Skip to main content
Download PDF

Bidirectional relationship between anxiety disorder and cancer: a longitudinal population-based cohort study

BMC Cancer volume 25, Article number: 761 (2025) Cite this article

Abstract

Background

Although research has highlighted the link between anxiety and cancer, studies on the relationship between the two have produced inconsistent findings. Therefore, we investigated this relationship and also examined which types of cancer are more likely to induce anxiety.

Methods

This retrospective longitudinal cohort study, conducted in Taiwan from 2003 to 2016, looked at the risk of cancer in 23,255 patients with anxiety disorder and the risk of anxiety in 33,334 patients with cancer diagnosed between 2003 and 2005. For both analyses, a comparison cohort was created using 1:4 case-control sampling. Cox proportional hazard regression models were used to analyze factors related to anxiety disorder or cancer.

Results

Patients with anxiety were more likely to develop cancer (adjusted hazard ratio [AHR] = 1.29; 95% confidence interval [CI]: 1.23–1.35) compared to those in the comparison group. Particularly high risks were observed for thyroid cancer (AHR: 2.13, CI: 1.60–2.82), skin cancer (AHR: 2.10, CI: 1.63–2.71), and prostate cancer (AHR: 1.97, CI: 1.59–2.47). Patients with cancer were more likely to develop anxiety than those without cancer (AHR: 1.63, 95% CI: 1.56–1.71), with particularly high risks observed in those with nose cancer (AHR: 3.12, 95% CI: 2.41–4.03), leukemia (AHR: 2.54, 95% CI: 1.63–3.96), thyroid cancer (AHR: 2.34, 95% CI: 1.84–2.97), and oral cancer (AHR: 2.04, 95% CI: 1.65–2.52).

Conclusions

Our findings highlight a bidirectional link between cancer and anxiety disorder. Understanding this two-way connection can help healthcare providers develop effective strategies for managing cancer and anxiety disorders.

Peer Review reports

Introduction

Anxiety prevalence varies significantly, ranging from 1.1 to 66% in Asian populations [1] and 13.6-28.8% in Western populations [2]. Contributing factors include genetics, temperament, natural disasters, alcohol use disorders, and severe physical conditions like hemodialysis, chronic obstructive pulmonary disease and heart failure [3,4,5,6,7,8,9]. Anxiety has been linked to a deterioration in health status, poor prognosis, and low quality of life [10, 11]. Coronavirus disease 2019 (COVID-19) increased global anxiety cases by 25.6% [12] adding psychological and socioeconomic burdens [13]. Furthermore, anxiety has been associated with higher cancer risk, including urological and generalized anxiety disorder [14, 15], though some studies found no significant links. Thus, anxiety is a major public health concern with considerable personal health-related and socioeconomic implications [16].

Cancer is a leading cause of death, with 19.3 million new cases and 10 million deaths globally in 2020 [17, 18]. Anxiety in cancer patients ranges from 9.8 to 38% [19,20,21], and over half develop anxiety disorders post-diagnosis due to fear of cancer, poor understanding of the disease, treatment side effects, and fear of recurrence [22,23,24,25]. These factors can exacerbate conditions related to negative emotions, such as depression and anxiety, ultimately lowering patient quality of life and physical and mental well-being, as well as increasing mortality rates [26].

Research on anxiety and cancer has yielded mixed results [10] with some studies reporting higher anxiety risk in cancer patients, especially those with gynecological, lung, or hematological cancers, while others found no significant association [27]. Population-based studies have explored anxiety in cancer patients, but data on different cancer types in Taiwan remain limited [19, 21, 28, 29]. We therefore, investigated the bidirectional relationship between anxiety disorder and cancer in the Taiwanese population, assessing both the risk of cancer in those with anxiety and the risk of anxiety in those with cancer.

Methods

Data sources

We utilized the National Health Insurance Research Database (NHIRD), managed by the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW), which covers 96% of Taiwan’s population and 97% of its clinics and hospitals. The entire population file from NHIRD was used to analyze the risk of subsequent cancer. Medical claims records provided demographic information and clinical details, using ICD-9-CM codes (up to 2015) and ICD-10-CM codes (from 2016).

Study sample

We conducted two analyses using the same participant selection process. Anxiety disorders were identified with ICD-9-CM codes 300.00-300.29, 309.21, 313.23, 293.84, and ICD-10-CM codes F41.9, F41.0, F41.1, F40.0x-F40.8, F93, F94.0, F06.4. Cancer was identified with ICD-9-CM codes 140–208 and ICD-10-CM codes C00-C96, D03. We included the 15 most common cancers in Taiwan: colon, lung, breast, liver, oral, prostate, thyroid, skin, stomach, gynecological, brain, urological, leukemia, bone, and nose cancer [30]. Breast and gynecological cancer analyses included only women, while prostate cancer analyses included only men.

Procedure

In the first analysis, we examined the association between anxiety disorder and cancer risk. We selected patients with anxiety as their principal diagnosis from inpatient or outpatient claims between January 1, 2003, and December 31, 2005. The index date was the first anxiety-related visit, and patients with prior cancer were excluded. Patients were followed until cancer diagnosis, death, or December 31, 2016. The control group included patients without anxiety or cancer, matched 1:4 by age, sex, and index year.

In the second analysis, we investigated cancer’s association with anxiety disorder risk. Cancer patients were selected from claims data between January 1, 2003, and December 31, 2005, with the first cancer visit as the index date. Patients with prior anxiety were excluded. Follow-up continued until an anxiety diagnosis, death, or December 31, 2016. Controls without cancer or anxiety were matched 1:4 by age, sex, and index year.

Demographic data were retrieved from the NHIRD. Patients were grouped by age (< 30, 30–44, 45–64, ≥ 65 years), monthly income (< NT$20,000, NT$20,000-NT$39,999, ≥NT$40,000), and region (Northern, Central, Southern, Eastern Taiwan). Regions were further categorized as urban, suburban, or rural. Comorbidities were assessed using Charlson Comorbidity Index (CCI) scores [31], with patients classified as low (CCI < 3) or high (CCI ≥ 3) comorbidity.

Statistical analysis

Statistical analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC, USA). The chi-square test compared demographic differences between groups, and incidence density rates were calculated by dividing incident cases by total person-years.

In the first analysis, a Cox proportional hazards model was used to calculate crude and adjusted hazard ratios (CHRs and AHRs) for cancer risk in individuals with anxiety, adjusting for age, sex, income, region, urbanization, and CCI score. A similar model was applied in the second analysis to assess anxiety disorder risk in cancer patients. Statistical significance was set at p <.05.

Ethics approval and consent to participate

This study was conducted in accordance with the ethical guidelines outlined in the Declaration of Helsinki and was approved by the Taipei Medical University Joint Institutional Review Board (TMU-JIRB No. N202004116). The requirement for written informed consent was waived by the board due to the retrospective nature of the study.

Results

Anxiety and subsequent risk of cancer

In this analysis, 23,255 patients were in the anxiety group and 93,020 in the anxiety-free group (Table 1). Most anxiety patients were aged 45–64 (36.12%) or 30–44 (33.76%), were women (62.42%), had monthly incomes below NT$20,000 (62.37%), lived in Northern Taiwan (45.83%), and resided in urban areas (41.13%). The two groups differed significantly in income, region, and CCI scores, with those without anxiety having lower CCI scores.

Table 1 Demographic characteristics of patients with anxiety disorder and comparison cohort (2003–2005)
Full size table

The cancer incidence rates in the patients with anxiety over the 14-year follow-up period are presented in Table 2. The cancer incidence was higher in those with anxiety disorder (1.08 vs. 0.90 per 100 person-years) than in those without anxiety disorder. Besides, in the higher CCIs group, all age groups, and both men and women, those with anxiety, and the lower CCIs group had a significantly higher incidence of cancer than those without anxiety disorder. Moreover, those with anxiety had a significantly higher risk of developing cancer than those without (CHR = 1.21; 95% CI: 1.16–1.26). After adjustment for age, sex, income, region, urbanization level, and CCI score, individuals with anxiety still had a higher risk of developing cancer than those without (AHR = 1.29; 95% CI: 1.23–1.35).

Table 2 Risk of cancer by demographics among individuals with anxiety disorder
Full size table

Table 3 presents the cancer incidence by cancer type as well as the CHR and AHR for patients with anxiety. The patients with anxiety exhibited particularly high risks of developing thyroid (AHR: 2.13, CI: 1.60–2.82), skin (AHR: 2.10, CI: 1.63–2.71), prostate (AHR: 1.97, CI: 1.59–2.47), nose (AHR: 1.84, CI: 1.39–2.44), brain (AHR: 1.78, CI: 1.26–2.51), urological (AHR: 1.40, CI: 1.16–1.69), breast (1.27, CI: 1.11–1.46), and lung cancers (AHR: 1.24, CI: 1.09–1.40).

Table 3 Risk of cancer by type among individuals with anxiety disorder
Full size table

Cancer and subsequent risk of anxiety

For this analysis, 33,334 and 133,336 patients were assigned to the cancer and cancer-free groups, respectively (Table 4). The patients with cancer predominantly were aged 45–64 or ≥ 65 years (42.10% and 34.92%, respectively), were men (50.59%), had a monthly income of < NT$20,000 (65.17%), lived in Northern Taiwan (45.19%), lived in urban areas (39.10%), and had high CCI scores (67.96%). The two patient groups differed significantly in income, region, urbanization level, and CCI score. In addition, the patients without cancer had significantly lower CCI scores than those with cancer.

Table 4 Demographic characteristics of patients with cancer and comparison cohort (2003–2005)
Full size table

The incidence of anxiety was higher in the individuals with cancer (1.29 vs. 0.99 per 100 person-years) than in those without cancer (Table 5). In all age groups, both men and women and CCI groups, individuals with cancer had a significantly higher incidence of anxiety than those without cancer. Those with cancer had a higher risk of developing anxiety (CHR: 1.30, CI: 1.25–1.36) than did those without cancer. After adjustment for age, sex, income, region, urbanization level, and CCI score, the patients with cancer still had a higher risk of developing anxiety than those without cancer (AHR: 1.63, 95% CI: 1.56–1.71).

Table 5 Risk of anxiety disorder by demographics among individuals with cancer
Full size table

The incidence densities of anxiety in patients with different cancer types are summarized in Table 6. Particularly high risks of anxiety were observed in patients with nose cancer (AHR: 3.12, 95% CI: 2.41–4.03), leukemia (AHR: 2.54, 95% CI: 1.63–3.96), thyroid cancer (AHR: 2.34, 95% CI: 1.84–2.97), and oral cancer (AHR: 2.04, 95% CI: 1.65–2.52).

Table 6 Risk of anxiety disorder by cancer type
Full size table

Discussion

Our findings reveal a significant bidirectional association between anxiety disorder and cancer. In our first analysis, we discovered that patients with anxiety were more likely to develop cancer than those without anxiety, with such patients having particularly high risks of developing thyroid, skin, prostate, nose, brain, urological, breast, and lung cancers. In our second analysis, we found that individuals with cancer had a greater likelihood of developing an anxiety disorder compared to those without cancer. The risk of developing an anxiety disorder was notably higher for all types of cancer included, except for bone cancer. For bone cancer, although the risk estimate was high, it was not statistically significant, with a wider 95% confidence interval (AHR = 2.00, 95% CI: 0.94–4.26), suggesting low statistical power.

Association between anxiety disorder and the risk of developing cancer

Our study found that individuals with anxiety have a significantly higher risk of developing cancer (CHR = 1.21, AHR = 1.29) compared to those without anxiety, slightly exceeding results from previous study [32]. One study found that anxiety and depression increase cancer risk and mortality by 41%, and anxiety-related insomnia treatments like sedative-hypnotics may further elevate cancer risk [33, 34].

Over a 14-year follow-up, cancer incidence was higher in those with anxiety (1.08 vs. 0.90 per 100 person-years), consistent with another study reporting a rate of 1.14 in individuals with generalized anxiety disorder [16]. Research has shown that lifestyle factors such as poor diet, lack of physical activity, smoking, and alcohol use, along with biological factors like viral oncogenes and impaired DNA repair, may increase cancer risk in those with anxiety [25, 35, 36].

Gender and age also play significant roles. Anxiety disorders are more prevalent in women, and sex-specific differences in brain function could influence cancer risk [37]. While men with anxiety often engage in riskier behaviors like smoking and drinking, increasing their cancer risk, women may seek timely treatment, potentially lowering their risk [38]. Older adults are more likely to develop cancer, and when combined with anxiety, this risk may be heightened [39].

We examined 15 cancer types and found a high risk of thyroid, skin, prostate, nose, brain, urological, breast, and lung cancers in individuals with anxiety, with thyroid cancer showing a particularly high risk. This aligns with studies linking stress and thyroid cancer, as anxiety may affect thyroid function, creating an environment conducive to cancer development [40,41,42,43].

Our findings also revealed an association between anxiety and skin cancer, adding to evidence that psychological factors may impact skin health and cancer risk [44]. Anxiety may weaken the skin’s defense against ultraviolet rays, increasing vulnerability [45]. Anxiety has also been linked to exacerbating preexisting skin conditions, which may contribute to a higher cancer risk [45].

Finally, we observed a heightened risk of prostate cancer in individuals with anxiety, consistent with previous studies [32]. Another study also reported elevated levels of anxiety in men actively seeking prostate cancer screening [46]. These results underscore the need for interventions addressing anxiety disorders, which could potentially reduce cancer risk. Despite the varying results, we can infer that those with anxiety disorders have an increased likelihood of developing cancer. Interventions focusing on anxiety disorders could thus assist in cancer prevention.

Association between cancer and the risk of developing anxiety disorder

Our results demonstrate that individuals with cancer are at a significantly higher risk of developing anxiety disorders compared to those without cancer. The incidence of anxiety was also higher among those with cancer, consistent with previous studies reporting that around 7.6% of cancer patients experience anxiety, with generalized anxiety disorder (GAD) being the most prevalent form [22, 47,48,49]. Most individuals with cancer experience anxiety upon receiving their diagnosis and as the cancer progresses [22, 48]. Anxiety may also be experienced during cancer treatment or screening or be triggered by anticipation of a recurrence [48], highlighting the need for anxiety assessments throughout cancer care.

Furthermore, we found that the risk of anxiety increased for nearly all cancer types, except bone cancer, with the highest risk observed in patients with nose cancer. This may be due to the facial disfigurement and social isolation that often accompany nose cancer. Patients may also experience anosmia (loss of smell), which can further heighten anxiety [50,51,52].

Leukemia patients had the second-highest risk of anxiety. Treatments like chemotherapy and bone marrow transplants, combined with the uncertainty of relapse, can trigger significant psychological distress [53]. The therapeutic regimen for managing chronic lymphocytic leukemia does not involve maintenance therapy after remission occurs; thus, patients with this condition often experience feelings of anxiety and apprehension regarding the possibility of relapse [54].

Similarly, thyroid cancer patients also showed elevated anxiety risk, possibly due to the thyroid’s role in mood regulation and the appearance-related concerns following surgery [55]. A study reported a significant link between perceived neck appearance and anxiety among patients with cancer who underwent a thyroidectomy [56]. Although some forms of thyroid cancer have a favorable overall prognosis, the condition can still prompt anxiety. Proper management and support are crucial to ensure patients successfully navigate this experience and maintain high quality of life.

Finally, in our study, the risk of anxiety was high in individuals with oral cancer. our results align with a study that revealed that participants experienced considerable anxiety regarding tumors related to human papillomavirus (HPV) infection upon receiving their initial diagnosis of HPV-related oropharyngeal cancer [57]. Oral cancer differs considerably from other forms of cancer. For example, treatment of advanced oral cancer often involves invasive procedures that can have a lasting impact on a patient’s ability to eat or speak as well as on their confidence in their appearance. These factors emphasize the need for holistic care that addresses both the physical and psychological burdens of cancer.

Strengths and limitations

This is the first study to evaluate the bidirectional relationship between cancer and anxiety in the Taiwanese population, using a large, population-based dataset and analyzing multiple cancer types. However, several limitations warrant caution in interpreting the results. First, we did not exclude patients with multiple diagnoses, as anxiety disorders often co-occur with other mental conditions [58], we did not exclude patients with multiple diagnoses; a study highlighted that a solitary diagnosis of an anxiety disorder cannot be universally applied to real-world scenarios in which multiple diagnoses often co-occur [59]. We only included patients with anxiety disorder-related principal diagnoses and at least two clinical visits for greater precision. Second, the retrospective design limits claims of causality. Third, we did not account for confounding factors like environmental exposures or health behaviors, which may have introduced bias. Fourth, we did not assess cancer risk for specific anxiety disorders. Fifth, as our analysis relied on Cox regression, we did not test for the proportional hazards assumption, and violations of this assumption could influence the results, particularly over long follow-up periods. Sixth, we did not account for competing risks, such as death from causes unrelated to the outcomes of interest. Lastly, the findings may not be generalizable beyond the Taiwanese population. Future research should address these limitations by excluding multiple anxiety diagnoses, adding more confounders, using a prospective design, testing the proportional hazards assumption for robustness, and incorporating competing risks in the analysis.

Conclusions

Our findings show a bidirectional link between cancer and anxiety disorder. Anxiety patients had a higher risk of developing cancers, especially thyroid cancer, while cancer patients, particularly with nose cancer, were more likely to develop anxiety. This emphasizes the importance of regular anxiety assessments for cancer patients to better address their mental health needs. However, several limitations must be considered in our study. The retrospective design and multiple diagnoses, potential unaccounted confounding variables, and focus on a Taiwanese population may limit generalizability. Given cancer’s complexity and the psychological burden it imposes, these insights can guide healthcare providers in developing more holistic treatment strategies that address both physical and mental health aspects. Future studies should adopt a prospective approach to deepen understanding.

Data availability

The data employed in this study were obtained from the Taiwan National Health Insurance Research Database; formal data requests should be directed to the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW).

Abbreviations

COVID-19:

Coronavirus disease 2019

NHIRD:

National Health Insurance Research Database

HWDC:

Health and Welfare Data Science Center

MOHW:

Ministry of Health and Welfare

HPV:

Human Papilloma Virus

References

  1. Hossain MM, Purohit N, Sultana A, Ma P, McKyer ELJ, Ahmed HU. Prevalence of mental disorders in South Asia: an umbrella review of systematic reviews and meta-analyses. Asian J Psychiatry. 2020;51:102041. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ajp.2020.102041

    Article  Google Scholar 

  2. Michael T, Zetsche U, Margraf J. Epidemiology of anxiety disorders. Psychiatry. 2007;6(4):136–42. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.mppsy.2007.01.007

    Article  Google Scholar 

  3. Hettema JM, Neale MDPDMC, Ph.D.and, Kendler KS. A review and Meta-Analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry. 2001;158(10):1568–78. https://doiorg.publicaciones.saludcastillayleon.es/10.1176/appi.ajp.158.10.1568

    Article  CAS  PubMed  Google Scholar 

  4. Akiskal HS. Toward a definition of generalized anxiety disorder as an anxious temperament type. Acta Psychiatrica Scandinavica. 1998;98(s393):66–73. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1600-0447.1998.tb05969.x

    Article  Google Scholar 

  5. Agyapong VIO, Hrabok M, Juhas M, Omeje J, Denga E, Nwaka B, Akinjise I, Corbett SE, Moosavi S, Brown M et al. Prevalence rates and predictors of generalized anxiety disorder symptoms in residents of fort McMurray six months after a wildfire. Front Psychiatry 2018, 9. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fpsyt.2018.00345

  6. Bahi A, Dreyer J-L. Anxiety and ethanol consumption in socially defeated mice; effect of hippocampal serotonin transporter knockdown. Behav Brain Res. 2023;451:114508. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.bbr.2023.114508

    Article  CAS  PubMed  Google Scholar 

  7. Cohen SD, Cukor D, Kimmel PL. Anxiety in patients treated with Hemodialysis. Clin J Am Soc Nephrol. 2016;11(12):2250–5. https://doiorg.publicaciones.saludcastillayleon.es/10.2215/CJN.02590316

    Article  PubMed  PubMed Central  Google Scholar 

  8. Panagioti M, Scott C, Blakemore A, Coventry PA. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. Int J Chronic Obstr Pulm Dis. 2014;9:1289–306. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/COPD.S72073

    Article  Google Scholar 

  9. Easton K, Coventry P, Lovell K, Carter L-A, Deaton C. Prevalence and measurement of anxiety in samples of patients with heart failure: Meta-analysis. J Cardiovasc Nurs. 2016;31(4):367–79. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/JCN.0000000000000265

    Article  PubMed  PubMed Central  Google Scholar 

  10. Niedzwiedz CL, Knifton L, Robb KA, Katikireddi SV, Smith DJ. Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer. 2019;19(1):943. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12885-019-6181-4

    Article  PubMed  PubMed Central  Google Scholar 

  11. Renna ME, Shrout MR, Madison AA, Lustberg M, Povoski SP, Agnese DM, Reinbolt RE, Wesolowski R, Williams NO, Ramaswamy B, et al. Distress disorder histories relate to greater physical symptoms among breast cancer patients and survivors: findings across the cancer trajectory. Int J Behav Med. 2023;30(4):463–72. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s12529-022-10115-4

    Article  PubMed  Google Scholar 

  12. Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, Abbafati C, Adolph C, Amlag JO, Aravkin AY, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398(10312):1700–12. https://www.sciencedirect.com/science/article/pii/S0140673621021437

    Article  Google Scholar 

  13. Asmundson GJG, Paluszek MM, Landry CA, Rachor GS, McKay D, Taylor S. Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping? J Anxiety Disord. 2020;74:102271. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.janxdis.2020.102271

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shen C-C, Hu Y-W, Hu L-Y, Hung M-H, Su T-P, Huang M-W, Tsai C-F, Ou S-M, Yen S-H, Tzeng C-H, et al. The risk of cancer in patients with generalized anxiety disorder: A nationwide Population-Based study. PLoS One. 2013;8(2):e57399. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/journal.pone.0057399

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Chen Y-C, Kao L-T, Lin H-C, Lee H-C, Huang C-C, Chung S-D. Increased risk for urological cancer associated with anxiety disorder: a retrospective cohort study. BMC Urol. 2016;16(1):67. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12894-016-0187-x

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kavelaars R, Ward H, Mackie dS, Modi KM, Mohandas A. The burden of anxiety among a nationally representative US adult population. J Affect Disord. 2023;336:81–91. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jad.2023.04.069

    Article  PubMed  Google Scholar 

  17. Cancer. [Accessed on 30/01/2024]. https://www.who.int/news-room/fact-sheets/detail/cancer

  18. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2021;71(3):209–49. https://doiorg.publicaciones.saludcastillayleon.es/10.3322/caac.21660

    Article  CAS  Google Scholar 

  19. Tao F, Xu M, Zou Q, Tang L, Feng J, Li Z. Prevalence and severity of anxiety and depression in Chinese patients with breast cancer: a systematic review and meta-analysis. Front Psychiatry 2023, 14. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fpsyt.2023.1080413

  20. Sam W, Geraldine L, Brian B, Philip P, Lily L, Susan E, George L. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2013-003901

    Article  Google Scholar 

  21. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. https://www.sciencedirect.com/science/article/pii/S147020451170002X

    Article  PubMed  Google Scholar 

  22. Arch JJ, Genung SR, Ferris MC, Kirk A, Slivjak ET, Fishbein JN, Schneider RL, Stanton AL. Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors. Support Care Cancer. 2020;28(9):4425–33. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00520-020-05297-0

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J. Fear of progression in chronic illnesses other than cancer: a systematic review and meta-analysis of a transdiagnostic construct. Health Psychol Rev. 2023;17(2):301–20. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/17437199.2022.2039744

    Article  PubMed  Google Scholar 

  24. Elangovan V, Rajaraman S, Basumalik B, Pandian D. Awareness and perception about cancer among the public in Chennai, India. J Glob Oncol. 2017;3(5):469–79. https://doiorg.publicaciones.saludcastillayleon.es/10.1200/JGO.2016.006502

    Article  PubMed  Google Scholar 

  25. Mohan A, Huybrechts I, Michels N. Psychosocial stress and cancer risk: a narrative review. Eur J Cancer Prev. 2022;31(6):585–99. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/CEJ.0000000000000752

    Article  PubMed  Google Scholar 

  26. Cheng V, Oveisi N, McTaggart-Cowan H, Loree JM, Murphy RA, De Vera MA. Colorectal cancer and onset of anxiety and depression: A systematic review and Meta-Analysis. Curr Oncol. 2022;29(11):8751–66. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/curroncol29110689

    Article  PubMed  PubMed Central  Google Scholar 

  27. Linden W, Vodermaier A, MacKenzie R, Greig D. Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord. 2012;141(2):343–51. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jad.2012.03.025

    Article  PubMed  Google Scholar 

  28. Zeynalova N, Schimpf S, Setter C, Yahiaoui-Doktor M, Zeynalova S, Lordick F, Loeffler M, Hinz A. The association between an anxiety disorder and cancer in medical history. J Affect Disord. 2019;246:640–2. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jad.2018.12.019

    Article  CAS  PubMed  Google Scholar 

  29. Kuba K, Esser P, Mehnert A, Hinz A, Johansen C, Lordick F, Götze H. Risk for depression and anxiety in long-term survivors of hematologic cancer. Health Psychol. 2019;38(3):187–95. https://psycnet.apa.org/doi/10.1037/hea0000713

    Article  PubMed  Google Scholar 

  30. Welfare MH. 2018 Taiwan Cancer Registry Annual Report. In. Edited by Administration HP: Health Promotion Administration; 2020:3. https://www.hpa.gov.tw/File/Attach/13498/File_21195.pdf

  31. Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sørensen HT. The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National registry of patients. BMC Med Res Methodol. 2011;11(1):83. https://biomedcentral-www.publicaciones.saludcastillayleon.es/1471-2288/11/83

    Article  PubMed  PubMed Central  Google Scholar 

  32. Liang J-A, Sun L-M, Su K-P, Chang S-N, Sung F-C, Muo C-H, Kao C-H. A nationwide Population-Based cohort study: will anxiety disorders increase subsequent cancer risk?? PLoS ONE. 2012;7(4):e36370. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/journal.pone.0036370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Fang H-F, Lee T-Y, Hui KC, Yim HCH, Chi M-J, Chung M-H. Association between Sedative-hypnotics and subsequent cancer in patients with and without insomnia: A 14-year Follow-up study in Taiwan. J Cancer. 2019;10(10):2288–98. https://doiorg.publicaciones.saludcastillayleon.es/10.7150/jca.30680

    Article  PubMed  PubMed Central  Google Scholar 

  34. Russ TC, Stamatakis E, Hamer M, Starr JM, Kivimäki M, Batty GD. Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ 2012, 345. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmj.e4933

  35. Nakhlband A, Farahzadi R, Saeedi N, Barzegar H, Montazersaheb S, Soofiyani SR. Bidirectional relations between anxiety, depression, and cancer: A review. Curr Drug Targets. 2023;24(2):118–30. https://doiorg.publicaciones.saludcastillayleon.es/10.2174/1389450123666220922094403

    Article  CAS  PubMed  Google Scholar 

  36. van Tuijl LA, Basten M, Pan K-Y, Vermeulen R, Portengen L, de Graeff A, Dekker J, Geerlings MI, Hoogendoorn A, Lamers F et al. Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis. Cancer. n/a(n/a). https://doiorg.publicaciones.saludcastillayleon.es/10.1002/cncr.34853

  37. Kim H-J, Lee S-H, Pae C. Gender differences in anxiety and depressive symptomatology determined by network analysis in panic disorder. J Affect Disord. 2023;337:94–103. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jad.2023.05.087

    Article  PubMed  Google Scholar 

  38. Turner S, Mota N, Bolton J, Sareen J. Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depress Anxiety. 2018;35(9):851–60. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/da.22771

    Article  PubMed  Google Scholar 

  39. Van Herck Y, Feyaerts A, Alibhai S, Papamichael D, Decoster L, Lambrechts Y, Pinchuk M, Bechter O, Herrera-Caceres J, Bibeau F, et al. Is cancer biology different in older patients? Lancet Healthy Longev. 2021;2(10):e663–77. https://www.sciencedirect.com/science/article/pii/S2666756821001793

    Article  PubMed  Google Scholar 

  40. Afrashteh S, Fararouei M, Parad MT, Mirahmadizadeh A. Sleep quality, stress and thyroid cancer: a case–control study. J Endocrinol Investig. 2022;45(6):1219–26. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s40618-022-01751-4

    Article  CAS  Google Scholar 

  41. Fischer S, Ehlert U. Hypothalamic–pituitary–thyroid (HPT) axis functioning in anxiety disorders. A systematic review. Depress Anxiety. 2018;35(1):98–110. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/da.22692

    Article  CAS  PubMed  Google Scholar 

  42. Tran T-V-T, Kitahara CM, de Vathaire F, Boutron-Ruault M-C, Journy N. Thyroid dysfunction and cancer incidence: a systematic review and meta-analysis. Endocrine-related Cancer. 2020;27(4):245–59. https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERC-19-0417

    Article  PubMed  Google Scholar 

  43. Wang S, Su M-l, Zhang Y, Wu H-m, Zou Z-h, Zhang W, Deng F, Zhao Y. Role of N-methyl-d-aspartate receptors in anxiety disorder with thyroid lesions. J Psychosom Res. 2022;161:110998. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jpsychores.2022.110998

    Article  PubMed  Google Scholar 

  44. Wang Y-H, Li J-Q, Shi J-F, Que J-Y, Liu J-J, Lappin JM, Leung J, Ravindran AV, Chen W-Q, Qiao Y-L, et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry. 2020;25(7):1487–99. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41380-019-0595-x

    Article  PubMed  Google Scholar 

  45. Tohid H, Shenefelt PD, Burney WA, Aqeel N. Psychodermatology: an association of primary psychiatric disorders with skin. Revista Colombiana De Psiquiatría (English Edition). 2019;48(1):50–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.rcpeng.2018.12.003

    Article  Google Scholar 

  46. Dale W, Bilir P, Han M, Meltzer D. The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer. 2005;104(3):467–78. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/cncr.21198

    Article  PubMed  Google Scholar 

  47. Spencer R, Nilsson M, Wright A, Pirl W, Prigerson H. Anxiety disorders in advanced cancer patients. Cancer. 2010;116(7):1810–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/cncr.24954

    Article  PubMed  Google Scholar 

  48. Baqutayan SM. The effect of anxiety on breast cancer patients. Indian J Psychol Med. 2012;34(2):119–23. https://doiorg.publicaciones.saludcastillayleon.es/10.4103/0253-7176.101774

    Article  PubMed  PubMed Central  Google Scholar 

  49. Romanazzo S, Mansueto G, Cosci F. Anxiety in the medically ill: A systematic review of the literature. Front Psychiatry. 2022;13:873126. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fpsyt.2022.873126

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lee JH, Zacharia BE, Ba D, Leslie D, Liu G, Goyal N. Mental health disorders associated with sinonasal and skull base malignancies: A large cohort study. J Neurol Surg B Skull Base. 2020;81(2):187–92. https://doiorg.publicaciones.saludcastillayleon.es/10.1055/s-0039-1679889

    Article  PubMed  Google Scholar 

  51. Stone A, Wright T. When your face doesn’t fit: employment discrimination against people with facial disfigurements. J Appl Soc Psychol. 2013;43(3):515–26. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1559-1816.2013.01032.x

    Article  Google Scholar 

  52. Neuland C, Bitter T, Marschner H, Gudziol H, Guntinas-Lichius O. Health-related and specific olfaction-related quality of life in patients with chronic functional anosmia or severe hyposmia. Laryngoscope. 2011;121(4):867–72. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/lary.21387

    Article  PubMed  Google Scholar 

  53. Wang Y, Yan J, Chen J, Wang C, Lin Y, Wu Y, Hu R. Comparison of the anxiety, depression and their relationship to quality of life among adult acute leukemia patients and their family caregivers: a cross-sectional study in China. Qual Life Res. 2021;30(7):1891–901. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s11136-021-02785-6

    Article  PubMed  Google Scholar 

  54. Robbertz AS, Weiss DM, Awan FT, Byrd JC, Rogers KA, Woyach JA. Identifying risk factors for depression and anxiety symptoms in patients with chronic lymphocytic leukemia. Support Care Cancer. 2020;28(4):1799–807. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00520-019-04991-y

    Article  PubMed  Google Scholar 

  55. Bauer M, Whybrow PC. Thyroid hormone, neural tissue and mood modulation. World J Biol Psychiatry. 2001;2(2):59–69. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00520-019-04991-y

    Article  CAS  PubMed  Google Scholar 

  56. Kurumety SK, Helenowski IB, Goswami S, Peipert BJ, Yount SE, Sturgeon C. Post-thyroidectomy neck appearance and impact on quality of life in thyroid cancer survivors. Surgery. 2019;165(6):1217–21. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.surg.2019.03.006

    Article  PubMed  Google Scholar 

  57. D’Souza G, Zhang Y, Merritt S, Gold D, Robbins HA, Buckman V, Gerber J, Eisele DW, Ha P, Califano J, et al. Patient experience and anxiety during and after treatment for an HPV-related oropharyngeal cancer. Oral Oncol. 2016;60:90–5. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.oraloncology.2016.06.009

    Article  PubMed  PubMed Central  Google Scholar 

  58. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialog Clin Neurosci. 2015;17(3):327–35. https://doiorg.publicaciones.saludcastillayleon.es/10.31887/DCNS.2015.17.3/bbandelow

    Article  Google Scholar 

  59. Goldstein-Piekarski AN, Williams LM, Humphreys K. A trans-diagnostic review of anxiety disorder comorbidity and the impact of multiple exclusion criteria on studying clinical outcomes in anxiety disorders. Translational Psychiatry. 2016;6(6):e847–847. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/tp.2016.108

Download references

Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

This study was supported by a grant from Taipei Municipal Wan Fang Hospital (109-WF-hhc-07).

Author information

Author notes

  1. Sang-Hue Yen and Yi-Hsuan Hsu contributed equally to this work.

Authors and Affiliations

  1. Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan

    Sang-Hue Yen

  2. School of Nursing, Taipei Medical University, Taipei, Taiwan

    Yi-Hsuan Hsu, Doreen Phiri & Min-Huey Chung

  3. Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei, Taiwan

    Chia-Chun Kuo

  4. Director of Administration Department, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan

    Hui-Fen Fang

Authors
  1. Sang-Hue Yen
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Yi-Hsuan Hsu
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Doreen Phiri
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Chia-Chun Kuo
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Hui-Fen Fang
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Min-Huey Chung
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

S.H.Y. contributed to conception and design, acquisition, critically revised manuscript. Y.H.H. contributed to conception and design, analysis, interpretation, drafted manuscript, and critically revised manuscript. D.P. contributed to interpretation, drafted manuscript, and critically revised manuscript. C.C.K. contributed to conception and design, critically revised manuscript. H.F.F. contributed to conception and design, critically revised manuscript. M.H.C. contributed to conception and design, analysis, interpretation, critically revised manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Min-Huey Chung.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the ethical guidelines outlined in the Declaration of Helsinki and was approved by the Taipei Medical University Joint Institutional Review Board (TMU-JIRB No. N202004116). The requirement for written informed consent was waived by the board due to the retrospective nature of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yen, SH., Hsu, YH., Phiri, D. et al. Bidirectional relationship between anxiety disorder and cancer: a longitudinal population-based cohort study. BMC Cancer 25, 761 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12885-025-13930-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12885-025-13930-6

Keywords

BMC Cancer

ISSN: 1471-2407

Contact us