title: Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type.
abstract: BACKGROUND
  Mixed anxiety/depression is associated with poorer psychosocial and treatment outcomes, worse quality of life, pooreradherence to treatment, slower recovery, greater suicide risk, and highercost-utilization.
  
  
  OBJECTIVE
  This study aimed to examine the cancer-specific prevalence of these symptoms.
  
  
  METHODS
  Cross-sectional anxiety and depression symptom data were collected with the Brief Symptom Inventory from adult outpatients presenting to a tertiary cancer center (N=8,265).
  
  
  RESULTS
  Mixed anxiety/depression symptoms were seen in 12.4% of patients; overall depression symptoms in 18.3%, overall anxiety symptoms in 24.0%, pure anxiety symptoms in 11.7%, and pure depression symptoms in 6.0%; 70% had neither. Higher rates of mixed anxiety/depression symptoms were seen with stomach, pancreatic, head and neck, and lung cancers, but lower rates were seen in those with breast cancers. The mixed anxiety/depression phenotype occurs in two-thirds of depressed cancer patients.
  
  
  CONCLUSIONS
  The fact that 70% of patients did not meet thresholds for depression or anxiety symptoms can be interpreted as a reflection of the resistance to developing a significant level of these symptoms. However, because stomach, pancreatic, head and neck, and lung cancers have higher levels of mixed anxiety/depression symptoms, the question can be raised as to whether these are associated with a more biological type of anxiety/depression (e.g., due to cytokine release) and whether this phenotype should be actively targeted because of its frequent occurrence in these cancers.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave., New York, NY 10022, USA. levint@mskcc.org
authors.forename: Karlynn M
authors.initials: KM
authors.lastname: Brintzenhofe-Szoc
authors.forename: Tomer T
authors.initials: TT
authors.lastname: Levin
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.forename: James R
authors.initials: JR
authors.lastname: Zabora
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012372:ROC Curve