Global Prevalence and Determinant Factors of Pain, Depression, and Anxiety Among Cancer Patients: an Umbrella Review of Systematic Reviews and Meta-analyses

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2025 Feb 19

PMID 39972435

Authors

Addisu Getie

Manay Ayalneh

Melaku Bimerew

Affiliations

Soon will be listed here.

Abstract

Introduction: Depression and anxiety are prevalent psychological disorders that significantly affect physical, emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especially challenging for cancer survivors, complicating treatment management, affecting adherence, and potentially impacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, and anxiety, as well as their determinants among cancer patients.

Method: An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants of pain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses. The review involved a thorough search of multiple databases and included studies published in English up to July 2024 that reported on these symptoms. The process involved screening and selecting studies based on specific criteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determine overall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understanding of these psychological issues in cancer survivors and guide future research and interventions.

Result: The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59-38.74), while anxiety had a prevalence of 30.55% (95% CI 24.04-37.06). Pain prevalence after treatment was 39.77% (95% CI 31.84-47.70). Before treatment, 65.22% (95% CI 62.86-67.57) of cancer patients reported pain, which persisted in 51.34% (95% CI 40.01-62.67) during treatment. The analysis also found that during the COVID-19 pandemic, depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI 41.25-45.26) and 52.93% (95% CI 50.91-54.96), respectively.

Conclusion: The umbrella review found that depression and anxiety prevalence among cancer survivors was 33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factors contributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxiety was significantly linked to advanced cancer stage and poor sleep quality.

Clinical Trial Number: Not applicable.

References

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P . Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015; 13(3):132-40. DOI: 10.1097/XEB.0000000000000055. View

van den Beuken-van Everdingen M, de Rijke J, Kessels A, Schouten H, van Kleef M, Patijn J . Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007; 18(9):1437-49. DOI: 10.1093/annonc/mdm056. View

Noorani Mejareh Z, Abdollahi B, Hoseinipalangi Z, Jeze M, Hosseinifard H, Rafiei S . Global, regional, and national prevalence of depression among cancer patients: A systematic review and meta-analysis. Indian J Psychiatry. 2022; 63(6):527-535. PMC: 8793718. DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_77_21. View

Rezagholi P, Abdi K, Barzanji A, Ghanei-Gheshlagh R, Eghbali T, Hasanpour Dehkordi A . Prevelence of depression in Iranian women with breast cancer: a systematic review and meta-analysis. Przegl Epidemiol. 2022; 76(1):29-36. DOI: 10.32394/pe.76.04. View

Tao F, Xu M, Zou Q, Tang L, Feng J, Li Z . Prevalence and severity of anxiety and depression in Chinese patients with breast cancer: a systematic review and meta-analysis. Front Psychiatry. 2023; 14:1080413. PMC: 10336240. DOI: 10.3389/fpsyt.2023.1080413. View

Serlin R, Mendoza T, Nakamura Y, Edwards K, Cleeland C . When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995; 61(2):277-284. DOI: 10.1016/0304-3959(94)00178-H. View

Obispo-Portero B, Cruz-Castellanos P, Jimenez-Fonseca P, Rogado J, Hernandez R, Castillo-Trujillo O . Anxiety and depression in patients with advanced cancer during the COVID-19 pandemic. Support Care Cancer. 2022; 30(4):3363-3370. PMC: 8735888. DOI: 10.1007/s00520-021-06789-3. View

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

10.

Mestdagh F, Steyaert A, Lavandhomme P . Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques. Curr Oncol. 2023; 30(7):6838-6858. PMC: 10378332. DOI: 10.3390/curroncol30070500. View

11.

van den Beuken-van Everdingen M, Hochstenbach L, Joosten E, Tjan-Heijnen V, Janssen D . Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016; 51(6):1070-1090.e9. DOI: 10.1016/j.jpainsymman.2015.12.340. View

12.

Chuang S, Lee Y, Wu G, Straif K, Hashibe M . Alcohol consumption and liver cancer risk: a meta-analysis. Cancer Causes Control. 2015; 26(9):1205-31. DOI: 10.1007/s10552-015-0615-3. View

13.

Darvishi N, Ghasemi H, Rahbaralam Z, Shahrjerdi P, Akbari H, Mohammadi M . The prevalence of depression and anxiety in patients with cancer in Iran: a systematic review and meta-analysis. Support Care Cancer. 2022; 30(12):10273-10284. DOI: 10.1007/s00520-022-07371-1. View

14.

Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S . The prevalence of psychological distress by cancer site. Psychooncology. 2001; 10(1):19-28. DOI: 10.1002/1099-1611(200101/02)10:1<19::aid-pon501>3.0.co;2-6. View

15.

Walker J, Holm Hansen C, Martin P, Symeonides S, Ramessur R, Murray G . Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry. 2015; 1(5):343-50. DOI: 10.1016/S2215-0366(14)70313-X. View

16.

Breivik H, Cherny N, Collett B, De Conno F, Filbet M, Foubert A . Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009; 20(8):1420-33. DOI: 10.1093/annonc/mdp001. View

17.

Poletti V, Pagnini F, Banfi P, Volpato E . The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature. Curr Cardiol Rep. 2022; 24(12):1995-2008. PMC: 9747824. DOI: 10.1007/s11886-022-01815-0. View

18.

Kouhestani M, Gharaei H, Fararouei M, Hosienpour Ghahremanloo H, Ghaiasvand R, Dianatinasab M . Global and regional geographical prevalence of depression in gastric cancer: a systematic review and meta-analysis. BMJ Support Palliat Care. 2020; 12(e4):e526-e536. DOI: 10.1136/bmjspcare-2019-002050. View

19.

Caruso R, GiuliaNanni M, Riba M, Sabato S, Grassi L . Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review. Curr Psychiatry Rep. 2017; 19(6):33. PMC: 5423924. DOI: 10.1007/s11920-017-0785-7. View

20.

Degefa M, Dubale B, Bayouh F, Ayele B, Zewde Y . Validation of the PHQ-9 depression scale in Ethiopian cancer patients attending the oncology clinic at Tikur Anbessa specialized hospital. BMC Psychiatry. 2020; 20(1):446. PMC: 7488004. DOI: 10.1186/s12888-020-02850-3. View