Brief ReportAnxiety After Diagnosis Predicts Lung Cancer-Specific and Overall Survival in Patients With Stage III Non-Small Cell Lung Cancer: A Population-Based Cohort Study

ContextThe question as to whether anxiety and depression are related to mortality in patients with lung cancer is inconclusive.ObjectivesTherefore, the present study is examining associations of anxiety and depression in a large representative sample of patients with Stage III non-small cell lung cancer.MethodsPatients (n = 684) were routinely assessed for anxiety and depression with the PsychoSocial Screen for Cancer questionnaire after diagnosis of lung cancer and before treatment initiation between 2004 and 2010. Survival data were retrieved in May 2012. Cox proportional hazards regression analyses had been used as statistical procedures allowing adjustment for demographic, biomedical, and treatment variables.ResultsIn analyses controlling for demographic, biomedical, and treatment prognosticators, anxiety but not depression was associated with increased lung cancer-specific (hazard ratio 1.04; 95% confidence interval 1.01-1.07; P = 0.035) and all-cause (hazard ratio 1.04; 95% confidence interval 1.01-1.07; P = 0.005) mortality. Secondary analyses revealed a confounder effect of performance status on the association between depression and mortality, such that the removal of performance status identified a significant relationship of depression on lung cancer-specific and all-cause mortality.ConclusionIn a large population-based sample of patients with non-small cell lung cancer analyses demonstrated associations of anxiety with mortality, adding to the evidence that psychosocial factors might play a role in disease progression in this patient group. Because emotional distress is associated with continued smoking and lack of success of smoking cessation attempts, psychological interventions potentially could influence length of survival in lung cancer patients.