1(1): 8, 2003PubMedCrossRefGoogle Scholar
  21. Holland JC, Bultz BD. National Comprehensive Cancer Network (NCCN). The NCCN guidelines for distress management: A case for making distress the sixth vital sign. J Natl Compr Cancer Netw, 5: 3–7, 2007Google Scholar
  22. Mitchell AJ. Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol, 25: 4670–81, 2007PubMedCrossRefGoogle Scholar
  23. First B, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press, Inc., Washington, D.C. 1996Google Scholar
  24. Mehnert A, Berg P, Henrich G, Herschbach P. Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psychooncol, 18: 1273–80, 2009CrossRefGoogle Scholar
  25. Hjerl K, Andersen EW, Keiding N, Mortensen PB, et al. Increased incidence of affective disorders, anxiety disorders, and non-natural mortality in women after breast cancer diagnosis: A nation-wide cohort study in Denmark. Acta Psychiat Scand, 105(4): 258–64, 2002PubMedCrossRefGoogle Scholar
  26. Greenberg DB. Barriers to the treatment of depression in cancer patients. J Natl Cancer Inst Monogr, 32: 127–35, 2004PubMedCrossRefGoogle Scholar
  27. Braun IM, William FP. Psychotropic medications in cancer care. In: Holland JC, et al., editors. Psycho-Oncology. 2nd ed. Oxford University Press, New York, 378–85, 2010Google Scholar
  28. Hellwig S, Merger M, van Calker D. Depressive Störungen bei Tumorpatienten. Pathophysiologie und medikamentöse Behandlungsstrategien. Nervenheilkund, 30: 138–43, 2011Google Scholar
  29. van Schaik DJF, Klijn AFJ, van Hout HPJ, et al. Patients' preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry, 26 (3): 184–9, 2004PubMedCrossRefGoogle Scholar
  30. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med, 363: 733–42, 2010PubMedCrossRefGoogle Scholar
  31. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer. JAMA, 302: 741–9, 2009PubMedCrossRefGoogle Scholar
  32. National Health and Medical Research Council (NHMCR). Clinical practice guidelines for the psychosocial care of adults with cancer. NSW, Camperdown: Breast Cancer Center 2003,

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Universitätsklinikum Schleswig-HolsteinCampus Lübeck, Ratzeburger AlleeLübeckGermany

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