Systematic Review of Associations between Anxiety, Depression, and Functional/Biological aging among Cancer Survivors.

Abstract

Background: Evidence suggests a mind-body component to aging, through which psychological distress from anxiety and depression drives molecular changes that promote early decline (ie, accelerated aging). Cancer survivors experience particularly high rates of anxiety and depression. Some survivors also have accelerated aging, though the relationships between anxiety/depression and aging are not clear. A synthesis of evidence is needed to understand the state of the science and impending priorities.

Methods: PubMed, Embase, CINAHL, Web of Science, and PsycNet databases were searched for studies that measured associations between depression, anxiety, and non-chronological aging in cancer survivors (2012 to 2022). Data were methodologically evaluated.

Results: Survivorship studies were included if they were peer-reviewed, published in English from 2012-2022, and measured associations between anxiety/depression and aging. 51 studies were included. Just over half were cross-sectional (53%). Foci included functional (n = 35, 69%) and biological (n = 16, 31%). Functional aging measures included frailty, sarcopenia, geriatric assessment, and cognition. Biological aging measures included telomere length, telomerase, age-related inflammatory blood-based biomarkers, renal insufficiency, anemia, and DNA methylation. 223 associations were tested. Associations between anxiety, depression and aging were generally positive, though with varying strengths. Most compelling were associations between functional aging-depression. There were concerns for selection and measurement biases.

Conclusions: Findings suggest positive associations between anxiety, depression and aging among cancer survivors. Future work is needed to clarify temporality, develop a consensus on the operationalization of aging, and diversify cohorts.