Greater Symptom Burden and Poorer Quality of Life Outcomes Are Associated With The Co-Occurrence of Anxiety and Depression During Cancer Chemotherapy - PubMed (original) (raw)

Greater Symptom Burden and Poorer Quality of Life Outcomes Are Associated With The Co-Occurrence of Anxiety and Depression During Cancer Chemotherapy

Alejandra Calvo-Schimmel et al. Semin Oncol Nurs. 2025 Apr.

Abstract

Objectives: Anxiety and depression are common symptoms in oncology patients undergoing chemotherapy. Study purpose was to evaluate for differences in severity of common symptoms (ie, fatigue, energy, sleep disturbance, cognitive function, pain) and quality of life (QOL) outcomes among three subgroups of oncology outpatients with distinct joint anxiety and depression profiles.

Methods: Oncology outpatients (N = 1328) completed measures of state anxiety and depression, six times over two cycles of chemotherapy. Latent profile analysis was done to identify subgroups of patients with distinct joint state anxiety AND depression profiles. Patients completed measures of trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain, as well as generic and disease-specific measures of QOL at enrollment. Differences among the classes in symptom severity scores and QOL scores were evaluated using parametric and non-parametric tests.

Results: Three distinct joint anxiety AND depression profiles were identified and named: Low Anxiety and Low Depression (57.5%, Both Low), Moderate Anxiety and Moderate Depression (33.7%, Both Moderate), and High Anxiety and High Depression (8.8%, Both High). All of the symptom severity scores showed a "dose-response effect" (ie, as the joint anxiety AND depression profiles worsened, the severity of all of the symptoms increased). Likewise, for both the general and disease-specific QOL (except spiritual well-being) measures, all of the scores decreased as the joint anxiety AND depression profiles worsened. Compared to the Both Low classes, the other two classes reported lower scores for the spiritual well-being domain.

Conclusions: More than 40% of patients receiving chemotherapy experience moderate to high levels of both anxiety AND depression. These patients report an extremely high symptom burden and significant decrements in all domains of QOL.

Implications for nursing practice: Clinicians need to perform comprehensive assessments of depression and anxiety and other common symptoms and QOL outcomes during chemotherapy. In addition, referrals for targeted interventions are needed to manage multiple symptoms and improve patients' QOL.

Keywords: Anxiety; Cancer; Chemotherapy; Depression; Latent profile analysis; Quality of life.

Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to declare.

Figures

Fig 1.

Fig 1.

Differences in Medical Outcomes Study-Short Form 12 (SF-12) physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), mental health (ME), physical component summary (PCS), and mental component summary (MCS) scores among the joint anxiety and depression latent classes. All values are plotted as means ± SDs. For all the SF-12 subscales, as well as the PCS and MCS scores, post hoc contrasts demonstrated significant differences among the classes that followed the same pattern (ie, low > moderate > high; all, P < .05).

Fig 2.

Fig 2.

Differences in Quality-of-Life Scale—Patient Version (QOL-PV) scores for the physical, psychological, social, and spiritual well-being domains as well as total quality of life (QOL) among the joint anxiety and depression latent classes. All values are plotted as means ± SDs. For the physical, psychological, and social domains, as well as QOL total scores, post hoc contrasts demonstrated significant differences among the classes that followed the same pattern (ie, low > moderate > high; all, P < .05). For the spiritual well-being domain, the post hoc contrasts demonstrated that the differences among the classes were as follows: low > moderate and high classes (P < .05).

References

    1. Peng YN, Huang ML, Kao CH. Prevalence of depression and anxiety in colorectal cancer patients: a literature review. Int J Environ Res Public Health. 2019;16(3). 10.3390/ijerph16030411. -DOI -PMC -PubMed
    1. Russell K, Moghaddam N, Tickle A. Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: a systematic review and meta-analysis. Eur J Cancer Care (Engl). 2022;31(6):e13678. 10.1111/ecc.13678. -DOI -PMC -PubMed
    1. Bhattacharyya S, Bhattacherjee S, Mandal T, et al. Depression in cancer patients undergoing chemotherapy in a tertiary care hospital of North Bengal, India. Indian J Public Health. 2017;61(1):14–18. 10.4103/0019-557x.200252. -DOI -PubMed
    1. Tan DJH, Quek SXZ, Yong JN, et al. Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: systematic review and meta-analysis. Clin Mol Hepatol. 2022;28(4):864–875. 10.3350/cmh.2022.0136. -DOI -PMC -PubMed
    1. Brunckhorst O, Hashemi S, Martin A, et al. Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis. 2021;24(2):281–289. 10.1038/s41391-020-00286-0. -DOI -PubMed

MeSH terms

Substances

LinkOut - more resources