VIENNA – Generalized anxiety disorder in men over age 40 was independently associated with a greater than twofold increased risk of death due to cancer during 15 years of follow-up, compared with men without the psychiatric disorder, in a large longitudinal population-based study, Olivia Remes reported at the annual congress of the European College of Neuropsychopharmacology.
In contrast, women with generalized anxiety disorder (GAD) were at no increased risk for cancer mortality, according to Ms. Remes, a PhD candidate in the department of public health and primary care at the University of Cambridge, England.
“I think an important message of this study is that anxiety is not just a personality trait,” she said in an interview. “In some cases, it may be more than worries and stress; it can represent a possible marker for future ill physical health that general practitioners and psychiatrists ought to be aware of.”
This creates a dilemma, because individuals with GAD typically are high users of health care resources. They frequently present in physicians’ offices and emergency departments with a wide range of physical complaints, including stomach pain, breathing difficulty, fatigue, nausea, or peripheral numbness.
Ms. Remes presented an analysis of 7,139 men and 8,799 women over age 40 at enrollment in the European Prospective Investigation of Cancer–Norfolk Study from the period of 1996-2000. At entry, the patients underwent a physical examination and completed numerous health-related questionnaires. Among these was the Health and Life Experiences Questionnaire (HLEQ), the responses to which enabled investigators to identify 1.8% of the men and 2.4% of women as meeting DSM-IV diagnostic criteria for GAD.
During 15 years of follow-up, 796 men and 648 women died of cancer. In multivariate analysis, men with GAD were at a 2.14-fold increased risk of death due to cancer. This analysis was extensively adjusted for potential confounders, including age, marital status, education level, socioeconomic status, major chronic physical illnesses, smoking, alcohol intake, major depressive disorder, body mass index, physical activity level, and the use of antidepressants or antihypnotic agents.
This was the first large, long-term study to examine the relationship between GAD and cancer mortality. Prior studies yielded conflicting results but were limited by small sample size and/or short follow-up, Ms. Remes said.
Even with more than 1,400 cancer deaths in the study, the sample size is too small to say whether GAD in men is preferentially associated with death due to any specific type of cancer.
Severe chronic anxiety has been linked to increased systemic inflammation, an observation that points to a possible mechanism by which GAD might increase affected individuals’ risk of fatal cancer as well as cardiovascular disease, chronic lung disease, and other conditions where inflammation figures prominently. But that doesn’t explain the gender difference in cancer mortality risk, the source of which remains speculative. It’s not the result of men being more likely to be smokers or to abuse alcohol, since those carcinogenic lifestyle factors were controlled for in the multivariate analysis, she observed.
One hypothetical possibility is that men with GAD who develop a malignancy might be more likely to delay seeking medical attention for it than might men without the anxiety disorder. Ms. Remes and her coinvestigators plan to explore this possibility in a roundabout way by analyzing the Norfolk study database looking for differences between men with and without GAD in the time from cancer diagnosis to death.
To eliminate the possibility that GAD in men might be triggered by an occult and ultimately fatal cancer, the investigators reanalyzed the Norfolk study data after excluding deaths that occurred during the first 5 years of follow-up. The results remained unchanged, according to Ms. Remes.
She reported having no financial conflicts regarding this study, which was sponsored by the U.K. Medical Research Council and Cancer Research UK.