Factors associated with mood and anxiety disorders in cancer survivors: A systematic review and meta-analysis.

e24106 Background: Mood and anxiety disorders affect up to 38% of cancer survivors and are associated with poorer quality of life and survival. These disorders remain underdiagnosed and undertreated due to limited psychiatric resources and lack of systematic identification of high-risk patients, despite guidelines for routine screening and intervention. To inform risk-stratified mental health care in oncology, we conducted a systematic review and meta-analysis to identify risk factors for mood and anxiety disorders (new/recurrent diagnoses or clinically significant symptoms) in adult cancer survivors. Methods: We systematically reviewed cohort and case-control studies evaluating cancer-related (tumor characteristics and treatments), sociodemographic, lifestyle, and psychosocial risk factors for mood and anxiety disorders in adults with breast, lung, colorectal, prostate, stomach, liver, or pancreatic cancer. We searched PubMed, Web of Science, EMBASE, PsycINFO, and Cochrane (January 2000-November 2024). Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models with robust variance estimation for factors assessed in ≥ 5 studies. Factors assessed in 3-4 studies were summarized qualitatively. Results: Of 53 eligible studies, 50 were meta-analyzed. Across cancers, high tumor stage (vs. low, n=28, pooled RR 95% CI = 1.55 1.21-1.97), more physical comorbidities (vs. fewer, n=36, 1.57 1.34-1.84), prior psychiatric history (yes vs. no, n=13, 4.85 2.77-8.50), female sex (vs. male, n=19, 1.52 1.32-1.75), underweight body mass index (vs. normal weight, n=6, 1.93 1.55-2.44), unmarried status (vs. married, n=25, 1.35 1.14-1.58), and current smoking (vs. never, n=12, 1.27 1.12-1.46) were consistently associated with higher risk of these disorders. We also found suggestive associations, though less consistent in sensitivity analyses, for high tumor grade (vs. low, n=7, 1.49 1.02-2.16), more extensive surgery (vs. limited, n=27, 1.16 1.01-1.35), low income (vs. high, n=13,1.52 1.15-2.00), low education (vs. high, n=29, 1.43 1.15-1.82), and low social support (vs. high, n=13, 2.63 1.67-4.17). In breast cancer-specific analyses, receipt of chemotherapy was associated with an increased risk of mood disorders (vs. no, n=9, 1.21 1.04-1.40). Systematic review also identified pain, fatigue, physical inactivity, and lack of insurance as additional, but understudied factors. Conclusions: This first meta-analysis identified several clinical and social factors consistently associated with increased risk of mood and anxiety disorders in adult cancer survivors. Findings inform risk-based psychiatric screening and early intervention strategies in resource-limited oncology settings. Additionally, they motivate future research to clarify causal pathways and test targeted preventive approaches.