Anxiety and Depression in Advanced Lung Cancer Patients Affected by Symptoms and Therapy

Lung cancer remains the leading cause of cancer death in the United States, with approximately 350 patients dying from the disease daily.¹ Although it is still a leading cause of death, in recent years the incidence of patients with advanced disease has declined while localized-stage disease has increased by 4.5% annually between 2004 and 2018.¹ Due to the COVID-19 pandemic, diagnosis of all types of cancer was delayed, and it is expected that there will be an increase in the incidence of patients with advanced-stage disease along with an accompanying increase in mortality.¹ Estimated new lung cancer cases and deaths for 2022 are 236,740 and 130,180, respectively.¹

Anxiety and depression are common psychological symptoms reported by patients with lung cancer. Anxiety affects ≤10% of patients with cancer and depression affects ≤20%, prevalence figures that remain stable regardless of the patient’s point in the course of cancer care, from diagnosis to palliative care.² Major depression affects approximately 13% of patients with lung cancer, and these patients have the highest reported anxiety levels among cancer patients in general.² Anxiety is more likely to occur concomitantly with depression rather than as a stand-alone symptom.² Cancer treatments, such as corticosteroids and chemotherapy, contribute to depression, and lung cancer itself can release chemicals that are thought to contribute to depression in patients.²

Depression and anxiety have been shown to contribute to a poor quality of life for patients with lung cancer. Furthermore, depression has been associated with poor patient compliance with treatment and poor cancer survival.²

To understand the factors that can predict anxiety and depression in patients with lung cancer who are in palliative care, a prospective observational study was conducted in 63 patients with histologically confirmed lung cancer from January 2020 to June 2021 in a rural cancer center in India.³ Patients who were being treated for psychiatric conditions, patients with uncertain diagnoses, and those with a poor performance status were excluded from the study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and various patient symptoms were assessed with the revised Edmonton Symptom Assessment System. Patient comorbidities and history of chemotherapy, surgery, and radiotherapy were also assessed.

The primary predictors for anxiety were diagnosis of small-cell carcinoma (P = .045), history of radiotherapy (P = .003), and the presence of breathlessness (P <.001) and hypertension (P = .014). Depression symptoms were predicted by history of radiotherapy (P = .046) and the presence of breathlessness (P = .010) and fatigue (P = .044).

References

1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33.
2. Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415.
3. Patil CR, Tanawade P, Dhamne N, et al. Predictors of anxiety and depression among advanced lung cancer patients attending palliative care department: an experience from the rural cancer centre. Ann Oncol. 2022;33(2):S64.