Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients

Abstract

Depression and anxiety are common comorbidities in breast cancer patients. Whether depression and anxiety are associated with breast cancer progression or mortality is unclear. Herein, based on a systematic literature search, 17 eligible studies involving 282,203 breast cancer patients were included. The results showed that depression was associated with cancer recurrence [1.24 (1.07, 1.43)], all-cause mortality [1.30 (1.23, 1.36)], and cancer-specific mortality [1.29 (1.11, 1.49)]. However, anxiety was associated with recurrence [1.17 (1.02, 1.34)] and all-cause mortality [1.13 (1.07, 1.19)] but not with cancer-specific mortality [1.05 (0.82, 1.35)]. Comorbidity of depression and anxiety is associated with all-cause mortality [1.34 (1.24, 1.45)] and cancer-specific mortality [1.45 (1.11, 1.90)]. Subgroup analyses demonstrated that clinically diagnosed depression and anxiety, being female and of younger age (<60 years), and shorter follow-up duration (≤5 years) were related to a poorer prognosis. Our study highlights the critical role of depression/anxiety as an independent factor in predicting breast cancer recurrence and survival. Further research should focus on a favorable strategy that works best to improve outcomes among breast cancer patients with mental disorders.

Fig. 1

Flow chart of identification of eligible studies.

Fig. 2. The effects of depression on recurrence, all-cause mortality, and cancer-specific mortality in patients with breast cancer.

Results of individual and summary HR estimates, 95% CI, and weights of each study were shown. Diamonds indicate study specific HRs; Horizontal lines represent 95% CI; Arrowheads indicate error bars that extend beyond the area shown.

Fig. 3. The effect of depression on recurrence: results of the subgroup analyses.

Studies reported results stratified by time of assessment of depression, measure of mental status and follow up duration, respectively. Squares indicate study specific HRs; Horizontal lines represent 95% CI. Arrowheads indicate error bars that extend beyond the area shown.

Fig. 4. The effect of depression on all-cause mortality: results of the subgroup analyses. Studies reported results stratified by age, time of assessment of depression, measure of mental status and follow up duration, respectively.

Squares indicate study specific HRs; Horizontal lines represent 95% CI.

Fig. 5. The effects of anxiety on recurrence, all-cause mortality, and cancer-specific mortality in patients with breast cancer.

Results of individual and summary HR estimates, 95% CI, and weights of each study were shown. Diamonds indicate study specific HRs; Horizontal lines represent 95% CI.