The COVID-19 pandemic has made a profound impact on all aspects of society. For humans, these include not only physical but also psychological effects. Collecting high-quality data to assess the mental health impact of the COVID-19 pandemic on the entire population, especially vulnerable groups (such as cancer patients) is an urgent area for research24. This aid understanding of the mental health status of vulnerable groups and can provide a basis for psychological intervention during a pandemic.
This systematic review and meta-analysis of 9 cross-sectional studies with 2,335 participants provided evidence. Our results showed that the prevalence of anxiety and depression in patients with malignant tumors was 53.17% and 46.08% respectively. It revealed that factors such as fear, worry, and treatment interruptions during the COVID-19 pandemic resulted in a considerable proportion of patients with malignant tumors experiencing anxiety and depression. This result is not only higher than that during the non-epidemic period10,11, but also higher than the prevalence of anxiety and depression in the general population and healthcare workers during the COVID-19 pandemic30–32. Studies have shown that anxiety and depression not only reduce the compliance of cancer patients with drug treatment33,34, but also affect the body's immune system to recognize and kill tumor cells, leading to immunosuppression and increasing their risk of death 35,36. In recent years, due to the high prevalence of anxiety in cancer patients, it has been designated as the sixth vital sign of cancer patients37,38 and many countries have adopted anxiety as a routine screening item for cancer patients39 and its reduction as an index of efficacy evaluation40,41. Therefore, in response to the rising prevalence of anxiety and depression in cancer patients caused by the sudden international public health emergency, the COVID-19 pandemic, early targeted intervention measures should be considered41.
Early, effective, and timely intervention can not only reduce the incidence of unhealthy emotions and their psychological pressure in cancer patients, but also help patients receive anti-tumor and symptomatic supportive treatment with a better attitude and improve their treatment efficacy and prognosis. In recent years, Mindfulness-based Therapy (MBT) has become an increasingly popular psychological intervention method for cancer patients. The current research results show that the anxiety, depression, and stress of different types of cancer patients were significantly reduced after receiving MBT, with improved quality of life, post-traumatic growth, and mindfulness attitudes 42–44. In addition, previous studies have also proposed the use of psychological education45, group therapy46, structured counseling47, self-esteem training48, and cognitive behavioral therapy49 to provide psychological interventions for cancer patients. These measures have a positive effect on alleviating the anxiety and depression of cancer patients. However, there is an urgent need for more rigorous research before recommending specific psychological interventions for cancer patients50.
It is worth noting that the results of our study show a high level of heterogeneity, which means that the prevalence of anxiety and depression is quite different in the included studies. Due to limited conditions, we only performed a subgroup analysis of the assessment methods. Although we still observed large heterogeneity, the sensitivity analysis suggests that when a certain study is removed, we can still obtain robust results. Heterogeneity between studies may be due to differences in many factors such as the severity of cancer, cancer treatment status, the prevalence of COVID-19 in different countries or regions, or how cancer patients are treated in different regions.
To our knowledge, the present study is the first systematic review and meta-analysis of the comprehensive prevalence of anxiety and depression in cancer patients during the COVID-19 outbreak. However, our review still has some limitations. Since various studies are cross-sectional, the prevalence of anxiety and depression will also change with the passage of the epidemic. Therefore, the results of anxiety and depression obtained in a certain study may only represent the level during that certain period of the epidemic. Different assessment methods were also used in the studies, and some of them were convenience sampling, snowball sampling, or online survey. It was thus difficult to reflect the diversity of research representatives, and the research results obtained may have bias. In addition, although we conducted extensive searches in different databases, most of the included studies were conducted in Mainland China and Hong Kong, China. Only one study was conducted in New York, USA. The generalization of our research results is also subject to certain restrictions. Given that the COVID-19 epidemic in countries around the world has led to delayed surgeries and treatment interruption for cancer patients51–54, it is reasonable to believe that the prevalence of anxiety and depression among cancer patients in other countries or regions also increased significantly, and psychological interventions targeting this group is necessary.