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. 2025 Feb 19;25(1):156.
doi: 10.1186/s12888-025-06599-5.

Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses

Addisu Getie  1 , Manay Ayalneh  2 , Melaku Bimerew  2
Affiliations

Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses

Addisu Getie et al. BMC Psychiatry. .

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.

Keywords: Anxiety; Cancer; Cancer survivors; Depression; Meta-analysis; Oncology; Pain; Systematic review; Umbrella review.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A PRISMA diagram illustrating the selection process of systematic reviews and meta-analyses reporting the prevalence of pain, depression, and anxiety among cancer survivors globally
Fig. 2
Fig. 2
A forest plot from the umbrella review showing the pooled prevalence of depression among cancer survivors worldwide
Fig. 3
Fig. 3
Funnel plot with 95% confidence interval on the distribution of systematic review and meta-analysis studies on the prevalence of depression among cancer patients included in this umbrella review
Fig. 4
Fig. 4
Filled funnel plot with pseudo 95% confidence interval on the distribution of systematic review and meta-analysis studies on the prevalence of depression among cancer patients included in this umbrella review
Fig. 5
Fig. 5
A forest plot from the umbrella review showing the pooled prevalence of anxiety among cancer survivors worldwide
Fig. 6
Fig. 6
Funnel plot with 95% confidence interval on the distribution of systematic review and meta-analysis studies on the prevalence of anxiety among cancer patients included in this umbrella review
Fig. 7
Fig. 7
Filled funnel plot with pseudo 95% confidence interval on the distribution of systematic review and meta-analysis studies on the prevalence of anxiety among cancer patients included in this umbrella review
Fig. 8
Fig. 8
Sensitivity analysis on the pooled prevalence of depression among cancer survivors worldwide
Fig. 9
Fig. 9
Sensitivity analysis on the pooled prevalence of anxiety among cancer survivors worldwide
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