Abstract
ObjectiveTo evaluate the risk of cancer among patients with generalized anxiety disorder (GAD) in a nationwide population-based dataset.MethodsWe recruited newly-diagnosed GAD patients aged 20 years or older without antecedent cancer from the Taiwan National Health Insurance Research database between 2000–2010. Standardized incidence ratios (SIRs) of cancers were calculated in GAD patients, and the subgroup of GAD patients diagnosed by psychiatric specialists.ResultsA total of 559 cancers developed among 19,793 GAD patients with a follow-up of 89,485 person-years (median follow-up of 4.34 years), leading to a significantly increased SIR of 1.14 [95% confidence interval (CI) 1.05–1.24]. Male GAD patients had a significantly increased SIR overall (1.30, 95% CI 1.15–1.46) and for lung and prostate cancer (1.77, 95% CI 1.33–2.30 and 2.17, 95% CI 1.56–2.93, respectively). Patients over 80 years of age also had a significantly increased SIR (1.56, 95% CI 1.25–1.92), especially in males. However, psychiatrist-diagnosed GAD patients did not show increased cancer risk relative to the general population, perhaps due to having fewer physical comorbidities than non-psychiatrist-diagnosed GAD patients.ConclusionThis study found that overall cancer risk is elevated among patients with GAD. The risk of lung and prostate cancer also increased in male patients with GAD. This increased cancer risk may be due to physical comorbidities and surveillance bias. Further prospective study is necessary to confirm these findings.
Highlights
Generalized anxiety disorder (GAD) is one of the most common anxiety disorders among the general population
Compared with the general population, patients with GAD had an increased overall cancer risk with an standardized incidence ratio (SIR) of 1.14
A subgroup analysis for gender showed that males had an increased SIR (1.30, 95% confidence interval (CI) 1.15–1.46, p,0.001), but females did not (1.02, 95% CI 0.91–1.15)
Summary
Generalized anxiety disorder (GAD) is one of the most common anxiety disorders among the general population. Despite the availability of several treatment options, GAD remains a major public health concern. It is consistently associated with considerable disability and overutilization of medical services. Psychological distress, such as ongoing depression and anxietyrelated symptomatology, has been associated with poorer survival rate of cancer patients. Numerous papers in the literature investigated associations between cancer incidence and psychosocial factors, such as anxiety, personality and depression. [20] In addition, a study in the UK showed that patients with anxiety disorders had higher risks for lung and brain cancer, but no increase in overall cancer risk. The results are controversial, [14,15,16,17,18,19,20,21,22,23,24] and few of these studies focused on anxiety or anxiety disorders. [20,21,22] A study in Taiwan found that patients with anxiety disorders had an increased risk of developing prostate cancer, a marginally decreased risk of cervical cancer, but no increase in overall cancer risk. [20] In addition, a study in the UK showed that patients with anxiety disorders had higher risks for lung and brain cancer, but no increase in overall cancer risk. [21]
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