Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors

• Published in: Supportive care in cancer 2020-09, Vol.28 (9), p.4425-4433
• Main Authors: Arch, Joanna J., Genung, Sarah R., Ferris, Michelle C., Kirk, Alex, Slivjak, Elizabeth T., Fishbein, Joel N., Schneider, Rebecca L., Stanton, Annette L.
• Format: Article
• Language: English
• Subjects: Adult; Advertising executives; Aged; Anxiety; Anxiety disorders; Anxiety Disorders - etiology; Cancer; Cancer survivors; Cancer Survivors - psychology; Comorbidity; Development and progression; Diagnosis; Female; Humans; Male; Medical diagnosis; Medicine; Medicine & Public Health; Mental health; Middle Aged; Neoplasms - complications; Neoplasms - psychology; Nursing; Nursing Research; Oncology; Oncology, Experimental; Original Article; Pain Medicine; Rehabilitation Medicine; Survivor; Young Adult
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05297-0

Purpose Despite cancer survivors’ frequent endorsement of anxiety symptoms, assessing the full range of anxiety disorders (AD), their timing of onset relative to cancer diagnosis, co-morbidity with mood disorder, and predictors of post-cancer onset, is rare or absent to date. This study provides a step toward addressing these gaps. Methods Cancer survivors at re-entry after primary treatment completion who screened positively for anxiety symptoms ( N  = 133) and sought care through an intervention trial completed standardized diagnostic interviews, dimensional assessment of disorder severity, and timing of disorder onset relative to cancer diagnosis. We evaluated sociodemographic and medical predictors of developing a first AD after cancer diagnosis. Results Most ADs began after cancer diagnosis (58%); for 68% of affected patients, this represented their first AD episode. The most common was generalized anxiety disorder (GAD; 41%), where “cancer-focused GAD” was distinguished from “typical GAD”; the next most common were specific phobia (14%) and social anxiety disorder (13%). A minority (31%) of ADs were comorbid with major depression. Relative to having no AD, experiencing more lingering treatment side effects predicted developing a first AD after cancer diagnosis. Relative to having an AD that began before cancer diagnosis, reporting a higher cancer stage predicted developing a first AD after diagnosis. Conclusions Cancer survivors at re-entry seeking care for anxiety symptoms manifested a broad range of ADs which most commonly developed after cancer diagnosis and were prompted by the experience of cancer. Such disorders represent an unusually late-life, cancer-linked etiology that warrants further investigation and clinical attention.