Anxiety and Depression in Cancer Survivors

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Key points

  • Many cancer survivors experience cancer-related fear of recurrence, posttraumatic stress symptoms, anxiety, or depression after completing treatment.

  • Anxiety and fear are more common than depression.

  • Risk factors are beginning to be understood for these issues. Women and girls, adolescents, and young adults and those who receive intensive treatment are more vulnerable.

  • Most of what is known is from breast cancer survivors; more research is needed with diverse cancer survivors.

  • Evidence supports

Symptoms

After cancer treatment, many survivors report feeling alone or even abandoned after the intensive support provided during their treatment. Survivors often are fearful and hypervigilant to physical sensations, especially prior to regularly scheduled testing for recurrence. These intermittent, preoccupying anxieties are called fear of recurrence (FOR), although they can also extend to include symptoms of posttraumatic stress, with hyperarousal when exposed to reminders of cancer, avoidance of

Diagnostic tests

Given the scope of mood problems cancer survivors may experience, clinicians need easy-to-administer methods for screening so that they can make appropriate recommendations and referrals. Numerous methods for screening and diagnosing mental health needs in survivors have been validated that balance ease of use and sensitivity and specificity for defining treatment needs. Many of these measures can be administered in print or online versions, although clinical interview is equally useful and

Differential diagnosis

Making a differential diagnosis can be critical with cancer survivors because many of the symptoms of anxiety and depression overlap with other problems survivors report, such as cognitive difficulties and fatigue. Because mood symptoms overlap with each other, clinicians need a thoughtful screening plan to allow differential diagnosis that can help determine a specific treatment strategy. It is important to recognize that a survivor may have an agitated depression with symptoms of both anxiety

Anxiety and depression in different populations of survivors

This section reviews the literature on anxiety and depression in adult survivors of childhood cancer, AYAs, and adult survivors. Within each section, prevalence, risk factors, and trajectories for various mood issues are discussed.

Treatment options

Evidence from randomized controlled trials indicate that several behavioral approaches are effective in improving mood in cancer survivors, although a majority of studies have been done in female breast cancer survivors. Therefore, all these interventions need further testing with diverse groups of survivors, in particular men. Cognitive behavioral therapy is effective in reducing mood symptoms in cancer survivors.82, 83, 84 Mindfulness-based approaches also have demonstrated efficacy in

Summary

Many survivors cope well with cancer and its associated treatments. For a subgroup of survivors, however, anxiety, depression, fears, and distress can linger for up to 10 years after treatment.107 For some of the issues discussed in this article, such as FOR, no standardized definitions exist, which makes comparing research results difficult.108 More research is needed with diverse survivors on many levels: types and stages of cancer, racial/ethnic diversity, sexual minorities, and rural

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