2026 ECNP Congress

PS04-4090

The impact of depression and anxiety on survival and treatment uptake in pancreatic cancer: a systematic review and meta-analysis

Hedvig Boros — K. Karimi, K.K. Fazekas, P. Hegyi, A.E. Doszpoly, A.K. Botos, X. Gonda · Semmelweis University, Centre for Translational Medicine, Budapest, Hungary

2026 ECNP Congress

Background

The role of psychological factors, including depression and anxiety, as well as their management in influencing course and outcome of severe somatic illnesses is increasingly acknowledged. Pancreatic cancer is one of the deadliest malignancies, with a 5-year survival rate of approximately 6–9%, and is associated with a substantial psychological burden. [1] Depression and anxiety affect up to half of patients, arising from pre-existing vulnerability, the psychological impact of diagnosis and prognosis, as well as disease- and treatment-related neurobiological mechanisms. [2] Despite growing recognition of the role of psychological factors in the course of severe somatic illnesses, routine psychological screening is not systematically integrated into oncological care. While prior studies suggest that depression and anxiety may negatively influence treatment adherence and survival, their impact in pancreatic cancer has not been quantitatively synthesized.[3]

Aims

To evaluate the association between depression and anxiety and overall survival and treatment uptake in adults with pancreatic cancer using a systematic review and meta-analysis.

Methods

This systematic review and meta-analysis followed PRISMA guidelines and was pre-registered in PROSPERO (CRD420251183170). A systematic search of PubMed, Embase, and CENTRAL was conducted on 4 December 2025. A total of 8,864 records were identified and 17 studies were included following screening. Eligible studies included adults with pancreatic cancer in whom depression and/or anxiety were assessed and survival or treatment-related outcomes were reported. Data extraction and risk-of-bias assessment were conducted independently by two reviewers. Random-effects meta-analyses were used to estimate pooled hazard ratios for overall survival and odds ratios for treatment uptake, with 95% confidence intervals. Heterogeneity was assessed using the Higgins&Thompson’s I² statistic. [4]

Results

Depression showed a non-significant trend toward worse overall survival compared with no depression (HR = 1.16, 95% CI: 0.85–1.57; p = 0.256), with substantial heterogeneity (I² = 73%). For treatment uptake, findings did not show statistically significant associations with depression and/or anxiety. Chemotherapy uptake showed an odds ratio of 0.89 (95% CI: 0.39–2.02), with considerable heterogeneity (I² = 90%). Surgical treatment uptake showed an odds ratio of 0.96 (95% CI: 0.38–2.41), with substantial heterogeneity (I² = 75%).

Conclusions

Current evidence remains inconclusive. Depression showed a possible but non-significant association with worse survival, while no reliable conclusions could be drawn for treatment uptake due to imprecision and substantial heterogeneity. Pancreatic cancer is associated with significant psychological distress arising from preexisting vulnerability, the impact of diagnosis, and disease- or treatment-related factors. Although depression and anxiety may be linked to poorer survival and reduced treatment uptake, this meta-analysis could not confirm a consistent effect, likely due to methodological limitations and underpowered studies.

Implications

Further prospective studies using standardized psychological assessments are needed to clarify whether depression and anxiety influence survival, treatment decisions, and adherence in pancreatic cancer. Future research should also evaluate the impact of psychological distress on quality of life and supportive care needs in this population.

References

  1. Seoud, T., et al., 2020. Survival outcomes and prognostic factors in pancreatic cancer: a population-based analysis. Pancreas 49 (10), 1360–1366.
  2. Ji, X., et al., 2023. Prevalence and predictors of depression and anxiety in patients with pancreatic cancer: a systematic review and meta-analysis. Cancer Medicine 12 (5), 6265–6278.
  3. Boyd, C.A., et al., 2012. The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma. Surgery 152 (3), 403–413.
  4. Higgins, Julian P. T., and Simon G. Thompson. 2002. “Quantifying Heterogeneity in a Meta-Analysis.” Statistics in Medicine 21 (11): 1539–58. https://doi.org/10.1002/sim.1186.