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Two or more years after diagnosis, anxiety is the mood problem that stays raised: 17.9 per cent of 48,964 people against 13.9 per cent of 226,467 who had not had cancer, a relative risk of 1.27. Depression at that distance is not raised. Where both members of a couple were measured, spouses reported anxiety at 40.1 per cent against 28.0 per cent.
The meta-analysis that separated survivors from patients in treatment found the pattern most services are not set up for. Across 43 included reports, the prevalence of depression was 11.6 per cent (95 per cent confidence interval 7.7 to 16.2) in a pooled sample of 51,381 people at least two years from diagnosis and 10.2 per cent (8.0 to 12.6) in 217,630 healthy controls, a relative risk of 1.11 (0.96 to 1.27, p equals 0.17): not significantly different. Anxiety was 17.9 per cent (12.8 to 23.6) in 48,964 survivors against 13.9 per cent (9.8 to 18.5) in 226,467 controls, a relative risk of 1.27 (1.08 to 1.50, p equals 0.0039). In the subset of studies comparing patients with their own spouses, neither depression (26.7 against 26.3 per cent) nor anxiety (28.0 against 40.1 per cent) differed significantly between the two, though the point estimate for anxiety is higher in the spouses. The authors' conclusion: "Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses."
During treatment the picture is different again. In the interview-based meta-analysis of cancer and blood cancer settings, anxiety disorders affected 10.3 per cent (5.1 to 17.0) and adjustment disorder 19.4 per cent (14.5 to 24.8). Adjustment disorder is the diagnosis that covers a reaction out of proportion to the ordinary, lasting beyond the event that caused it, without meeting criteria for depression or an anxiety disorder; it is commoner than either and is almost never what services screen for.
Why this is missed. Screening instruments and service pathways in cancer were built around depression, which is the mood disorder oncology inherited from general medicine. The data above say that in the years after treatment the thing to ask about is anxiety, that fear of recurrence is one of its commonest specific forms and has its own record here, and that the person in the room who is most anxious may be the one who does not have cancer.
What helps. The ASCO 2023 guideline recommends, for moderate anxiety symptoms, cognitive behaviour therapy, behavioural activation, structured physical activity, acceptance and commitment therapy, or an empirically supported psychosocial intervention; for severe symptoms it lists cognitive therapy, behavioural activation, cognitive behaviour therapy, mindfulness-based stress reduction and interpersonal therapy. Mindfulness-based programmes and cognitive behavioural therapy for fatigue and distress already have records in the corpus with their own trial evidence, and structured exercise is the best-evidenced single thing a person can do for themselves after treatment. Medication is placed after psychological treatment rather than before it, because the panel found the drug evidence in this population inconsistent.
Anxiety after cancer is maintained less by the risk itself than by the uncertainty around it: an unpredictable threat with no action available to reduce it produces sustained vigilance, which is exactly what surveillance follow-up, bodily symptoms with innocent and sinister explanations, and a lost sense of bodily reliability provide. Treatments that help work on tolerating that uncertainty rather than on resolving it, because it cannot be resolved.
Query for this technology: (TITLE:"Anxiety after cancer, in survivors and in their partners" OR ABSTRACT:"Anxiety after cancer, in survivors and in their partners") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Anxiety after cancer, in survivors and in their partners, not a curated reading list.
Shares Relaxation training and guided imagery, Mindfulness-based stress reduction and cognitive therapy, Fear that the cancer will come back: how common it is, and when it stops being ordinary worry, Getting psychological help after cancer: the stepped-care model, and what is actually commissioned and the tags rejuvenation, survivorship, psychosocial.
Shares Carers: what you can do and UK carer support (breast cancer), Partners and relationships after cancer: what the divorce data actually show, Depression during and after cancer: the interview-based prevalence, and the care model that works, The carer's own recovery: what is known about the person who is not the patient and the tags rejuvenation, survivorship, psychosocial.
Shares Post-traumatic stress after cancer: what is measured, and how much of it is measurement, Mindfulness-based stress reduction and cognitive therapy, Testicular germ cell tumours, Psycho-oncology and distress screening and the tags rejuvenation, survivorship, psychosocial.
Shares The surveillance schedule, and the evidence that routine scans do not find relapse first, Fear that the cancer will come back: how common it is, and when it stops being ordinary worry, Psycho-oncology and distress screening, Quality of life and the tags rejuvenation, survivorship, psychosocial.
Shares Mindfulness-based stress reduction and cognitive therapy, The exercise prescription after cancer: the dose the guidelines state, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, psychosocial.
Shares Getting psychological help after cancer: the stepped-care model, and what is actually commissioned, Psycho-oncology and distress screening, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, psychosocial.
Shares Getting psychological help after cancer: the stepped-care model, and what is actually commissioned, Psycho-oncology and distress screening, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, psychosocial.
Shares Partners and relationships after cancer: what the divorce data actually show, Psycho-oncology and distress screening, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, psychosocial.