Individuals with clinical anxiety have higher health service utilisation, both related and unrelated to anxiety. Given anxiety is more common in cancer patients than in the general population, our aim was to examine the literature to identify whether anxiety in cancer patients also results in increased health service use and costs.
We searched the literature for articles published since 2006 using Medline, EMBASE, CINAHL, National Health Service Economic Evaluation Database, and the Cochrane Library. We used broad search terms and criteria to select all studies with adult cancer patients with a diagnosed anxiety disorder that included any monetary or health service utilisation outcome. Data abstracted by two reviewers included participant characteristics, diagnostic criteria for anxiety, study design, costs and resources captured, subgroup analyses and results.
Of 411 abstracts identified, six studies met our inclusion criteria – three in breast cancer, and one each in head and neck, prostate and heterogenous cancers. Only one study used formal diagnostic criteria to identify clinical anxiety; other studies used patient self-reported measures with clinical cut-offs.
The two observational studies found that anxiety is associated with higher health care expenditure from the health care system perspective. In the three randomised controlled trials of anxiety treatments, anxiety was related to greater levels of unmet need and resource use, such as psychosocial support services, but did not result in significantly higher healthcare costs. A cross-sectional survey found that those with anxiety had greater unmet needs, and were more willing to use supportive services.
The limited evidence available suggests that individuals with cancer who have comorbid anxiety use some additional healthcare resources. Although stronger evidence is required, this implies that development and implementation of effective screening and intervention programs for anxiety could improve patient outcomes while reducing resource use and associated costs.