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Extent of disease at first cancer presentation and previous anxiety and depressive symptoms: the HUNT study

  • Robert Stewart (a1), Sophie Dorothea Fosså (a2), Matthew Hotopf (a3) and Arnstein Mykletun (a4)



Depressive symptoms are associated with higher cancer mortality, whereas anxiety symptoms are associated with lower than expected risk.


This study aimed to investigate the prospective association between depressive/anxiety symptoms and the extent of disease (EOD) of first cancer at diagnosis.


Prospective population-based study conducted from the second wave of the Nord-Trøndelag Health (HUNT) study. Of 65 000 residents comprehensively interviewed and examined for health status, 407 received first lifetime cancer diagnoses 1–3 years later, ascertained from the Cancer Registry of Norway, and had EOD recorded. Patients with localised disease or regional/distant spread at cancer diagnosis were analysed for earlier depressive/anxiety symptoms ascertained by the Hospital Anxiety and Depression Scale in HUNT.


Beyond-local EOD was present in 59.8% of those with neither anxiety nor depression, in 76.6% of those with depression alone (odds ratio, 2.20; 1.08–4.49), in 39.3% of those with anxiety alone (odds ratio, 0.44; 0.20–0.96) and in 57.7% of those with both anxiety and depression (odds ratio, 0.92; 0.41–2.06). After adjustment for demographic and health status, and cancer type, these associations were marginally stronger, but no longer statistically significant (odds ratios, 2.26; 0.84–6.11; 0.43; 0.15–1.26; and 1.00; 0.98–1.03, respectively).


In people who develop cancer, beyond-local EOD at diagnosis was more common in people with previous depression and less common in people with previous anxiety; however, independence from confounding factors could not be concluded.


Corresponding author

Correspondence: Arnstein Mykletun, Haukeland University Hospital, Sandviken Hospital, Sandviksleitet 1, 5036 Bergen, Norway. Email:


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Extent of disease at first cancer presentation and previous anxiety and depressive symptoms: the HUNT study

  • Robert Stewart (a1), Sophie Dorothea Fosså (a2), Matthew Hotopf (a3) and Arnstein Mykletun (a4)
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