Mental Comorbidity and Psychosocial Care in Patients with Cancer

Background: Patients with cancer suffer from cancer- and

treatment-specific, psychosocial and care-related stress and

mental disturbances.

Methods: This article is based on pertinent publications retrieved by a search in PubMed, as well as on the German clinical practice guideline on psycho-oncology.

Results: The most common mental disorders in cancer patients are anxiety disorders, affective disorders, and adjustment disorders. The point prevalence of any mental disorder in patients with cancer is 20% to 50%. Common disease-associated psychological symptoms include distress (a non-specific experience of emotional discomfort), demoralization, and fear of cancer recurrence or progression. These can cause severe suffering even if they do not meet the diagnostic criteria for any particular mental disorder. Mental comorbidity is associated with complications of treatment, lesser adherence to treatment, lower quality of life, and increased mortality. Psychotherapeutic interventions are effective and show moderate to large effects in current meta-analyses with respect to the reduction of anxiety and depression and improvement in quality of life. These effects persist over several months of follow-up. The empirical evidence for psychopharmacotherapy in cancer patients is limited. Psychopharmacological treatment should be integrated into an overall psycho-oncological treatment plan.

Conclusion: A large body of evidence shows that mental comorbidity is common among cancer patients and harmful to them. Psychotherapeutic interventions lessen the symptoms of mental disturbances and improve quality of life. Nonetheless, despite improvements in recent years, there are remaining barriers to the adequate provision of psychosocial care.

Cite this as: Dinkel A, Goerling U, Karger A, Teufel M, Zimmermann T, Stengel A: Mental comorbidity and psychosocial care in patients with cancer. Dtsch Arztebl Int 2025; 122: 475–82. DOI: 10.3238/arztebl.m2025.0086

Most people in Germany fear cancer more than anything else (e1). Cancer is generally thought of as a disease that develops slowly and insidiously, is frightening, and must be “defeated” in “battle” (e2). The common view of cancer as an ever-present threat makes it unsurprising that a real diagnosis of cancer is often a shock and a source of fear. People who have to deal with a cancer diagnosis and its consequences face a multitude of challenges (1) (Box 1).

Box 1

Stressors experienced by patients after receiving a diagnosis of cancer (1)

Learning objectives

This article is intended to make readers aware of

• the mental comorbidities of cancer,
• the specific needs of cancer patients for a diagnostic evaluation of potential mental impairment,
• and the nature of needs-based psychosocial care.

Methods

This article is based on pertinent publications retrieved by a selective search in in the PubMed database, with additional reference to the current German S3 clinical practice guideline on psycho-oncology (2) (eBox 1).

eBox 1

Literature search

Mental comorbidity

Mental disorders of pathological severity

Anxiety disorders are the most common type of mental disorder in patients with cancer, just as they are in the general population (e3) (Table 1). In Germany, approximately 13% of cancer patients suffer from anxiety disorders at any given time. Affective disorders and adjustment disorders are also among the more common ones (2). The prevalences listed in Table 1 are intended as rough estimates, as the real prevalence may differ depending on the treatment setting, the type of disease, or the patient’s age category.

Table 1

Point prevalence of mental disorders in cancer patients

In the largest representative epidemiological study of mental disorders in cancer patients in Germany to date, Mehnert et al. (3) found that 32% of cancer patients overall were currently suffering from a mental disorder, with the percentage varying across different types of cancer (Figure 1). A secondary analysis showed that the point prevalence of mental disorders was especially high among adolescents and young adults (AYA), defined as persons aged 15 to 39, at 47% (5). The 12-month prevalences are even higher, at 39% overall (6) and 55% among AYA (5). The pattern of administrative prevalences of mental disorders among cancer patients in Germany, i.e., prevalence figures derived from health insurance billing data, differs from that obtained from epidemiological and clinical studies of depression and places depression in the leading position: its 12-month administrative prevalence was found to be 31% (e4), compared to 13% in an epidemiological study (6). This discrepancy underscores the difficulty of validly diagnosing mental disorders in routine clinical practice (e5). To summarize these figures, one can state that 20% to 50% of patients with cancer are suffering from a mental disorder at any given time (point prevalence).

Figure 1

The prevalence (%) of mental disorders in patients with cancer

Moreover, empirical evidence suggests that certain mental disorders are more common in cancer patients in certain situations than in people who do not have cancer. For example, in the study by Mehnert and colleagues (3), the 12-month prevalence of mental disorders among patients with cancer was higher than the corresponding figures for the age- and sex-matched sample of the general population in the German Health Interview and Examination Survey for Adults (DEGS1-MH). This was particularly true of affective disorders, which were twice as common, while there was no difference in the prevalence of anxiety disorders (7). In the World Mental Health Survey (e6), affective and anxiety disorders were more prevalent in people undergoing active cancer treatment than in people without cancer. A higher prevalence was not found, however, among people who had suffered from cancer previously or were currently living with cancer, but not undergoing active treatment for it.

It is particularly important to consider suicidality in patients with depressive disorders. An estimated 14% of cancer patients express thoughts of suicide (2), but actual suicidal acts are rare. Hu et al. (e7) found that, among 16.7 million people with cancer, 20,792 (0.1%) died by suicide. It remains true, however, that suicide is approximately twice as common among people with cancer than in the general population. The risk is markedly higher in the first year after diagnosis, especially in the first three months (8, e7, e8, e9).

Although cancer patients face stress of multiple kinds (Table 1), a mental disorder in a cancer patient is not necessarily a direct psychological reaction to the disease and the associated stress. Mental comorbidity can arise in various ways:

• Manifestations of mental illness can arise as a biological effect of cancer or its treatment, e.g., depression in pancreatic cancer can be mediated by cytokines (mainly interleukin-6) (9, e10).
• Some patients with cancer coincidentally have pre-existing mental disorders.
• A diagnosis of cancer can trigger the recurrence of prior mental illness that has gone into remission. In fact, prior mental illness in a cancer patient is a relevant predictor of a current mental disorder (Box 2).
• Studies on incidence provide evidence that mental disorders can be understood as a reaction to cancer. The incidence of mental disorders (new or recurrent) is higher in cancer patients than in people without cancer (10, e11, e12, e13, e14, e15).

Box 2

Predictors of mental disorders in cancer patients (2)

The elevated incidence of mental disorders among patients with cancer suggests that the experience of suffering from cancer can lead to a depletion of psychological resources. Whether the comorbid mental disorder should be regarded as a psychological reaction to the stressors associated with adjustment to the diagnosis must be judged individually in each case.

General and disease-associated mental health problems

Patients with cancer may suffer from mental health problems that do not meet current diagnostic criteria for a mental disorder, perhaps because the symptoms are too few in number or their frequency of occurrence is too low. The clinician should, therefore, consider the nature and intensity of the patient’s mental impairment independently of its categorization in the common classification systems for mental disorders.

24% of cancer patients in a German epidemiological study suffered from clinically relevant depressive symptoms, a frequency five times higher than in the general population (11). The pooled prevalence of clinical anxiety in long-term cancer survivors is 21%; the prevalence of clinically relevant depressive symptoms is also 21% (12). The higher prevalence in comparison to people without cancer persists for more than 20 years after diagnosis (e15, e16, e17, e18).

These reported intergroup differences between people with and without cancer do not reflect the potential variability of manifestations in any affected individual over time. Studies on the trajectories of anxiety and depression have shown that the manifestations tend to remain stable; most patients are either continuously mentally unburdened or continuously burdened. Nonetheless, a degree of volatility is present: 10% to 30% of patients have an improvement or a deterioration of mental well-being over time (13, e19, e20). These figures understandably depend on the timing of symptom ascertainment (when, with what frequency, and for how long) (13).

One problematic aspect of diagnosing a mental disorder is the associated stigma; another is the narrow view of the mental health of cancer patients. As an alternative, the concept of “distress” is intended as a designation of the experience of stress without any stigmatizing connotations. The symptoms are considered to be associated with the disease, in distinction to anxiety and depression in general. Distress as an umbrella term is defined as “a broad spectrum of unpleasant experiences of a psychological, social, or spiritual nature, ranging from normal feelings of vulnerability, sadness, and anxiety to severely limiting problems such as depression, anxiety disorders, panic, social isolation, and spiritual crises” (e21).

Aside from its use as an umbrella term, “distress” is also used to designate a disease-related, non-specific psychological impairment. In a German study of patients receiving in-hospital treatment for cancer, the prevalence of clinical distress was 66% (14). Herschbach et al. (15) found a prevalence of 33% among 21,000 people being treated for cancer in various settings in Germany. A German epidemiological study found a prevalence of 52% (4). The prevalence varies depending on the survey instrument and the diagnostic groups (Figure 1).

The most severe mental health impairment associated with cancer is considered to be the fear of progression or recurrence (16), a reactive, realistic fear relating to the disease, its treatment, and its possible consequences (16, e22). This is an appropriate psychological response, but it can cause marked impairment in everyday life (16, e23). The fear of progression is at least moderate in approximately 60% of cancer patients and severe in approximately 20% (17).

Studies on distress (18), demoralization—i.e., feelings of meaninglessness, hopelessness, and personal failure (19)—and the fear of progression (20) have shown that some patients suffer from these disease-associated symptoms to a clinically relevant extent without having a mental disorder, as strictly defined (Figure 2).

Figure 2

Percentages (%) of cancer patients with and without mental disorders

The diagnostic evaluation of mental comorbidity

Mental disorders are diagnosed by physicians and clinical psychologists. It must be borne in mind that many mental disorders cause somatic symptoms, and that these can be of many kinds. The classification of somatic symptoms can be a difficult matter, as they are often due to the cancer or its treatment (2, 8). The patient’s mental manifestations may also be hard to categorize, as cancer and other chronic diseases can be accompanied by psychological and behavioral reactions that are inadequately covered, if at all, by the existing classification systems (e24).

General and disease-related psychological symptoms are ascertained with self-assessment questionnaires. Distress screening is recommended in the German clinical practice guideline as an initial evaluation in all cancer patients. The result implies a certain degree of probability of the presence or absence of a mental health impairment. If the result is positive, further evaluation is indicated (2). Distress screening can be used in all care settings. Multiple reliable and valid self-assessment tools are available for this purpose (2):

• Distress Thermometer (DT)
• Hospital Anxiety and Depression Scale – German version (HADS-D)
• Questionnaire on Stress in Cancer Patients (QSC-R10)
• Depression module of the Patient Health Questionnaire (PHQ-9)
• Anxiety module of the Patient Health Questionnaire (GAD-7).

Given the increased risk of suicidal behavior, the question arises whether screening should be carried out for suicidality as well. Support for routine screening has been expressed (e25), but a major problem with such screening is its low predictive power. It was found in one study, for example, that the cancer patients who committed suicide either had not filled out the screening instrument or had done so without expressing any suicidal intent (e26).

Psychosocial care

cdComorbid mental disorders and symptoms are harmful in many ways (eBox 2). This underscores the importance of needs-based psychosocial care (1, 2), although the question of what constitutes need can be answered in different ways. The diagnosis of a mental disorder implies a need for treatment, but many patients with cancer suffer from mental impairments that do not meet the diagnostic criteria for a disorder. A further question concerns whether the need should be ascertained by the treating professional or, alternatively, by the patient himself or herself through the self-assessment questionnaire and the reported subjective need for treatment. Treating professionals often inadequately assess their patients’ mental impairment and subjective needs (21, e66, e67, e68, e69). For due consideration of the wide variety of problems that can arise, psychosocial care needs are defined in the psycho-oncology clinical practice guideline both “objectively,” as an existing clinical mental impairment, preferably self-reported, and “subjectively,” as an expressed need for psychosocial support (2).

eBox 2

The consequences of mental comorbidity

Settings of care

In Germany, professional specialized psychosocial care is provided in multiple settings (1):

• acute care hospitals (certified organ cancer centers and oncology centers)
• oncological rehabilitation clinics
• psychosocial cancer counseling centers
• outpatient psychotherapy

Psychosocial care for cancer patients is well established in acute care hospitals, as long as they are certified cancer centers. The focus is on inpatients who are cared for by psycho-oncological consultation and liaison services. Organ cancer centers and oncology centers are required to carry out distress screening and provide psycho-oncological care, with specific recommendations for comprehensive cancer centers (CCC) (22, 23). The increasing shift of cancer treatment to outpatient settings poses a new challenge in this respect. Specialized psycho-oncological outpatient clinics exist, particularly in CCCs, which can partially address these changes while also taking on a coordinating function across sectors (23).

Psycho-oncological care is also structurally mandated in cancer rehabilitation clinics. Its availability is required by the German Pension Insurance Fund (Deutsche Rentenversicherung), which is the largest provider of rehabilitation services in Germany (24), and supported by expert-based recommendations (e70). The announced requirements for the structure and content of such services cannot yet be met, however, and a current deficiency in the extent of care services can be assumed (24).

Psychosocial cancer counseling centers offer outpatient services at no cost, including patient information, psychosocial and psychological counseling, and crisis intervention (25). Cancer counseling centers are not part of a certification system but must nonetheless adhere to quality standards (e71) as a prerequisite for the partial reimbursement of cancer counseling by health insurance carriers (25).

Outpatient psychotherapy is provided mainly by licensed clinical psychologists and by physicians specializing in psychosomatic medicine and psychotherapy. The demand for psychotherapy is greater than can now be met because of barriers including an insufficient number of therapists, long waiting times for the initiation of psychotherapy, and the ofen unpredictable timing of the need for psychotherapy, particularly among somatically ill patients (1, 26).

Stepped care

Many cancer patients suffer from temporary or subclinical mental health problems. Nearly all have psychosocial needs, such as a need for information or support with physical or sexual problems. Most cancer patients surveyed state that their major psychosocial needs are not being adequately met. This is most often true of their need for psychological and emotional support, particularly to help them cope with the fear of progression (27, 28).

Addressing this matter is also the responsibility of the treating oncologists and general practitioners. Primary care is especially important because people with cancer and cancer survivors visit their general practitioners more often than their oncologists (29, 30). Patients generally see the general practitioner as their preferred source of psychosocial care, except when it comes to the fear of progression, which they prefer to discuss with the oncologist (29, 31).

Family doctors and oncologists should take a patient-centered approach to psycho-oncological care: they should explore the patient‘s emotional situation, assess possible suicidality, identify psychosocial needs, and provide basic psychological support interventions (see eMethods). Patients with milder psychological problems can be helped by e-health interventions and digital health applications of documented efficacy (2, 32, 33). If the problem worsens, the patient should be referred for specialized psycho-oncological care as the next step in the tiered care approach. This may not always be achievable in practice; general practitioners and specialists in Germany report difficulties in referring cancer patients for outpatient psycho-oncological care, especially in rural areas, and this becomes even harder if the patient is from an immigrant background and has a poor command of the national language (e77, e78).

The utilization of specialized care

The integration of psychosocial care into routine care remains difficult (34, e79, e80). This is partly due to structural barriers such as the lack of universal distress screening and a shortage of resources (34, e79, e80). The attitudes and psychosocial skills of health care professionals play a role as well (34, e81); for example, an explicit recommendation for psycho-oncology by the treating physician is associated with higher utilization (35, e82, e83). Finally, there are barriers on the part of patients themselves. During inpatient oncological treatment, a feeling of being overwhelmed can discourage interest in psychosocial care (36). Patients may also be negatively disposed toward psychotherapy or insufficiently informed about it, or they may think they can cope with their problems on their own (34). 50% to 70% of cancer patients do not want psychological support (34), at least not at the moment when they are asked; they may nevertheless turn to psychosocial support at a later opportunity (36, 37).

In the end, approximately 30% of cancer patients decide to seek specialized psychological support. Younger age, female sex, and a positive attitude toward psycho-oncological care favor utilization (35, 38, e84). A greater burden of psychological symptoms does as well, but the correlation between psychological impairment and utilization is only of moderate strength (34). Just as some mentally distressed patients are not interested, about one-fourth want psychological support even though they do not mention any relevant impairment in self-assessment questionnaires (e85).

Psycho-oncological interventions

The wide range of psycho-oncological interventions includes psychosocial counseling, psychoeducation, relaxation techniques, art therapies (e.g., music therapy), and psychotherapy.

There have been numerous studies of the efficacy of psychotherapy. Only a minority of these studies have been about mental disorders as strictly defined by nosological criteria; many, on the other hand, have concerned psychological symptoms and their relation to the quality of life. In a study of the treatment of depressive disorders in breast cancer patients, psychodynamic psychotherapy was found to be superior to standard treatment (remission rate, 44% vs. 23%) (e86). In a different study of the same subject, interpersonal psychotherapy, problem-solving therapy, and supportive therapy were found to be similarly effective (e87). Moreover, extensive empirical evidence indicates that psychotherapy lessons anxiety, depression, distress, and fatigue and improve patients’ quality of life (2).

These findings receive further support from meta-analyses that appeared too recently to be considered for the psycho-oncology clinical practice guideline. These meta-analyses have shown that cognitive-behavioral therapy, mindfulness-based psychotherapy, and acceptance and commitment therapy have moderate to large effects with respect to anxiety and depression at the end of treatment. These effects are sustained at nearly the same level over several months of follow-up. Smaller, mostly short-term effects have been observed for online-based psychotherapeutic interventions. Psychotherapy has also been found to lessen the fear of progression (small effect) (39) and the fear of death (large effect) (40)—outcomes that were not explicitly considered in the psycho-oncology clinical practice guideline (eTable, Table 2). In summary, the results indicate that psychotherapy is generally effective in cancer patients, but there has not yet been a systematic analysis of the individual outcome of psychotherapy (response, remission) or its possible side effects.

Table 2

Evidence table on the efficacy of psychotherapeutic interventions in patients with cancer

eTable

Evidence table on the efficacy of psychotherapeutic interventions in cancer patients: central aspects of selected meta-analyses of (randomized) controlled trials

Psychopharmacotherapy and psycho-oncology

The use of psychoactive drugs is not considered a psycho-oncological intervention (2), although it is naturally a component of the treatment of psychological comorbidity in patients with cancer. In both the German guideline (2) and the guideline of the American Society for Clinical Oncology (ASCO), caution is expressed about the use of drugs to treat anxiety and depression, as the evidence for their efficacy in patients with cancer is weak (2, e108, e109). Pharmacotherapy is not recommended as a first-line treatment, either as a stand-alone treatment or in combination with other treatments (e110). In contrast, the European Society for Medical Oncology (ESMO), in its guidelines, recommends a combination of psychotherapy and pharmacotherapy to treat anxiety and depressive symptoms, acknowledging the lack of empirical support for the treatment of cancer patients with psychoactive drugs but pointing to their demonstrated efficacy in patients with other chronic diseases. Escitalopram and mianserin are recommended at the highest level for the treatment of depressive symptoms, while fluoxetine is recommended for the treatment of anxiety (e111).

Recommendations for standard dosages of psychotropic drugs would be inappropriate, as antidepressants are a risk factor for drug interactions in patients being treated for cancer (e112, e113), and because cancer patients often find themselves in a complex disease situation (comorbidities, polypharmacy). Individualized patient assessment, drug prescribing, and treatment monitoring should generally be carried out in the setting of specialized psychiatric care.

There have not been any studies comparing the efficacy of psychopharmacotherapy and psychotherapy in cancer patients.

It should be noted, however, that cancer patients clearly prefer psychotherapy to psychopharmacotherapy (2, e110, e114, e115, e116). Psychopharmacological treatment should therefore be embedded in an overall psycho-oncological treatment concept (2).

Conflict of interest statement
AD was a member of the board of directors of the Psycho-Oncology Working Group (AG PSO) of the German Cancer Society. He is deputy spokesperson for the Working Group for Psycho-Oncology in the Network of Oncology Centers of the German Cancer Aid (Deutche Krebshilfe), and also a member of the board of the directors of the Psycho-Oncology Project Group of the Munich Tumor Center.

UG is spokesperson for the Working Group on Psycho-Oncology in the Network of Oncology Centers of the German Cancer Aid.

AK was a member of the board of the Psycho-Oncology Working Group (AG PSO) of the German Cancer Society and head of the Psycho-Oncology Working Group in the German College of Psychosomatic Medicine.

MT receives financial support from Novartis, for which he also serves as a paid consultant. He is deputy spokesperson for the Psycho-Oncology Working Group) in the Network of Oncology Centers of the German Cancer Aid.

TZ was a member of the board of directors of the Psycho-Oncology Working Group of the German Cancer Society.

AS was spokesperson for the Provision of Psycho-Oncological Care subgroup of the Psycho-Oncology Working Group in the Network of Oncology Centers of the German Cancer Aid.

Manuscript submitted on 18 November 2024, revised version accepted on 8 May 2025.

Translated from the original German by Ethan Taub, M.D.

Corresponding author
Prof. Dr. rer. nat. Andreas Dinkel

Informationen on CME

This article has been certified by the North Rhine Academy for Continuing Medical Education. The questions may be found at the end of this article. The closing date for entries is 21 August 2026.
Participation is possible at: cme.aerzteblatt.de

References

1. Mehnert A, Lehmann-Laue A: Psychoonkologie. Psychother Psychosom Med Psychol 2019; 69: 141–56

2. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Psychoonkologische Diagnostik, Beratung und Behandlung von erwachsenen Krebspatient*innen, Langversion 2.1, 2023, AWMF-Registernummer: 032–051OL; www.leitlinienprogramm-onkologie.de/leitlinien/psychoonkologie/ (last accessed on 20 September 2023).

3. Mehnert A, Brähler E, Faller H, et al.: Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol 2014; 32: 3540–6

4. Mehnert A, Hartung TJ, Friedrich M, et al.: One in two cancer patients is significantly distressed: Prevalence and indicators of distress. Psychooncology 2018; 27: 75–82

5. Geue K, Brähler E, Faller H, et al.: Prevalence of mental disorders and psychosocial distress in German adolescent and young adult cancer patients (AYA). Psychooncology 2018; 27: 1802–9

6. Kuhnt S, Brähler E, Faller H, et al.: Twelve-month and lifetime prevalence of mental disorders in cancer patients. Psychother Psychosom 2016; 85: 289–96

7. Vehling S, Mehnert-Theuerkauf A, Philipp R, et al.: Prevalence of mental disorders in patients with cancer compared to matched controls—secondary analysis of two nationally representative samples. Acta Oncol 2022; 61: 7–13

8. Heinrich M, Hofmann L, Baurecht H, et al.: Suicide risk and mortality among patients with cancer. Nat Med 2022; 28: 852–9

9. Pitman A, Suleman S, Hyde N, Hodgkiss A: Depression and anxiety in patients with cancer. BMJ 2018; 361: k1415

10. Lu D, Andersson TML, Fall K, et al.: Clinical diagnosis of mental disorders immediately before and after cancer diagnosis. A nationwide matched cohort study in Sweden. JAMA Oncol 2016; 2: 1188–96

11. Hartung TJ, Brähler E, Faller H, et al.: The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types. Eur J Cancer 2017; 72: 46–53

12. Brandenbarg D, Maass SWMC, Geerse OP, et al.: A systmatic review on the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors: Implications for primary care. Eur J Cancer Care (Engl) 2019; 28: e13086

13. Curran L, Mahoney A, Hastings B: A systematic review of trajectories of clinically relevant distress amongst adults with cancer: Course and predictors. J Clin Psychol Med Settings 2025; 32: 1–18

14. Peters L, Brederecke J, Franzke A, de Zwaan M, Zimmermann T: Psychological distress in a sample of inpatients with mixed cancer—a cross-sectional study of routine clinical data. Front Psychol 2020; 11: 591771

15. Herschbach P, Britzelmeir I, Dinkel A, et al.: Distress in cancer patients: Who are the main groups at risk? Psychooncology 2020; 29: 703–10

16. Dinkel A, Herschbach P: Fear of progression in cancer patients and survivors. Recent Results Cancer Res 2018; 210: 13–33

17. Luigjes-Huizer YL, Tauber NM, Humphris G, et al.: What is the prevalence of fear of cancer recurrence in cancer patients and survivors? A systematic review and individual participant data meta-analysis. Psychooncology 2022; 31: 879–92

18. Ernst J, Friedrich M, Vehling S, Koch U, Mehnert-Theuerkauf A: Cancer-related distress: How often does it co-occur with a mental disorder?—Results of a secondary analysis. Front Psychol 2021; 12: 660588

19. Vehling S, Kissane D, Lo C, et al.: The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer 2017; 123: 3394–3401

20. Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C: Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry 2014; 36: 613–9

21. Dinkel A, Jahnen M: Patientenberichtete Endpunkte – die Bedeutung der subjektiven Patientenperspektive für Forschung und klinische Versorgung. Urologie 2024; 63: 886–92

22. Stengel A, Dinkel A, Karger A, et al.: Best Practice: Psychoonkologisches Distress-Screening an Comprehensvie Cancer Centers. Forum 2021; 36: 278–83

23. Dinkel A, Goerling U, Hentschel L, et al.: Best Practice: Empfehlungen zur psychoonkologischen Versorgung in einem von der Deutschen Krebshilfe geförderten Comprehensive Cancer Center. Forum 2024; 39: 294–301

24. Schulte T, Steimann M, Weis J, Bergelt C: Herausforderungen für eine bedarfsgerechte psychoonkologische Versorgung in der Rehabilitation. Rehabilitation (Stuttg) 2024; 63: 9–12

25. Ernst J, Heyne S, Mehnert-Theuerkauf A, Kuhnt S: Ambulante Krebsberatungsstellen (KBS) in Deutschland – Versorgungsauftrag, Leistungsspektrum, Finanzierung. Onkologie 2024; 30: 394–9

26. Singer S, Kojima E, Beckerle J, Kleining B, Schneider E, Reuter K: Practice requirements for psychotherapeutic treatment of cancer patients in the outpatient setting—a survey among certified psychotherapists in Germany. Psychooncology 2017; 26: 1093–8

27. Paterson C, Toohey K, Bacon R, Kavanagh PS, Roberts C: What are the unmet supportive care needs of people affected by cancer: An umbrella systematic review. Semin Oncol Nurs 2023; 39: 151353

28. Springer F, Mehnert-Theuerkauf A, Gebhardt C, Stolzenburg JU, Briest S: Unmet supportive care needs among cancer patients: Exploring cancer entity-specific needs and associated factors. J Cancer Res Clin Oncol 2024; 150: 190

29. Smith TG, Strollo S, Hu X, Earle CC, Leach CR, Nekhlyudov L: Understanding long-term cancer survivors’ preferences for ongoing medical care. J Gen Intern Med 2019; 34: 2091–7

30. Hermes-Moll K, Blaschke K, Lappe V, Ihle P, Schubert I, Baumann W: Behandlungspfade von Krebspatienten. Analyse der Inanspruchnahme ambulanter und stationärer Leistungen. Onkologe 2019; 25: 456–65

31. Deckx L, Chow KH, Askew D, van Driel ML, Mitchell GK, van den Akker M: Psychosocial care for cancer survivors: A systematic literature review on the role of general practitioners. Psychooncology 2021; 30: 444–54

32. Shaffer KM, Turner KL, Siwik C, et al.: Digital health and telehealth in cancer care: A scoping review of reviews. Lancet Digit Health 2023; 5: e316–27

33. Springer F, Maier A, Friedrich M, et al.: Digital therapeutic (Mika) targeting distress in patients with cancer: Results from a nationwide waitlist randomized controlled trial. J Med Internet Res 2024; 26: e51949

34. Pichler T, Herschbach P, Frank T, Mumm F, Dinkel A: Barrieren der Inanspruchnahme psychoonkologischer Versorgung. Onkologe 2022; 28: 708–12

35. Goerling U, Albus C, Bergelt C, et al.: Predictors of cancer patients‘ utilization of psychooncological support: Examining patient’s attitudes and physician’s recommendation. J Cancer Res Clin Oncol 2023; 149: 17997–8004

36. Pichler T, Dinkel A, Marten-Mittag B, et al.: Factors associated with the decline of psychological support in hospitalized patients with cancer. Psychooncology 2019; 28: 2049–59

37. Rausch R, Bäuerle A, Rentrop V, et al.: Falling off the screening grid—predictors of postponed utilization of psycho-oncological support in cancer patients and its implications for distress assessment and management. Psychooncology 2023; 32: 1727–35

38. Weis J, Hönig K, Bergelt C, et al.: Psychosocial distress and utilization of professional psychological care in cancer patients: An observational study in National Comprehensive Cancer Centers (CCCs) in Germany. Psychooncology 2018; 27: 2847–54

39. Tauber NM, O‘Toole MS, Dinkel A, et al.: Effect of psychological intervention on fear of cancer recurrence: A systematic review and meta-analysis. J Clin Oncol 2019; 37: 2899–2915

40. Shaygan M, Khaki S, Zarei D, Moshfeghinia R, Beheshtaeen F, Sadeghi Y: Effects of meaning-based psychotherapy on post-traumatic growth and death anxiety in patients with cancer: A systematic review and meta-analysis. Support Care Cancer 2024; 32: 251

e1. Forsa. Angst for Krankheiten. https://caas.content.dak.de/caas/v1/media/86256/data/1ec9f4841b483e1a204ebe7688457db6/241202-download-forsa-angst-vor-krankheiten.pdf (letzter Zugriff am 10.12.2024).

e2. Clarke JN, Everest MM: Cancer in the mass print media: fear, uncertainty and the medical model. Soc Sci Med 2006; 62: 2591-600.

e3. Jacobi F, Höfler M, Strehle J, et al.: Psychische Störungen in der Allgemeinbevölkerung. Studie zur Gesundheit Erwachsener in Deutschland und ihr Zusatzmodul Psychische Gesundheit (DEGS1-MH). Nervenarzt 2014; 85: 77-87 [Erratum: Nervenarzt 2016; 87: 88-0].

e4. Salm S, Blaschke K, Ihle P, et al.: Mental disorders and utilization of mental health services in newly diagnosed cancer patients: an analysis of German health insurance claims data. Psycho-Oncology 2021; 30: 312-20.

e5. Pena-Gralle APB, Talbot D, Trudel X, et al.: Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results form the PROspective Québec (PROC) study. BMC Psychiatry 2021; 21: 491.

e6. Nakash O, Levav I, Aguilar-Gaxiola S, et al.: Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys. Psycho-Oncology 2014; 23: 40-51.

e7. Hu X, Ma J, Jemal A, et al.: Suicide risk among individuals diagnosed with cancer in the US, 2000-2016. JAMA Network Open 2023; 6: e2251863.

e8. Calati R, Filipponi C, Mansi W, et al.: Cancer diagnosis and suicide outcomes: umbrella review and methodological considerations. J Affect Disord 2021; 295: 1201-14.

e9. Chang WH, Lai AG: Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers. Nat Med 2022; 28: 860-70.

e10. Young K, Singh G: Biological mechanisms of cancer-induced depression. Front Psychiatry 2018; 9: 299.

e11. Zhu J, Fang F, Sjölander A, Fall K, Adami HO, Valdimarsdottir U: First-onset mental disorder after cancer diagnosis and cancer-specific mortality: a nationwide cohort study. Ann Oncol 2017; 28: 1964-9.

e12. Shang X, Peng W, Hill E, Szoeke C, He M, Zhang L: Incidence of medication-treated depression and anxiety associated with long-term cancer, cardiovascular disease, diabetes and osteoarthritis in community-dwelling women and men. EClinicalMedicine 2019; 15: 23-32.

e13. Lee MJ, Huang CW, Lee CP, et al.: Investigation of anxiety and depressive disorders and psychiatric medication use before and after a cancer diagnosis. Psycho-Oncology 2021; 30: 919-27.

e14. Carreira H, Williams R, Funston G, Stanway S, Bhaskaran K: Associations between breast cancer survivorship and adverse mental health outcomes: a matched population-based cohort study in the United Kingdom. PLoS Med 2021; 18: e1003504.

e15. Forbes H, Carreira H, Funston G, et al.: Early, medium and long-term mental health in cancer survivors compared with cancer-free comparators: matched cohort study using linked UK electronic health records. EClinicalMedicine 2024; 76: 102826.

e16. Mols F, Schoormans D, de Hingh I, Oerlemans S, Husson O: Symptoms of anxiety and depression among colorectal cancer survivors from the population-based, longitudinal PROFILES registry: prevalence, predictors, and impact on quality of life. Cancer 2018; 124: 2621-8.

e17. Baclig NV, Comulada WS, Ganz PA: Mental health and care utilization in survivors of adolescent and young adult cancer. JNCI Cancer Spectr 2023; 7: pkad098.

e18. Firkins J, Hansen L, Driessnack M, Dieckmann N: Quality of life in “chronic” cancer survivors: a meta-analysis. J Cancer Surviv 2020; 14: 504-17.

e19. Pu J, Zhou W, Zeng W, Shang S: Trajectories and predictors of anxiety and depression among older cancer survivors: a nationally representative cohort study. J Cancer Surviv 2025; 19: 1255-63.

e20. Scott AJ, Correa AB, Bisby MA, Dear BF: Depression and anxiety trajectories in chronic disease: a systematic review and meta-analysis. Psychother Psychosom 2023; 92: 227-42.

e21. Mehnert A, Müller D, Lehmann C, Koch U: Die deutsche Version des NCCN Distress Thermometers. Empirische Überprüfung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. Z Psychiatr Psychol Psychother 2006; 54: 213-23.

e22. Lebel S, Ozakinci G, Humphris G, et al.: From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer 2016; 24: 3265-8.

e23. Mutsaers B, Butow P, Dinkel A, et al.: Identifying the key characteristics of clinical fear of cancer recurrence: an international Delphi study. Psycho-Oncology 2020; 29: 430-6.

e24. Amonoo HL, Brown LA, Scheu CF, et al.: Beyond depression, anxiety and post-traumatic stress disorder symptoms: qualitative study of negative emotional experiences in hematopoietic stem cell transplant patients. Eur J Cancer Care 2020; 29: e13263.

e25. Granek L, Nakash O: Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients. Curr Opin Support Palliat Care 2020; 14: 239-46.

e26. Gascon B, Leung Y, Espin-Garcia O, Rodin G, Chu D, Li M: Suicide risk screening and suicide prevention in patients with cancer. JNCI Cancer Spect 2021; 5: pkab057

e27. Wang YH, Aggarwal A, Stewart R, Davies EA: Impact of pre-existing mental health disorders on the receipt of guideline recommended cancer treatments: a systematic review. Psycho-Oncology 2023; 32: 307-30.

e28. Kisely S, Alotiby MKN, Protani MM, Soole R, Arnautovska U, Siskind D: Breast cancer treatment disparities in patients with severe mental illness: a systematic review and meta-analysis. Psycho-Oncology 2023; 32: 651-62.

e29. Charlesworth L, Fegan C, Ashmore R: How does severe mental illness impact on cancer outcomes in individuals with severe mental illness and cancer? A scoping review of the literature. J Med Imaging Radiat Sci 2023; 54: S104-14.

e30. Seppänen AV, Daniel F, Houzard S, Le Bihan C, Coldefy M, Gandré C: The double burden of severe mental illness and cancer: a population-based study on colorectal cancer care pathways from screening to end-of-life care. Epidemiol Psychiatr Sci 2024; 33: e27.

e31. Haskins CB, McDowell BD, Carnahan RM, et al.: Impact of preexisting mental illness on breast cancer endocrine therapy adherence. Breast Cancer Res Treat 2019; 174: 197-208.

e32. Howren MB, Christensen AJ, Pagedar NA: Examination of risk factors for discontinuation of follow-up care in patients with head and neck cancer. Cancer Med 2023; 12: 631-9.

e33. Mausbach BT, Schwab RB, Irwin SA: Depression as a predictor of adherence to adjuvant endocrine therapy in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 152: 239-46.

e34. Song H, Zhu J, Lu D, et al.: Psychiatric morbidity and its impact on surgical outcomes for esophageal and gastric cancer patients: a nationwide cohort study. Oncotarget 2017; 8: 81305-14.

e35. Liu Q, Song H, Andersson TML, et al.: Psychiatric disorders are associated with increased risk of sepsis following a cancer diagnosis. Cancer Res 2020; 80: 3436-42.

e36. Lee KM, Jung D, Hwang H, et al.: Pre-treatment anxiety is associated with persistent chemotherapy-induced peripheral neuropathy in women treated with neoadjuvant chemotherapy for breast cancer. J Psychosom Res 2018; 108: 14-9.

e37. Jarvis CA, Bonney PA, Yuan E, et al.: Comorbid depression in surgical cancer patients associated with non-routine discharge and readmission. Surg Oncol 2021; 37: 101533.

e38. Kulshrestha S, Bunn C, Gonzalez R, Afshar M, Luchette FA, Baker MS: Unhealthy alcohol and drug use is associated with an increased length of stay and hospital cost in patients undergoing major upper gastrointestinal and pancreatic oncologic resections. Surgery 2021; 169: 636-43.

e39. Hwang J, Baird BA, Taylor T, et al.: The association between mood and anxiety disorders with perioperative outcomes following radical cystectomy. Urology 2022; 168: 143-9.

e40. Dinesh AA, Pinto SAPS, Brunckhorst O, Dasgupta P, Ahmed K: Anxiety, depression and urological cancer outcomes: a systematic review. Urol Oncol 2021; 39: 816-28.

e41. Kirsch JL, Roche AI, Bronars C, Donovan KA, Hassett LC, Ehlers SL: Emotional distress and future healthcare utilization in oncology populations: a systematic review. Psycho-Oncology 2024; 33: e6322.

e42. Khushalani JS, Qin J, Cyrus J, et al.: Systematic review of healthcare costs related to mental health conditions among cancer survivors. Expert Rev Pharmacoecon Outcomes Res 2018; 18: 505-17.

e43. Mausbach BT, Decastro G, Schwab RB, Tiamson-Kassab M, Irwin SA: Healthcare use and costs in adult cancer patients with anxiety and depression. Depress Anxiety 2020; 37: 908-15.

e44. van Beek FE, Wijnhoven LMA, Holtmaat K, et al.: Psychological problems among cancer patients in relation to healthcare and societal costs: a systematic review. Psycho-Oncology 2021; 30: 1801-35.

e45. Williams JTW, Pearce A, Smith AB: A systematic review of fear of cancer recurrence related healthcare use and intervention cost-effectiveness. Psycho-Oncology 2021; 30: 1185-95.

e46. Renna ME, Shrout MR, Madison AA, et al.: Distress disorder histories relate to greater physical symptoms among breast cancer patients and survivors: findings across the cancer trajectories. Int J Behav Med 2023; 30: 463-72.

e47. Voskanyan V, Marzorati C, Sala S, et al.: Psychosocial factors associated with quality of life in cancer survivors: umbrella review. J Cancer Res Clin Oncol 2024; 150: 249.

e48. Faller H, Brähler E, Härter M, et al.: Performance status and depressive symptoms as predictors of quality of life in cancer patients. A structural equation modeling analysis. Psycho-Oncology 2015; 24: 1456-62.

e49. Krajewski C, Benson S, Elsenbruch S, Schadendorf D, Livingstone E: Predictors of quality of life in melanoma patients 4 years after diagnosis: results of a nationwide cohort study in Germany. J Psychosoc Oncol 2018; 36: 734-53.

e50. Liu YJ, Schandl A, Markar S, Johar A, Lagergren P: Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study. BJS Open 2021; 5: zraa038.

e51. Breidenbach C, Ernstmann N, Schellack S, et al.: Rückkehr in das Erwerbsleben nach Krebs – eine systematische Übersichtsarbeit zu Prädiktoren in Deutschland. Rehabilitation 2024; 63: 229-37.

e52. Plym A, Johansson ALV, Bower H, et al.: Causes of sick leave, disability pension, and death following a breast cancer diagnosis in women of working age. Breast 2019; 45: 48-55.

e53. Jensen LS, Overgaard C, Garne JP, Bøggild H, Fonager K: The impact of prior psychiatric medical treatment on return to work after a diagnosis of breast cancer: a register-based study. Scand J Public Health 2019; 47: 519-27.

e54. Schellack S, Breidenbach C, Rick O, Kowalski C: Predictive factors for return to work among cancer survivors in Europe: a systematic review. Crit Rev Oncol Hematol 2024; 200; 104422.

e55. Wang YH, Li JQ, Shi JF, et al.: Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry 2020; 25: 1487-99.

e56. Herweijer E, Wang J, Hu K, et al.: Overall and cervical cancer survival in patients with and without mental disorders. JAMA Netw Open 2023; 6: e2336213.

e57. Kuczmarski TM, Tramontano AC, Mozessohn L et al.: Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study. Lancet Hematol 2023; 10: e530-8.

e58. Batty GD, Russ TC, Stamatakis E, Kivimäki M: Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ 2017; 356: j108.

e59. Kim SJ, Kang D, Kim IR, et al.: Impact of fear of cancer recurrence on survival among lymphoma patients. Psycho-Oncology 2020; 29: 364-72.

e60. Roche KN, Cooper D, Armstrong TS, King AL: The link between psychological distress and survival in solid tumor patients: a systematic review. Cancer Med 2023; 12: 3343-64.

e61. Kroenke CH: A conceptual model of social networks and mechanisms of cancer mortality, and potential strategies to improve survival. Transl Behav Med 2018; 8: 629-42.

e62. Kroenke CH, Paskett ED, Cené CW, et al.: Prediagnosis social support, social integration, living status, and colorectal cancer mortality in postmenopausal women from the Women’s Health Initiative. Cancer 2020; 126: 1766-75.

e63. Krajc K, Mirosevic S, Sajovic J, et al.: Marital status and survival in cancer patients: a systematic review and meta-analysis. Cancer Med 2023; 12: 1685-08.

e64. Mierzynska J, Piccinin C, Pe M, et al.: Prognostic value of patient-reported outcomes from international randomised clinical trials on cancer: a systematic review. Lancet Oncol 2019; 20: e685-98.

e65. Fukushima T, Suzuki K, Tanaka T, et al.: Global quality of life and mortality risk in patients with cancer: a systematic review and meta-analysis. Qual Life Res 2024; 33: 2631-43.

e66. Gouveia L, Lelorain S, Brédart A, et al: Oncologists’ perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates. BMC Psychol 2016; 3: 6.

e67. Nolte S, van der Mei SH, Strehl-Schwarz K, et al.: Comparison of patient-reported need of psycho-oncologic support and the doctor’s perspective: how do they relate to disease severity in melanoma patients? Psycho-Oncology 2016; 25: 1271-7.

e68. Limburg K, Dinkel A, Schmid-Mühlbauer G, et al.: Neurologists’ assessment of mental comorbidity in patients with vertigo and dizziness in routine clinical care – comparison with a structured clinical interview. Front Neurol 2018; 9: 957.

e69. Schneider A, Mayer V, Dinkel A, Wagenpfeil S, Linde K, Henningsen P: Verbessert eine Schulungsintervention die Diagnostik von psychischen Erkrankungen in der hausärztlichen Praxis? Z Evid Fortbild Qual Gesundhwes 2019; 147-148: 20-7.

e70. Reese C, Weis J, Schmucker D, Mittag O: Development of practice guidelines for psychological interventions in the rehabilitation of patients with oncological diseae (breast, prostate, or colorectal). Methods and results. Psycho-Oncology 2017; 26: 1513-8.

e71. Kuhnt S, Mehnert A, Giesler JM, Faust T, Weis J, Ernst J: Die Entwicklung von Qualitätsstandards für die ambulante psychosoziale Krebsberatung – Ergebnisse einer Delphibefragung. Gesundheitswesen 2018; 80: 113-21.

e72. Whooley MA, Avins AL, Miranda J, Browner WS: Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997; 12: 439-45.

e73. Grulke N, Bailer H, Blaser G, et al.: Depressivitäts-Screening – zwei Fragen für die Praxis. Wien Med Wochenschr 2005; 155: 297-302.

e74. Fähndrich E, Stieglitz RD: Leitfaden zur Erfassung des psychopathologischen Befundes. Halbstrukturiertes Interview anhand des AMDP-Systems (6., überarbeitete Aufl). Göttingen: Hogrefe 2023.

e75. DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg.) für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression - Langfassung, 2. Auflage, Version 1, November 2015. https://www.bpm-ev.de/images/startseite/depression-2aufl-vers1-20151112-fin.pdf (letzter Zugriff 03.03.2025).

e76. Liu J, Butow P, Bui KT, et al.: Novel clinician-led intervention ot address fear of cancer recurrence in breast cancer survivors. JCO Oncol Pract 2021; 17: e774-84.

e77. Zimmermann-Schlegel V, Hartmann M, Sklenarova H, Herzog W, Haum MW: Accessibility, availability, and potential benefits of psycho-oncology services: the perspective of community-based physicians providing cancer survivorship care. Oncologist 2017; 22: 719-27.

e78. Riccetti N, Hempler I, Hermes-Moll K, Heidt V, Walawgo T, Singer S: Experience of office-based haematologists and oncologists with outpatient psycho-social support services for cancer patients with and without migration background in Germany. J Cancer Res Clin Oncol 2023; 149: 4185-94.

e79. Breidenbach C, Kowalski C, Ansmann L, et al.: Incorporating psychosocial care into routine oncological care: insights into challenges and strategies from certified cancer centers‘ audit data. Psycho-Oncology 2022; 31: 1331-9.

e80. Deshields TL, Wells-Di Gregorio S, Flowers SR, et al.: Addressing distress management challenges: recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71: 407-36.

e81. Senf B, Fettel J, Demmerle C, Maiwurm P: Physicians’ attitudes towards psycho-oncology, perceived barriers, and psychosocial competencies: indicators of succesful implementation of adjunctive psycho-oncological care? Psycho-Oncology 2019; 28: 415-22.

e82. Frey Nascimento A, Tondorf T, Rothschild SI, et al.: Oncologist recommendation matters! – Predictors of psycho-oncological service uptake in oncology outpatients. Psycho-Oncology 2019; 28: 351-7.

e83. Billaudelle F, Bayer O, Hechtner M, et al.: “That was a tip from my physician” – gender-specific pathways of patients and relatives to outpatient psychosocial cancer counselling centers – a qualitative study. Psycho-Oncology 2022; 31: 1022-30.

e84. Faller H, Weis J, Koch U, et al.: Utilization of professional psychological care in a large German sample of cancer patients. Psycho-Oncology 2017; 26: 537-43.

e85. Faller H, Weis J, Koch U, et al.: Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. J Psychosom Res 2016; 81: 24-30.

e86. Beutel ME, Weißflog G, Leuteritz K, et al.: Efficacy of short-term psychodynamic psychotherapry (STPP) with depressed breast cancer patients: results of a randomized controlled multicenter trial. Ann Oncol 2014; 25: 378-84.

e87. Blanco C, Markowitz JC, Hellerstein DJ, et al.: A randomized trial of interpersonal psychotherapy, problem solving therapy, and supportive therapy for major depressive disorder in women with breast cancer. Breast Cancer Res Treat 2019; 173: 353-64.

e88. Chayadi E, Baes N, Kiropoulos L: The effects of mindfulness-based interventions on symptoms of depression, anxiety, and cancer-related fatigue in oncology patients: a systematic review and meta-analysis. PLoS ONE 2022; 17: e0269519.

e89. Fan M, Wang Y, Zheng L, Cui M, Zhou X, Liu Z: Effectiveness of online mindfulness-based interventions for cancer patients: a systematic review and meta-analysis. Jpn J Clin Oncol 2023; 53: 1068-76.

e90. Fang P, Tan L, Cui J, Yu L: Effectiveness of acceptance and commitment therapy for people with advanced cancer: a systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2023; 519-38.

e91. Jiang X, Sun J, Song R, Wang Y, Li J, Shi R: Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Front Psychol 2024; 14: 1253266.

e92. Krueger E, Secinti E, Stewart JC, Rand KL, Mosher CE: Cognitive-behavioral and mindfulness-based interventions for distress in patients with advanced cancer: a meta-analysis. Psycho-Oncology 2024: 33: e6259.

e93. Li Z, Li Y, Guo L, Li M, Yang K: Effectiveness of acceptance and commitment therapy for mental illness in cancer patients: a systematic review and meta-analysis of randomized controlled trials. Int J Clin Pract 2021; 75: e13982.

e94. Lin LY, Lin LH, Tzeng GL, et al.: Effects of mindfulness-based therapy for cancer patients: a systematic review and meta-analysis. J Clin Psychol Med Settings 2022; 29: 432-45.

e95. Liu T, Xu J, Cheng H, et al.: Effects of internet-based cognitive behavioral therapy on anxiety and depression symptoms in cancer patients: a meta-analysis. Gen Hosp Psychiatry 2022; 79: 135-45.

e96. Sun M, Tian X, Peng Y, Wang Z, Lu Y, Xiao W: Effects of meaning therapy on spirituality, psychological health, and quality of life in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Asia Pac J Oncol Nurs 2024; 11: 100388.

e97. Wang T, Tang C, Jiang X, Guo Y, Zhu S, Xu Q: Effectiveness of web-based mindfulness interventions for cancer patients: systematic review and meta-analysis. J Med Internet Res 2024; 26: e47704.

e98. Xia W, Zheng Y, Guo D, Zhu Y, Tian L: Effects of cognitive behavioral therapy on anxiety and depressive symptoms in advanced cancer patients: a meta-analysis. Gen Hosp Psychiatry 2024; 87: 20-32.

e99. Yu J, Han M, Miao F, Hua D: Using mindfulness-based stress reduction to relieve lonelieness, anxiety, and depression in cancer patients: a systematic review and meta-analysis. Medicine 2023; 102: e34917.

e100. Zhang L, Liu X, Tong F, et al.: Cognitive behavioral therapy for anxiety and depression in cancer survivors: a meta-analysis. Sci Rep 2022; 12: 21466.

e101. Zhang Y, Li J, Hu X: The effectiveness of dignity therapy on hope, quality of life, anxiety, and depression in cancer patients: a meta-analysis of randomized controlled trials. Int J Nurs Stud 2022: 132: 104273.

e102. Zhang A, Wang K, Blumenstein K, et al.: For whom and what outcomes does cognitive-behavioral-therapy work among cancer survivors: a systematic review and meta-analysis. Support Care Cancer 2022; 30: 8625-36.

e103. Zhang Y, Ding Y, Chen X, Li Y, Li J, Hu X: Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: a meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2023; 20: 582-92.

e104. Zhang T, Wakefield CE, Ren Z, et al.: Effects of digital psychological interventions on physical symptoms in cancer patients: a systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84; 47-59.

e105. Zhao C, Lai L, Zhang L, et al.: The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: a meta-analysis with trial sequential analysis. J Psychosom Res 2021; 140: 110304.

e106. Kang N, Yu ES: Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: a systematic review and meta-analysis. Psycho-Oncology 2023; 32: 1348-58.

e107. Vrontaras N, Koulierakis G, Ntourou I, et al.: Psychosocial interventions on the posttraumatic growth of adults with cancer: a systematic review and meta-analysis of clinical trials. Psycho-Oncology 2023; 32: 1798-26.

e108. Vita G, Compri B, Matcham F, Barbui C, Ostuzzi G: Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2023; 3: CD011006.

e109. Rabin EE, Kim M, Mozny A, et al.: A systematic review of pharmacologic treatment efficacy for depression in older patients with cancer. Brain Behav Immun Health 2022; 21: 100449.

e110. Andersen BL, Lacchetti C, Ashing K, et al.: Management of anxiety and depression in adult survivors of cancer: ASCO guideline update. J Clin Oncol 2023; 41: 3426-53.

e111. Grassi L, Caruso R, Riba MB, et al.: Anxiety and depression in adult cancer patients: ESMO clinical practice guideline. ESMO Open 2023; 8: 101155.

e112. Bellesoeur A, Gataa I, Jouinot A et al.: Prevalence of drug-drug interactions in sarcoma patients: key role of the pharmacist integration for toxicity risk management. Cancer Chemother Pharmacol 2021; 88: 741-51.

e113. Song YK, Oh JM: Nationwide prevalence of potential drug-drug interactions associated with non-anticancer agents in patients on oral anticancer agents in South Korea. Support Care Cancer 2020; 28: 3711-0.

e114. Wu SM, Brothers BM, Farrar W, Andersen BL: Individual counseling is the preferred treatment for depression in breast cancer survivors. J Psychosoc Oncol 2014; 32: 637-46.

e115. Arch JJ, Vanderkruik R, Kirk A, Carr AL: A closer lens: cancer survivors’ supportive intervention preferences and interventions received. Psycho-Oncology 2018; 27: 1434-41.

e116. Markowitz JC, Hellerstein DJ, Falabella G, et al.: Psychopharmaphobia: elevated fear of antidepressant medication among patients with major depression and breast cancer. Gen Hosp Psychiatry 2023; 83: 117-22.