The link between psychological distress and survival in solid tumor patients: A systematic review

Abstract

Purpose: Research has demonstrated that solid tumor patients experience high levels of psychological distress at the time of diagnosis. While distress has been associated with many adverse clinical outcomes, little is known about how this symptom may influence the disease trajectory for cancer patients, affecting outcomes such as progression, recurrence, and survival. The purpose of this systematic review was to explore the literature linking distress with survival in solid tumor patients, which may guide future work exploring clinical outcomes as a function of distress.

Methods: A systematic search of PubMed, Embase, and Web of Science was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with predefined eligibility criteria. Thirteen studies met the inclusion criteria and were selected for review.

Results: Findings from this review demonstrated a weak-to-moderate relationship between cancer patients' experience of distress and overall survival, with most included studies (11/13) finding at least one predictive analysis to be significant when controlling for confounders. However, significant heterogeneity in the literature, particularly with study sample characteristics and varying methodologies, made direct comparisons across studies challenging.

Conclusion: Findings from this review suggest that psychological distress may have an impact on disease-related outcomes, including (but not limited to) survival. Future work should consider performing disease-specific analyses controlling for key prognostic factors to better understand the nuanced relationship between distress and clinical outcomes, which may allow further understanding of the biological underpinnings of this relationship and enable the development of targeted interventions for improving distress.

Keywords: cancer; distress; patient-reported outcomes; survival; tumors.

FIGURE 1

PRISMA flow diagram for systematic review of the literature linking psychological distress with survival in solid tumor patients, which included searches of databases and registers. PRISMA indicates Preferred Reporting Systems for Systematic Reviews and Meta‐Analyses.

FIGURE 2

Review of literature assessing the predictive relationship between distress and survival in solid tumor patients. Abstracted data for each study include sample, objective, design, instruments, covariates, key findings, and limitations.

FIGURE 3

Timing of distress measurement across the disease trajectory for included articles. Figure 3 illustrates the windows that each study included in this review measured distress within. Three major timepoints in the clinical course – time of diagnosis, time of surgery, and time of chemotherapy and/or radiation treatment are marked on the timeline for comparison.