6. Psychiatric Comorbidity – Psycho-oncology

Version 2.0 · May 2023 · AWMF 032-051OL
Leitlinienprogramm Onkologie · Deutsche Krebsgesellschaft · Deutsche Krebshilfe · AWMF

6.1 · Evidence-based Statement · checked 2023

The most common mental disorders in cancer patients are affective disorders, anxiety disorders, adjustment disorders, and psychotropic substance disorders. A history of pain, a high physical symptom burden, fatigue, and the presence of an existing mental disorder heighten the risk of developing a mental disorder in cancer patients.

Level of evidence: 1b
Consensus: Strong consensus (97,5%)
References: [39] [75] [251] [252] [253] [254] [255] [256] [257] [258] [259] [260] [261] [262] [263] [264] [265] [266] [267] [268] [269] [270] [271] [272] [273] [274] [275] [276] [277] [278] [279] [280] [281] [282] [283] [284] [285] [286] [287] [288] [289] [290] [291] [292] [293] [294] [295] [296] [297] [298] [299] [300] [301] [302] [303] [304] [305] [306] [307] [308] [309] [310] [311] [312] [313] [314] [315] [316] [317] [318] [319] [320] [321] [322] [323] [324] [325] [326] [327] [328] [329] [330] [331] [332] [333] [334] [335] [336] [337] [338] [339] [340] [341] [342] [343] [344] [345] [346] [347] [348] [349] [350] [351] [352] [353] [354] [355] [356] [357] [358] [359] [360] [361] [362] [363] [364] [365] [366] [367] [368] [369] [370] [371] [372] [373] [374] [375] [376] [377] [378] [379] [380]

Evidence tables (1)

Prävalenz und Prädiktoren psychischer Störungen

6.2 · Evidence-based Recommendation · checked 2023

Mental distress as well as the presence of a mental disorder shall be clarified, especially in the case of persistent pain, severe physical symptom burden, or fatigue.

Recommendation grade: A: Starke Empfehlung für oder gegen ein Maßnahme - verwendete Ausdrucksweise = soll/soll nicht
Level of evidence: 1b
Consensus: Consent (92%)
References: [287] [255] [332]

Evidence tables (1)

Prävalenz und Prädiktoren psychischer Störungen

The recommendations are based on a systematic literature review with a concluding summary of the available empirical evidence. Studies were included in which the prevalence of comorbid mental disorders in the classification areas F1, F3, and F4 was recorded on the basis of structured interview procedures for the diagnosis of mental disorders according to ICD and DSM. For the topic of suicidality, studies with standardized and validated self-description instruments were also included.

Since the quality of the relevant studies judged as being very heterogeneous both in terms of sample size and in terms of the representativeness of the prevalence data collected, all relevant studies were therefore initially considered for the pooling of the prevalence data.

6.1 Risk Factors that Promote the Occurrence of Mental Disorders

Pain, high physical symptom burden, and fatigue, as well as the presence of a history of mental disorder favor the occurrence of a mental disorder in cancer patients [39], [75], [178], [244], [250], [381], [382], [383], [384], [385], [386], [387], [388], [389], [263], [390], [265], [266], [267], [391], [269], [392], [271], [272], [273], [274], [275], [276], [393], [278], [394], [280], [281], [395], [283], [396], [285], [286], [287], [288], [397], [290], [398], [292], [399], [400], [295], [296], [297], [298], [299], [300], [301], [302], [303], [304], [305], [306], [307], [401], [309], [310], [311], [402], [403], [404], [315], [405], [317], [318], [319], [406], [321], [322], [323], [324], [325], [407], [327], [408], [329], [330], [331], [332], [409], [334], [410], [336], [337], [338], [339], [411], [412], [413], [343], [344], [345], [347], [414], [348], [349], [350], [351], [352], [353], [415], [416], [356], [357], [358], [359], [360], [361], [362], [363], [364], [365], [366], [367], [368], [369], [370], [371], [372], [417], [373], [374], [375], [418], [376], [377], [378], [379], [419], [420], [380]. The risk of mental disorders tends to be increased by younger age, tumor entities with poorer prognosis in terms of survival, and advanced disease [39], [75], [178], [244], [250], [381], [382], [383], [384], [385], [386], [387], [388], [389], [263], [390], [265], [266], [267], [391], [269], [392], [271], [272], [273], [274], [275], [276], [393], [278], [394], [280], [281], [395], [283], [396], [285], [286], [287], [288], [397], [290], [398], [292], [399], [400], [295], [296], [297], [298], [299], [300], [301], [302], [303], [304], [305], [306], [307], [401], [309], [310], [311], [402], [403], [404], [315], [405], [317], [318], [319], [406], [321], [322], [323], [324][421], [325], [407], [327], [408],[329], [330], [331], [332], [409], [334], [410], [336], [337], [338], [339], [411], [412], [413], [343], [344], [345], [347], [414], [348], [349], [350], [351], [352], [353], [415], [416], [356], [357], [358], [359], [360], [361], [362], [363], [364], [365], [366], [367], [368], [369], [370], [371], [372], [417], [373], [374], [378], [379], [419], [376], [380].

There are inconclusive findings with regard to the characteristics gender, education level, marital status and partnership, socioeconomic status, tumor stage, time since diagnosis, as well as the treatment carried out and treatment setting.

Vulnerability factors and predictors of mental disorders

Sociodemographic factors

Age

Of the 131 studies included, 60 studies examined age as a potential influencing factor with regard to psychiatric comorbidity: 26 studies showed a negative association (i.e., younger patients have a higher risk of developing a mental disorder), seven studies showed a positive association (i.e., older patients have a higher risk of developing a mental disorder), and 27 studies failed to demonstrate an association.

Gender

Of the 131 studies included, 43 studies examine gender as a potential influencing factor with regard to psychiatric comorbidity: 16 studies show that women are at higher risk for the occurrence of a mental disorder, five studies show that men are at higher risk for the occurrence of a mental disorder, and 22 studies failed to demonstrate gender as an influencing factor.

Education level

Of the 131 studies included, 26 studies reported educational level as a potential influencing factor with regard to psychiatric comorbidity: five studies showed a negative association (i.e., patients with a lower level of education have a higher risk for the occurrence of a mental disorder), 1 study showed a positive association, and 19 studies could not demonstrate an association.

Marital status and partnership

Of the 131 studies included, 29 studies examined marital status and partnership as a potential influencing factor regarding psychiatric comorbidity: nine studies showed that single and divorced individuals are at higher risk for the occurrence of a mental disorder, one study showed that individuals who are married are at higher risk for the occurrence of a mental disorder, and 19 studies failed to demonstrate an association.

Socioeconomic status

Of the 131 studies included, 21 studies examined socioeconomic status as a potential influencing factor: 10 studies showed that unemployment or low income was associated with a higher risk of developing a mental disorder, one study showed that individuals with higher income had a higher risk of comorbidity, and 10 studies failed to demonstrate an association.

Medical and disease-related factors

Type of tumor entity

Of the 131 studies included, 29 studies provide information on the influence of tumor entity on psychological comorbidity. Increased risk was found for lung cancer (5 studies), head and neck tumors (4 studies), breast cancer (2 studies), gastrointestinal tumors (2 studies), as well as gynecologic, visceral surgical, and urologic tumors (1 study each). Thirteen studies failed to demonstrate an association.

Tumor stage and disease progression

Of the included 131 studies, 17 studies provide information on the influence of tumor stage and 10 studies provide information on the influence of disease progression/remote metastasis on psychiatric comorbidity. With respect to tumor stage, 6 studies show a positive association, one study a negative association, and 10 studies no association. With respect to disease progression, 8 studies showed a positive association, whereas 2 studies demonstrated no association.

Time since diagnosis

Of the included 131 studies, 11 studies provide information on the influence of time since diagnosis/recurrence on psychiatric comorbidity. Overall, the majority of studies (8 studies) show no association, one study shows a positive association, and two studies show a negative association.

Treatment and treatment setting.

Of the included 131 studies, 18 studies provide information on the influence of treatment or treatment setting on psychiatric comorbidity. The results show an increased risk for the presence of a mental disorder with chemotherapy (3 studies), hormone therapy (2 studies), in the inpatient treatment setting (2 studies), and in the diagnostic phase (1 study). 7 studies failed to demonstrate an association.

Physical and psychosocial factors

Pain, physical symptom burden, and fatigue.

Of the included 131 studies, 57 studies reported pain, physical symptom burden, and fatigue as potential influencing factors regarding psychiatric comorbidity. Regarding pain, 22 studies show a positive association, while six studies demonstrate no association. Impaired physical functional status and high symptom burden were shown to be a risk factor for psychiatric comorbidity in 24 studies, whereas four studies found no associations. Fatigue was shown to be a risk factor in seven studies.

History of mental illness

Of the included 131 studies, 19 studies investigated previous mental illness as a potential influencing factor with regard to psychiatric comorbidity in the presence of cancer. While 2 studies showed no association, the majority of studies (17) showed that a history of mental illness (11 studies), and in particular depression (6 studies), led to higher mental comorbidity.

6.2 Mental Disorders According to ICD-10/DMS-IV Classification

Affective disorders (F30-39) (see Table Frequency of Mental Disorders in Cancer Patients) occur on average in 13% (point prevalence) of cancer patients (0-49%). In Germany, the average point prevalence in cancer patients for affective disorder is 9.8%. The most common mental disorder among affective disorders is depression (F32.0-32.2) with a point prevalence of 8.2 % (0-49 %) (German studies: 5.4 %). Other affective disorders in cancer patients include Dysthymic Disorder (F34.1) with a point prevalence of 1.9% (Germany: 2.2%) as well as Bipolar Disorder and Mania (F31.0-31.9) with a point prevalence of 1.7% (0-4%).

Anxiety disorders (F40-42.9) occur on average in 11.1 % (point prevalence) of cancer patients (0-50 %). In Germany, the average point prevalence for anxiety disorders in cancer patients is 13.1 %. The most common mental disorders among anxiety disorders in cancer patients are generalized anxiety disorder (F41.1) with a point prevalence of 2.7 % (0-15 %) (German studies: 2.2 %) and specific phobias (F40.2) with a point prevalence of 3.5 % (0-14 %) (German studies: 3.8 %). Other anxiety disorders include panic disorder (F41.0) with a point prevalence of 2.3 % (0-11 %) (German studies: 2.1 %), obsessive-compulsive disorder (F42.0-42.9) with a point prevalence of 2.3% (1-5%) (German studies: 2.5%), social phobias (F40.1) with a point prevalence of 1.1% (0-7%) (German studies: 0.7%), and agoraphobia (F40.0) with a point prevalence of 1.6% (German studies: 2.3%).

An adjustment disorder (F43.2.) occurs on average in 12.1% (point prevalence) of cancer patients (0-40%). In Germany, the average point prevalence for an adjustment disorder in cancer patients is 8.8%. Acute stress disorder (F43.0) occurs on average in 4.8% (point prevalence) of cancer patients (0-28%). In Germany, the average point prevalence for acute stress disorder in cancer patients is 4.1%. Post-traumatic stress disorder (F43.1) occurs on average in 2.2% (point prevalence) of cancer patients (0-22%). In Germany, the average point prevalence for post-traumatic stress disorder in cancer patients is 1.9%. Somatoform disorders (F45.0- 45.9) occur on average in 2.7% (point prevalence) of cancer patients (0.5- 13%). In Germany, the average point prevalence for any somatoform disorder in cancer patients is 4.7%.

Also to be mentioned is the dependence on psychotropic substances such as alcohol, alkaloids, including nicotine, opioids or other drugs such as analgesics or sedatives, whereby the point prevalence in cancer patients can only be named for tobacco dependence and alcohol dependence. Across all studies, tobacco dependence/abuse (F17) occurs on average in 11.3% (point prevalence) of cancer patients (2-51%). In Germany, the average point prevalence for tobacco dependence/abuse in cancer patients is 6.2%. Alcohol dependence/abuse (F10) occurs on average in 4.9% (point prevalence) of cancer patients (0-40%). In Germany, the average point prevalence for alcohol dependence/abuse in cancer patients is 2.9%.

A comparison of the point prevalences of affective and anxiety disorders with the results of the German National Health Survey 1998/99, Additional Survey "Mental Disorders" shows a comparable prevalence for depression (5.6 %) in cancer patients compared to the general population [422]. Somewhat lower are the point prevalences in the general population for total affective disorders (6.3%), generalized anxiety disorder (1.2%), panic disorder (1.1%), and anxiety disorders overall (9.0%), although the comparison could be based on significantly fewer studies for these disorders. Comparison of 12-month prevalences shows comparable incidence rate for depression (8.3%), dysthymia (4.5%), bipolar disorder (0.8%), generalized anxiety disorder (1.5%), agoraphobia (2.0%), social phobia (2.0%), and obsessive-compulsive disorder (0.7%) [423]. Somewhat lower are the 12-month prevalences in the general population for total affective disorders (11.9%), panic disorder (2.3%), specific phobias (7.6%), and anxiety disorders overall (14.5%). However, it must be taken into account that the number of studies on the 12-month prevalence of mental disorders in cancer patients is very small and that they largely included small numbers of cases.

Table 3: Frequency of Mental Disorders in Cancer Patients

Mental disorder	Point prevalence (international)	Range	Point prevalence (Germany)
1. Affective disorders (F30-39)	13.0 %	0-49 %	9.8 %
a. Depression (F32.0-32.2)	8.2 %	0-49 %	5.4 %
b. Dysthymia (F34.1)	2.2 %	0-15 %	1.9 %
c. Bipolar affective disorder (F31.0-31.9)	1.7 %	0-4 %	n/a
2. Anxiety disorders (F40-42.9)	11.1 %	0-50 %	13.1 %
a. Generalized anxiety disorder (F41.1)	2.2 %	0-15 %	2.7 %
b. Panic disorder (F41.0)	2.3 %	0-9 %	2.1 %
c. Obsessive-compulsive disorder (F42.0-42.9)	2.3 %	1-5 %	2.5 %
d. Social phobias (F40.1)	1.1 %	0-7 %	0.7 %
e. Agoraphobia (F40.0)	1.6 %	0-3 %	2.3 %
3. Acute stress reaction (F43.0)	4.8 %	0-28 %	4.1 %
4. Post-traumatic stress disorder (F43.1)	2.2 %	0-22 %	1.9 %
5. Adjustment disorder (F43.2)	12.1 %	0-40 %	8.8 %
6. Somatoform disorders (F45.0-45.9)	2.7 %	0.5-13 %	4.7 %
7. Mental and behavioral disorders due to tobacco (F17)	11.3 %	2-51 %	6.2 %
8. Mental and behavioral disorders due to alcohol (F10)	4.9 %	0-40 %	2.9 %

A total of 43 studies focus on the topic of suicidality. The majority of the studies were conducted in patients with advanced cancer. The results show that suicidal ideation occurs in an average of 14.3% of patients (SD=13.4), median=15.2% (range 0.8-51%). The frequency of attempted suicide averaged 1.3% (SD=8.8) with a median of 1% (range 0-22.6%). An average of 15.9% expressed a desire for an early death (Desire for Hastened Death) (SD=10.7), median 15.4% (range 2-41%). The standardized suicide risk related to the frequency of suicides is mean M=1,9 (SD=1.0) with a median of 1.5 (range 1,2-4.2) [424], [425], [426], [427], [254], [414], [428], [429], [390], [430], [379], [378], [431], [432], [433], [434], [435], [420], [436], [437], [380], [438], [439], [440], [441], [442], [443], [444], [445], [O'Mahony, Sean et al. 2005], [447], [448], [449], [410], [450], [451], [452], [453], [454], [419], [455], [456], [457], [458].

Evidence tables

Prävalenz und Prädiktoren psychischer Störungen

Erstautor/ Jahr/ Land	Stichprobengewinn	Erfas-sung	Set-ting	n	% Weibl	Alter (M)	Alter (SD)	Tumorlokali-sation	Stadium	Zeit seit Diagnose	Prävalenzen, aktuell(%)	Prävalenzen, Lebenszeit (%)
Akechi 2002 Japan	k	SCID (DSM-III-R)	G	89	28 %	61	9	Lunge	III: 52 %; IV: 48 %	< 1 Mon.	(T2 6 Mon. nach T1) D: 4,7; 3,4 (T2) DYS: 0 BIP.: 1,1 PAN: 2,2 SOZ: 1,1 ANP-M: 15; 16 (T2) ALK-A: 8 TAB-A: 45	D: 15 ALK-A. : 14 TAB-A. : 65
Akechi 2004a [83] Japan	k	SCID (DSM-III-R)	G	T1: 209; T2: 85	34 %	61	10	Lunge: 38 %; Kolon: 12 %; Magen: 67 %	Terminal	M=25, 2 Mon. (SD=38,8)	(T2: M=102 Tage nach T1, SD=119 Tage) D: 6,7 (T1); 11,8 (T2) PTSD: 0 ANP-M: 4,3 (T1); 2,4 (T2) ANP-A: 0,5 (T1); 3,5 (T2) ANP-D: 11,5 (T1); 4,7 (T2)
Akizuki 2016 Japan	k	SCID (DSM-III-R	S	T1: 110; T2: 91	38,2%	61,7	9,8	Pankreas	NB	T1 vor Behandlungsbeginn	(T2 1 Monat nach T1) D: 5,5 (T1 und T2) DYS: 0,9 (T1); 1,1 (T2) GAD: 0,9 (T1); 0 (T2) PAN: 0,9 (T1); 1,1 (T2) PTSD: 0,9 (T1)
Alexander 2010 [84] Groß-britannien	NB	SCID (DSM-IV)	A	208	100 %	58,1	12,2	Brust	NB	3 Mon. - 2 J. nach Primär-behandlung	D: 9 GAD: 3,5
Andrykowski 1998 [85] USA	NB	SCID (DSM-IV)	NB	82	100 %	56,6	10,5	Brust	0: 8 %; I: 54 %; II: 32 %; IIIA: 6 %	6-72 Mon. nach Primärbehandlung	PTSD: 6	PTSD: 10
Aragona 1996 [86] Italien	NB	SCID (DSM-III-R)	S	85	100 %	54	12	Brust	I: 28 %, II: 64 %, III: 9 %, IV: 0 %	< 1 Mon.	D: 2,4 DYS: 15,3 ANP-D: 9,4
Aragona 1997 [87] Italien	k	semistr. klin. Interview (DSM-III-R)	S	108	100 %	PG: 54,1	PG: 12,6	Brust	I: 24 %, II: 69 %, III: 7 %; IV: 0 %	< 1 Mon.	D: 2 DYS: 13 Depr. Störung NOS: 40 ANP-D: 9
Arolt 1998 [88] Deutschland	r	CIDI (ICD-10)	S	250	51,6 %	60,6	19,2	NB	NB	M=31,5 Mon. (SD=71,9)	D: 4,8 DYS: 4,0 ANP-M: 7,6
Atesci 2004 [89] Türkei	k	SCID (DSM-IV)	NB	117	51,3	53,7	14,2	Hämatol.: 30,8 %; Gastroint.: 15,4 %; Lunge: 13,7 %, Gynäk.:12,8 %	NB	1-12 Mon.: 79,5 %	D: 13,7 GAD: 0,9 ANP-M: 0 ANP-A: 1,7 ANP-D: 12,8 Somatisierungsstörung: 0,9	Aff. St.: 4,3 Angstst.: 4,3 ALK-M: 0,9
Berard 1998 [90] Südafrika	NB	SCID (DSM-IV)	A	100	84 %	50,1	13,0	Brust: 55 %; Lymphom: 43 %	I: 22 %; II: 35 %; III: 17 %; IV: 26 %	NB	D: 19 ANP-D: 2
Blázquez 2016 Spanien	k	MINI (DSM-IV)	S	103	55,3 %	58,2	13,3	Brust: 29,1%; Hals-/Kopf: 19,4 %; Urogenital: 13,6 % Gastroint.: 12,6 %; Atmungssyst.: 12,6%; Andere: 12,6 %	I: 16,5 %; II: 50,5 %; III: 4,9 %, IV: 28,2 %	T1 vor Strahlen-therapie	(T2 1 Wo. & T3 1 Mo. nach Behandlungsbeginn) D: 4,9 (T1); 2,9 (T2); 1,9 (T3) DYS: 1 (T1); 1 (T2); 1 (T3) Aff. Störung: 6,8 (T1); 3,9 (T2); 3,9 (T3) GAD: 2,9 (T1); 2,9 (T2); 1,9 (T3) PAN: 9,7 (T1); 8,7 (T2); 9,7 (T3) AGO: 2,9 (T1); 2,9 (T2); 1,9 (T3) SOZ: 0 (T1);0 (T2); 0 (T3) Angstst: 16,5 (T1); 18,4 (T2); 16,5 (T3) ANP-M: 2,9 (T1); 1,9 (T2); 3,9 (T3) ANP-A: 4,9 (T1); 1,9 (T2); 3,9 (T3) ANP-D: 2,9 (T1); 1,9 (T2); 0 (T3) ANP: 10,7 (T1); 5,8 (T2); 7,8 (T3)
Braeken 2010 [91] Niederlande	NB	SCID (DSM-IV)	NB	Interview: 76; Ges.: 289	Gesamt 13,8 %	Ges-amt 67,8	Ges-amt 8,9	Prostata: 70,6 %, Lunge:20,1 % Brust: 2,8 %, Gynäk.: 6,5 %	NB	NB	D: 6,6 ANP: 5,3
Breitbart 2000 [92] USA	NB	SCID (DSM-IV); SAHD	S	92	60 %	65,9	15,6	NB	Terminal	NB	D: 17
Bringmann 2008 [93] Deutschland	NB	SCID (DSM-IV)	S	62	66 %	59,5	11,7	Urogenital: 40 %; Brust: 26 %; Gastroint: 19 %	0: 6 %; I: 8 %; II: 31 %; III: 16 %; IV: 6 %	NB	(T2 : 6-18 Mon. n. T1 ; T3 : 24-36 Mon. n. T1) D : 12,9 (T1) ; 4,8 (T2) ; 3,2 (T3) DYS : 0 (T1) ; 8,1 (T2) ; 12,9 (T3) Aff. Störung : 12,9 (T1) ; 12,9 (T2) ; 16,1 (T3) GAD : 4,8 (T1) ; 9,7 (T2) ; 11,3 (T3) PAN : 1,6 (T1) ; 9,7 (T2) ; 11,3 (T3) SPEZ : 3,2 (T1) ; 4,8 (T2) ; 9,7 (T3) SOZ : 0 (T1) ; 3,2 % (T2) ; 6,5 (T3) PTSD : 1,6 (T1) ; 8,1 (T2) ; 3,2 (T3) ASD : 9,7 (T1) ; 0 (T2) ; 4,8 (T3) Angstst. : 21,0 (T1) ; 27,4 (T2) ; 35,5 (T3) ANP: 3,2 (T1); 0 (T2); 4,8 (T3) ALK-M: 3,2 (T1); 4,8 (T2); 6,5 (T3) TAB-M: 8,1 (T1); 6,5 (T2); 11,3 (T3) Medikam.- Missbrauch: 4,8 (T1); 1,6 (T2); 4,8 (T2)
Bruera 1995 [94] USA	k	CAGE¹	A	66	56 %	61,9	13,6	Lunge: 23 %; Gastroint.: 24 %; Kopf-/Hals: 18 %; Urogenital: 16 %	Terminal	NB	ALK-A (Screening): 27
Burgess 2005 [95] Groß-britannien	k	SCID (DSM-III-R)	NB	202 (alle MZP: 170)	100 %	48,4	7,8	Brust	NB	1-6 Mon.	(T1: ED; T2: 3 Mon. nach T1; T3: 1 Jahr nach T1) Aff. St. oder Angstst.: 33 (T1); 24 (T2); 15 (T3) Nach Rezidiv: 45	12-Mon.-Präv.: 48 (1. Jahr nach ED) 25 (2. Jahr nach ED) 23 (3. Jahr nach ED) 22 (4. Jahr nach ED) 15 (5. Jahr nach ED)
Bussian 2010 [96] Deutschland	NB	SCID (DSM-IV)	A	306	9 %	64,9	NB	Kehlkopf	NB	NB	D: 4,9 DYS: 4,3 GAD: 1,9 SOZ: 0,3 PTSD: 0,3 ANP: 4,6 ALK-A: 3,6
Dinkel 2014 Deutschland	k	SCID-I (DSM-IV)	S	341	35,2 %	58,4	12,8	Hämatol.: 38,7 % Gastroint.: 61,3 %	NB	NB	GAD: 2,1 PAN: 2,1 AGO: 1,2 SPEZ: 4,7 SOZ: 3,5 ZWA: 1,8 PTSD: 3,5 Angstst.: 17,6
Chan 2015 Malaysia	k	SCID (DSM-IV)	A	T3: 219 T4: 114	NB	NB	NB	NB	< 24 Mon.	NB	(T2 4-6 Mon. nach T1; T4 12-18 Mon. nach T4) D: 25,3 (T3); 50,8 (T4) DYS: 2,7 (T3); 15,3 (T4) GAD: 18,8 (T3); 17,7 (T4) ANP: 25,3 (T3); 5,6 (T4)
Chochinov 1997 [97] Kanada	NB	SADS² (RDC³)	S	197	52,3 %	71	10,7	NB	Terminal	NB	D: 7,6
Chow 2001 [98] USA	k	CAGE¹	A	128	46,9 %	NB	NB	Lunge: 44 %; Gastroint.: 22 %; CUP: 11 %; Prostata: 11 %	Palliativ	NB	ALK-A (Screening): 7
Ciaramella 2001 [99] Italien	k	SCID (DSM-III-R)	A	100	50 %	64	NB	Gastroint.: 47 %; Urogenital: 37 %; Atmungs-syst.: 16 %	IV: 30 %	NB	D: 49 (SCID); 29 (Endicott)	D: 9
Compen 2017 Niederlande	k	SCID (DSM-IV)	NB	85,7%	51,7 %	10,7	NB	Brust: 61,6 %; Gynäkol.: 7,3 %; Postata: 6,5 %; Kolon: 4,9 %; Andere 19,5 %	NB	NB	Aff.St.: 36,3 ANP: 8,2
Couper 2006 [100] Australien	k	CIDI (DSM-IV)	G	103	0 %	66	9,5	Prostata	IV: 54 %	1-6 Mon.	D: 5,6 GAD: 3,3 PAN: 1,1 Agoraph.: 0 SOZ: 1,1
Coyne 2004 [101] USA	k	SCID (DSM-IV)	A	113	100 %	55,8	NB	Brust	I: 22 %; II: 52 %; III: 16 %; IV: 10 %	< 1 J.: 19 %; 1-2 J.: 14 %; 2-5 J.: 35 %; > 5 J.: 31 %	D: 9 GAD: 6	D: 30
Dausch 2004 [102] USA	c	DSM-IV-Checklist	NB	207	100 %	52,9	10,6	Brust	0/I: 63 %; II: 32 %; III: 5 %	< 1 Mon.	D: 1,9 DYS: 1,9 GAD: 2,4 PAN m. Agoraph.: 0,9 PAN o. Agoraph.: 1,9 SPEZ (Blut/Spritzen): 2,4 SOZ: 1,9 PTSD: 5,3 ASD: 2,4 ANP: 2,4 Aff. St.: 3,9 Angstst.: 14	D: 20,3 DYS: 6,3 GAD: 10,1 PAN m. Agoraph.: 2,9 PAN o. Agoraph.: 7,2 SPEZ (Blut/Spritzen): 2,9 SOZ: 6,8 PTSD: 16,4 ANP: 21,3
Endo 2008 [103] Japan	NB	SCID (DSM-IV)	A	100	19 %	65,4	9,8	Lunge	I:6 %, II:8 %, III: 36 %, IV:48 %	NB	D: 9
Esser 2019 Deutschland	k	CIDI-O (DSM-IV)	S	2141	52 %	58	11	Brust: 21 %; Prostata: 15 %; Kolorektal: 14 %; Lunge: 9 %; Gynäkol.: 9 %; Hämatol.: 8 %; Andere: 27 %	I: 20 %; II: 26 %; III: 21 %; IV: 34 %	14 Mon. (SD=25)	PTSD: 2
Fatiregun 2016 Nigeria	k	SCAN (DSM-IV)	S	200	100 %	49,6	11,2	Brust	I-II: 45 %; III-IV: 55 %	NB	GAD: 3,8 PAN: 5,1 AGO: 2 SOZ: 6,9 Angstst.: 19
Fritzsche 2003 [28] Deutschland	k	MINI-DIPS (DSM-IV)	S	72	46 %	NB	NB	Hämatol.: 72 %	NB	NB	D: 17,8 ANP-M: 25 ANP-D: 15 Somatoforme St.: 1 ALK: 1 Persönlichkeitsst.: 1
Fritzsche 2004 [104] Deutschland	k	MINI-DIPS (DSM-IV)	S	87	35,6 %	63,6	12,9	K olorektal: 13,8 %, Ösophagus: 11,5 %; Lunge: 12,6 %; Hirn: 11,5 %; Brust: 9,2 %; Kopf/Hals: 9,2 %	I: 9 %, II: 18 %, III: 55 %; IV: 18 %	NB	D: 3,4 PAN: 1,1 Phobien: 2,3 ZWA: 1,1 PTSD: 5,8 ANP-M: 9,3 ANP-D: 3,5 ALK: 2,3 Persönlichkeitsst.: 1,1
Gandubert 2009 [105] Frankreich	k	MINI (DSM-IV)	A	144	100 %	Md=53	NB	Brust	0: 5,6 %; I: 39,6 %; II: 40,3 %, II: 3,5 %	1-3 J.	D: 16 DYS: 4,2 Manische Episode: 3,5 GAD: 15,3 PAN: 2,8 SPEZ: 6,3 ZWA: 2,1	(bis 3 J. vor T1) (3 J. vor T1) D: 38,2; 19,4** Manische Episode: 4,2; 1,4* GAD: 18,1; 10,4* PAN: 4,2;4,2* SPEZ: 13,2; 6,9* ZWA: 1,4; 0,7* Suchterk.: 0
Garland 2004 [106] Irland	NB	SCAN⁴	S	55	100 %	51,2	NB	Brust	I: 25,5 %, II: 41,2 %, III: 33,3 %	< 1 Mon.	D: 18,2 ANP: 21,8
Ginsburg 1995 [107] Kanada	k	DIS⁵ (DSM-III-R)	A	52	25 %	63	NB	Lunge	IV: 23 %	Md=45 Tage	D: 2 DYS: 2 BIP: 0 Aff. St.: 4 Angstst.: 0 ANP-M: 0 ANP-A: 1,9 ANP-D: 9,6 ALK-M: 13 TAB-M: 33	D: 17 DYS: 10 BIP: 2 Aff. St.: 21 GAD: 10 SPEZ: 13 Angstst.: 17 ALK-M: 46 TAB-M: 63
Goebel 2011 [108]	k	SCID (DSM-IV)	S	26	50 %	59,0	NB	Hirn	I: 46 %; II/III: 31 %; IV: 23 %	< 1 Mon.	D: 4 GAD: 0 PTSD: 0 ASD: 19 ANP: 15
Gopalan 2016 Indien	k	MINI (DSM-IV)		384	63,5 %	NB	NB	NB	NB	> 12 Mon.	D: 10,9 ANP-A: 3,1 ANP-D: 19,5 ANP: 22,6
Grabsch 2006 [109] Australien	NB	MILP⁶ (DSM-IV)	G	227	100 %	51,7	9,1	Brust	IV: 100 %	M=65 Mon. (SD=47)	D: 7 DYS: 1,3 GAD: 1,3 PAN: 0 Agoraph.: 1,3 SOZ: 0,9 PTSD: 0,9 ANP-M: 24,2 ANP-A: 4,0 ALK-A: 0,9 TAB-A: 7,9 And. Suchterkr.: 1,8
Grassi 1996 [110] Italien	NB	SCID (DSM-III-R)	NB	52	83 %	51,6	NB	Brust 74 %, Magen: 10 %, Lymph-knoten: 10 %	NB	NB	(T2: 6 Jahre nach T1) D: 9,6 (T1); 3,8 (T2) DYS : 5,8 (T1); 7,7 (T2) Aff. St. : 15,4 (T1); 13,5 (T2) GAD : 1,9 (T1); 9,6 (T2) PAN : 1,9 (T1); 1,9 (T2) SPEZ : 1,9 (T1); 0 (T2) SOZ : 1,9 (T1); 3,8 (T2) Angstst. : 7,7 (T1) ; 15,4 (T2) ANP-M : 5,8 (T1); 1,9 (T2) ANP-A : 3,8 (T1); 0 (T2) ANP-D: 9,6 (T1); 1,9 (T2) Somatisierungsst.: 1,9 (T1); 0 (T2)
Grassi 2009 [111] Italien	c	CIDI (ICD-10)	A	109	76,1 %	57,5	11,4	Brust: 52,3 %; Gastrointest.: 26,6 %; Lunge: 7,3 %	IV: 28,4 %	6-18 Mon.	D: 8,3 DYS: 4,6 Aff. St.: 12,8 Angstst.: 2,7 NP: 24,8
Green 1998 [112] USA	NB	SCID (DSM-III-R)	NB	160	100 %	53,4	9,7	Brust	I/II: 100 %	6-12 Mon. nach Primärbehandlung	D: 11 PTSD krebsspez.: 2,5 PTSD nicht krebsspez.: 0 Angstst.: < 1	D: 28 DYS: 3 PTSD krebsspez.: 5 PTSD nicht krebsspez.: 4,4 Angstst.: 17 uchterkr.: 7
Greer 2011 USA	r	SCID (DSM-IV)	NB	225	62,1 %	62,9	NB	Brust: 24 %; Haut: 18,7 %; Gynäk.: 19 %; Prostata: 8 %; Kolorektal: 7 %; Hämatol.: 1,8 %; Lunge: 0,7 %; andere: 25,6 %	NB	NB	GAD: 3,4 PAN: 2,2 AGO: 1,2 SPE: 10,9 SOZ: 6,9 PTSD: 4,3 Angstst.: 18,8
Hall 1999 [113] Groß-britannien	NB	PSE⁷ (DSM-III)	NB	266	100 %	NB	NB	Brust	I/II: 100 %	1-6 Mon.	Aff. St.: 37,2 Angstst.: 49,6
Härter 2000 [114] Deutschland	k	CIDI (DSM-IV)	G	Akut-beh.: 82, Reha: 38	A: 88 %; R: 71 %	A: 56, R: 50	NB	A: Brust: 37 %; Gynäkol.: 33 %; Gastroint.: 10 %; R: Brust: 35 %; Hämatol.: 17 %; Gynäk.: 12 %	R: IV: 42 %; A: IV:15 %	A: M=3,2 Mon.; R: M=45,6 Mon.	(A: Akutbeh.; R: Reha) Aff. St.: 11 (A); 13,2 (R) Angstst.: 17 (A); 16,8 (R) Somatoforme St.: 2,4 (A), 2,6 (R) Suchterkr.: 2,4 (A); 8 (R) ESS: 1,2 (A); 0 (R)
Härter 2001 [115] Deutschland	k	CIDI (DSM-IV)	G	Inter-view: 200; Ge-samt: 491	Ge- samt 75 %	Ge-samt 55	NB	Gesamt: Brust: 38 %; Gastrointest: 18 %; Gynäkol.: 16 %	Gesamt: IV: 51 %	Gesamt: M=2,7 J.	D: 4 DYS: 4 Aff. St. med. KHF: 1,5 Aff. St.: 9,5 GAD: 0 PAN: 3 SPEZ: 7,5 SOZ: 1,5 ZWA: 1 PTSD: 1,5 Angstst.: 13 Somatoforme Schmerzst.: 2,5 ALK: 0,5 TAB: 2 Suchterkr.: 2,5 ESS: 1	12-Mon.Präv. LZP D: 8; 14,5** DYS: 5;5* Aff. St. med. KHF: 4,5; 6* Aff. St.: 17,5; 26* GAD: 0; 4* PAN: 5,5; 10* SPEZ: 12; 16,5* SOZ: 2; 3* ZWA: 1,0; 2* PTSD: 1,5; 2* Angstst.: 20,5; 30,5* Som. Schmerzst.: 7,5; 16* ALK: 1,5; 6,0* TAB: 3,5; 13* Suchterkr.: 5; 16,5* ESS: 1,5; 2,5*
Härter 2007 [116] Deutschland	r	CIDI (DSM-IV)	G	174	NB	NB	NB	NB	NB	NB		12-Mon.-Präv.: Aff. St.: 19,6 Angstst.: 18,5 Somatoforme St.: 9,1 Suchterkr.: 4,8
Henry 2018 Kanada	c	SCID (DSM-IV)	NB	223	31,2 %	62,9	11,7	Kopf-/Hals	NB	< 2 Wo.	(T2 3 Mon. nach T1) D: 6,9 (T1); 14,2 (T2) Angstst.: 19,4 (T1); 16,6 % (T2) ALK: 4,2 (T1); 3,6 (T2)	D: 22,6 Angstst.: 24,7 Suchterk.: 23,8 ALK: 23,7
Hosaka 1999 [117] Japan	NB	SCID (DSM-III-R)	S	50	18 %	56,6	14,4	Kopf-/Hals: 82 %	NB	NB	D: 18 ANP-M: 12 ANP-A: 6 ANP-D: 10
Inoguchi 2016 Japan	k	CIDI (DSM-IV)	S	467	35,3 %	60,9	13,3	Knochen/Weichteil: 18,8 %; Hämatol.: 15,8 %; Lunge: 13,3 %; Urologenital: 12,2 %; Leber: 10,5 %; Prostata: 9,9 %; Pankreas: 7,3 %; Brust: 7,1 %; Andere: 5,1 %	NB	NB	D: 0,6	D: 5,2
Iqbal 2004 [118] Pakistan	NB	SCID (DSM-IV)	NB	365	48,5	NB	NB	Hämatol: 43,9 %; Brust: 30,7 %; Urogenital: 11,5 %	NB	NB	Aff. St.: 17,8 Angstst.: 16,8 ANP: 20,8 Somatoforme St.: 0,5
Jacobsen 2010 [119] USA	NB	SCID (DSM-IV)	G	123	-	56,1	11,9	NB	IV: 100 %	NB	D: 4,9
Jenkins 2000 [120] Kanada	k	CAGE¹	S	100	45 %	67	12	Gastrointest.: 26 %; Lunge: 21 %; CUP: 15 %; Urogenital: 11 %; ZNS: 8 %	Palliativ	NB	ALK-A: 24 (Screening)
Kadan-Lottick 2005 [121] USA	NB	SCID (DSM-IV)	NB	251	45 %	58	12	Gastrointest.:46 %; Lunge: 20 %	IV: 100 %	NB	D: 6,8 GAD: 3,2 PAN: 4,8 PTSD: 2,4
Kangas 2005 [122] Australien	k	SCID (DSM-IV); ASDI⁸; CAPS⁹	A	82 (T1); 63 (T2); 49 (T3)	25,6	60,0	NB	Kopf-/Hals: 68,3 %; Lunge:31,7 %	NB	< 1 Mon.	(T2: 6 Mon. n. ED; T3: 12 Mon. n. ED) D: 28,6 (T1); 22,4 (T2); 20,4 (T3) PTSD: 22 (T2); 14 (T3) ASD: 28 (T1) ALK-M: 0 ALK-A: 2 (T1); 0 (T2); 0 (T3)	D: 28,6 Angstst.: 46,9 ALK-M: 12,2 ALK-A: 20,4 And. Suchterkr.:2
Kangas 2007 [123] Australien	k	ASDI⁸; SCID (DSM-IV)	NB	82	26 %	60,1	12,2	Kopf-/Hals: 68 %; Lunge: 32 %	I: 27 %, II: 11 %, III: 52 %, IV: 10 %	< 1 Mon.	D: 23 ASD: 28	D: 31 PTSD: 16,3 Angstst.: 45 Suchterkr.: 40
Katz 2004 [124] Kanada	NB	SADS²	A	60	21,7 %	60,5	13	Kopf-/Hals	I: 8,3 %, II: 15 %, III:23,3 %, IV: 38,3 %	NB	D: 5
Kassm 2018 Libanon	k	MINI (DSM-IV)	S	102	100 %	54	10,4	Brust	I: 37,2 %; II: 20,5 %; III: 41,1 %; IV: 41,1 %	> 6 Mon.	D: 30,3 DYS: 4,9	D: 50,9
Kawase 2006 [125] Japan	NB	SCID (DSM-IV)	NB	282	NB	NB	NB	NB	NB	NB	D: 8,5
Keller 2004 [126] Deutschland	k	SCID (DSM-IV)	S	78	39,7 %	59 % 51-70 J.	NB	Kolorektal: 43,9 %; Gastrointest.: 15,3 %; Pankreas/ Leber: 12,7 %; Weichteil: 9,5 %	NB	NB	D: 5 Angstst.: 3 ANP-M: 15,4 ANP-A: 2,7 ANP-D: 3,9
Keszte 2013 Deutschland	k	SCID (DSM-IV)	S	171	11%	NB	NB	Kopf-/ Hals	I-II: 19 %; III-IV: 81 %	(T1) vor Kehlkopf-tektomie	((T2) 2 Wo. nach Kehlkopttektomie; (T4) 3 Mon. nach Kehlkopftektomie) D: 2,3 % (T2); 4,7 % (T4) DYS: 1,2 % (T2); 0 (T4) GAD: 2,3 % (T2); 1,2 % (T4) SOZ: 0 % (T2 & T4) PTSD: 1,2 % (T2 & T4) ANP: 8,2 % (T2); 4,1 % (T4) ALK-A: 9,4 % (T2 & T4)
Keszte 2017 Deutschland	k	SCID (DSM-IV)	S	176	8%	NB	NB	Larynx 91%, Hypopharynx 9%	I-II: 82, III-IV: 18	(T1) 1 Wo. nach OP	((T2) 3 Mon. nach OP; (T3) 12 Mon. nach OP) D: 2 % (T1); 5 % (T2); 1 % (T3) DYS: 0 % (T1); 1 % (T2); 0 % (T3) GAD: 0 % (T1-T3) PAN: 0 % (T1-T3) SPE: 0 % (T1); 1 % (T2); 2 % (T3) SOZ: 0 % (T1-T3) ASD: 2 % (T1); 0 % (T2); 0 % (T3) ANP: 11 % (T1); 15 % (T2); 14 % (T3) ALK: 0 % (T1); 2 % (T2); 2 % (T3) ALK-A: 3 % (T1); 3 % (T2); 6 % (T3)
Kirsh 2004 [127] USA	c	SCID (DSM-IV)	A	95	43,2 %	45,8	11,7	Hämatol.	NB	NB	D: 11,6 GAD: 5,3 ANP: 34,7
Kissane 1998 [128] Australien	k	MILP⁶ (DSM-IV)	A	303	100 %	46	8	Brust	I: 17 %; II: 83 %	1-6 Mon.	D: 9,6 DYS: 2,3 GAD: 1,7 PAN: 1,3 Agoraph.: 0,6 SOZ: 2,0 PTSD: 1,7 ANP-A: 3,9 ANP-D: 24,8 ALK-A: 0,3 TAB-A: 8,9
Kissane 2004 [129] Australien	NB	MILP⁶ (DSM-IV)	G	503	100 %	48,0	8,4	Brust	I/II: 60,2 %; IV: 39,8 %	I/II: M=102 Tage (SD=56 Tage); III/IV: M=63 Mon. (SD=44)	D: 8,3 DYS: 2,0 GAD: 1,6 PAN: 0,8 Agoraph.: 1,0 SPEZ: 3,4 SOZ: 1,6 PTSD: 1,4 ANP: 27,8 ALK-A: 0,6 TAB-A: 8,6 And. Suchterkr.: 0,8
Krauß 2007 [130] Deutschland	NB	SCID (DSM-IV)	S	485	36,7 %	Md=61	NB	Gynäkol.: 12,2 %; Prostata: 19,2 %; Urologische: 11,3 %; Gastrointest.: 16,7 %	IV: 36,3 %	< 1 Mon.: 44,9 %; 1-3 Mon.: 29,9 %; > 3 Mon.: 25,2 %	D: 9,1 DYS: 1,6 Aff. St.: 9,9 GAD: 4,7 PAN: 2,5 SPEZ: 6,8 SOZ: 0,4 ZWA: 5,4 PTSD: 3,5 Angstst.: 13,8 Somatisierungsst.: 11,1 ALK-A: 4,9 TAB-A: 7,8 Opiod-A: 1,2 Suchterkr.: 8,9
Krauß 2011 Deutschland	k	SCID (DSM-IV)	S	99	32%	NB	NB	Gastrointest.: 59,4 % Endokrinol.: 40,4 %	I: 18 %; II: 18 %; III: 14 %; IV: 23 %	T1 zu beginn der Behandlung	D: 8 DYS: 0 Aff.St.: 8 GAD: 4 PAN: 3 AGO: 1 SPE: 3 SOZ: 0 ZWA: 7 PTSD: 0 ASD: 0 Angstst.: 9 Somatoforme St.: 13 ALK: 5 TAB: 6 MED: 3
Kugaya 1998 [131] Japan	k	SCID (DSM-III-R)	G	128	37,5 %	61,1	10,8	Lunge: 46,9 %; Kopf-/Hals: 41,4 %	NB	NB	D: 13,3 ANP: 23,4
Kugaya 2000 [132] Japan	k	SCID (DSM-III-R)	NB	107	24 %	61,0	11,8	Kopf-/Hals	III/IV: 61 %	< 1 Mon.	D: 3,7 Angstst: 0 ANP-M: 8,4 ANP-A: 4,7 ANP-D: 0 ALK-M: 6,5 ALK-A: 33,6 TAB-A: 32,7	D: 15,9
Lau 2013 China	k	SCID (DSM-IV)	S	113	100 %	60	NB	Zervix	I-II: 87 %; III-IV: 13 %	NB	D: 19 Aff.St.: 31 GAD: 13 PAN: 5 AGO: 2 SPE: 0,9 SOZ: 0,9 PTSD: 0,9 Angstst.: 16	D:24 Aff.St.:36 GAD:13 PAN: 5 Angstst.: 19
Le Fevre 1999 [133] Groß-britannien	k	CIS-R¹⁰ (ICD-10)	S	79	56 %	69,9	10,1	NB	Terminal	NB	D: 18
Lee 2016 Taiwan	k	SCID (DSM-IV)	G	106 (T1) 93 (T2)	14 %	52,7	9,5	Kopf-/Hals	NB	NB	(T2 3 Mon. nach T1; T3 6 Mon. nach T1) D: 4,7 (T1); 9,6 (T2); 12,9 (T3) DYS: 0 (T1-T3) Aff.St.: 8,5 (T1); 12,9 (T2); 14 (T3) GAD: 0,9 (T1); 0 (T2 & T3) ASD: 0,9 (T1); 0 (T2 & T3) Angstst.: 7,5 (T1); 2,1 (T2); 1,1 (T3) ALK: 18,9 (T1); 21,3 (T2); 20,4 (T3)
Leopold 1998 [134] USA	k	PRIME-MD¹¹	A	122	38 %	Md=67	NB	Lunge: 36 %, Prostata: 16 %, Brust: 12 %	Palliativ: 38 %	NB	D: 12 PAN: 1,3 Angstst.: 0 Angst-/Depr. St. gemischt (F41.2): 10 DYS: 10 BIP: 1 Aff. St.: 47 GAD: 5 PAN: 5 Angstst. NOS: 14 Angstst.: 21
Love 2008 [135] Australien	NB	CIDI (DSM-IV)	NB	367	0 %	67,8	8,9	Prostata	Früh: 57,5 %; Fortg.: 42,5 %	< 1 Mon.	D: 3,3 DYS: 0,6 GAD: 2,2 PAN: 1,1 SPEZ: 1,4 SOZ: 0,8
Lichtenthal 2009 [136] USA	NB	SCID (DSM-IV)	G	289	44 %	58,7	12,0	Lunge: 20 %, Kolon: 15 %, Brust: 9 %, Pankreas: 8 %	Terminal	NB	D: 5,2 GAD: 2,2 PAN: 3 PTSD: 2,6
Lloyd-Williams 2001 [137] Groß-britanninen	NB	PSE⁷ (ICD-10)	A	100	56 %	57,3	NB	Lunge: 26 %, Brust: 14 %, Darm: 11 %	Terminal	NB	D: 22
Lloyd-Williams 2004 [138] Groß-britannien	NB	Semistr. klin. Interview	A	74	50 %	66,9	13,6	NB	Terminal	NB	D: 27
Lloyd-Williams 2007 [139] Groß-britannien	NB	PSE⁷	A	246	56,5 %	61,9	95 % CI: 61,1-62,7	Lunge: 29 %, Brust: 25 %, Darm: 11 %	Terminal	M=27 Mon. (Range=1,3-44)	D: 30
Maguire 1999 [140] Groß-britannien	k	PAS (DSM-III-R)	NB	59	28,5 %	69	11	Kolorektal	Palliativ	NB	D: 5 GAD: 7 ANP: 10
Maneeton 2014 Thailand	k	MINI (DSM-IV)	S	104	48 %	61,5	9,4	Lunge	I: 4,8 %; II: 5,8 %; III: 20,2 %; IV: 69,2 %	NB	D: 14,4
Mangelli 2005 [141] Italien	k	SCID (DSM-IV)	A	104	NB	NB	NB	NB	NB	1-2 J.	D: 12,5
Matsuoka 2002 [142] Japan	k	SCID (DSM-IV)	A	74	100 %	48,1	5,7	Brust	0-II: 89 %; III: 10 %	> 2 J.	D: 0	D: 27 (seit ED) PTSD: 3 (seit ED)
McCaffrey 2007 [143] USA	NB	SCID (DSM-IV)	NB	24	16,7 %	73	NB	Kopf-/Hals	III: 38 %; IV: 62 %	< 1 Mon.	D: 26,1 ALK-A: 11,9	ALK-M: 63,6 ALK-A: 61,9
Mehnert 2007 [144] Deutschland	k	SCID (DSM-IV)	S	127	100 %	54,9	10,7	Brust	0: 11,8 %; I: 30,7 %; I: 45,7 %; III/IV: 11,8 %	< 1 Mon.	D: 4,7 DYS: 3,1 GAD: 6,3 PTSD: 2,4 ASD: 2,4	PTSD: 8,7
Mehnert 2014 Deutschland	k	CIDI-O (DSM-IV)	S	2141	52 %	58	11	Brust: 21 %; Prostata: 15 %; Kolorektal: 14 %; Lunge: 9 %; gynäkol.: 9 %; hämatol.: 8 %; Andere: 27 %	NB	NB	Aff.St.: 6,5 Angstst.: 11,5 ANP: 11 Somatoforme St.: 5,3 ALK: 0,3 TAB: 4,5
Meyer 2003 [145] Groß-britannien	k	SCID (DSM-IV)	S	45	58 %	70-79 J.: 40 %; 60-69: 25 %	NB	Gastroint: 29 %; Lunge: 27 %; Brust: 18 %; Urogenital: 13 %	Terminal	NB	D: 20
Minagawa 1996 [146] Japan	k	SCID (DSM-III-R)	S	93	41 %	67,2	11,9	Magen: 22 %; Lunge: 14 %; Pankreas: 11 %; Kolon: 11 %	Terminal	M=20,2 Mon. (SD=34,5)	D: 3,2 GAD: 1,1 ANP: 4,3 ANP-A: 1,1 ANP-D: 2,1
Morasso 2001 [147] Italien	NB	SCID (DSM-III-R)	NB	132	100 %	< 50 J.: 66,2 %; 51-60 J.: 74,2 %; > 60 J.: 77,1 %	NB	Brust	NB	1-2 J.	D: 9,8 Hypoman. Episode: 1,6 Angstst.: 1,6 ANP-M: 4,6 ANP-A: 6,1 ANP-D: 10,6
Mundy 2000 [148] USA	NB	SCID (DSM-IV)	G	BMT=17; n-BMT=20	100 %	BMT: 43,3; n-BMT: 50,2	BMT: 7,2; n-BMT: 7,6	Brust	BMT: I:0 %; II:24 %; III:35 %; IV:41 %; n-BMT: I:30 %; II:55 %; III:5 %; IV:10 %	BMT: M=37,5 Mon.; n-BMT: M=54,7 Mon.	D: 0 GAD: 0 PTSD: 0
Nakaya 2006 [149] Japan	NB	SCID (DSM-III-R)	A	229	60,3 %	62,4	NB	Lunge	I: 76,1 %; II: 19,7 %; III: 4,2 %	1-6 Mon.	D: 5,7
Nuhu 2008 [150] Nigeria	k	SCID (DSM-IV)	S	210	70 %	53	4	Brust: 32 %; Zervix: 28 %; Kolorektal: 19 %; Prostata: 21 %	Früh: 32 %; Fortg.: 50 %	NB		D: 30 (12-Mon.-Präv.)
Nuhu 2013 Nigeria	k	SCID (DSM-IV)	S	210	70 %	53	4	Brust: 32 %; Zervix: 28 %; Kolon: 19 %; Prostata: 21 %	Früh: 32 %; Fortg.: 50 %	NB	D: 29,5
Okamura 2000 [151] Japan	k	SCID (DSM-III-R)	G	55	100 %	52	9	Brust	NB	1-6 Mon. (Rezidiv-diagn.)	D: 7 ANP-M: 16,4 ANP-A: 10,9 ANP-D: 7,3
Okamura 2005 [152] Japan	k	SCID (DSM-III-R)	A	50	100 %	M54	10	Brust	0: 80 %; I: 16 %; II: 4 %	1-6 Mon. (Rezidiv-diagn.)	D: 2 PTSD: 2 ANP-M: 10 ANP-A: 2 ANP-D: 8
Olden 2009 [153] USA	NB	SCID (DSM-IV)	S	422	56,6 %	65,8	13,7	Lunge: 17,5 %, Kolorektal: 13,7 %, Brust: 10,9 %	Terminal	NB	D: 17,1
Osório 2015 Brasilien	k	SCID (DSM-IV)	G	400	61,5 %	NB	NB	Brust: 18,9 %; Urolog.: 17,04 %; Kopf-/Hals 11,5 %; Gynäkol.: 10,5 %; Gastrointest.: 15,5 %; a Andere: 11,9 %	NB	NB	PAN: 20,4
Özalp 2008 [154] Türkei	k	SCID (DSM-IV)	S	204	100 %	50,8	11,9	Brust	I/II/IIIa: 71 %; IIIb/IV: 29 %	NB	D: 8,3 Angstst.: 2 ANP: 12,3
Parsons 2008 [155] USA	k	CAGE¹	A	598	41,8 %	Md= 59,7	NB	Kopf-/Hals: 24 %; Gastrointest.: 23 %; Lunge: 19 %	Palliativ	NB	ALK-A: 17 (Screening)
Pasacreta 1997 [156] USA	NB	DIS (DSM-IV)	A	79	100 %	54,9	12,7	Brust	Früh: 75 %, Fortg.: 14 %	M=157 Tage (SD=28,6)	D: 6,3 DYS: 2,5	D: 6,3 DYS: 5
Passik 2001 [157] USA	c	MINI (DSM-IV)	A	60	53,3 %	58,3	11,9	Brust: 28,3 %; Leukämie: 25 %, Lunge: 8,3 %	NB	NB	D: 41,7 ANP: 15
Patel 2010 [158] Australien	c	CIDI	A	100	100 %	53,1	12,4	Brust	I : 28,6 %; II : 54,3 %; III : 17,1 %	1-6 Mon.	D: 8,1 Angstst.: 8,1	D: 25,3; 3 (seit ED) Angstst.: 14,1; 0 (seit ED)
Patel 2010 [159] Australien	NB	CIDI (ICD-10)	G	95	38,4 %	65,7	NB	Kolorektal	I :16,2 %, II :30,3 %, III :33,3 %, IV :14,1 %	1-6 Mon.	D: 9,1 DYS: 2 GAD: 2 PAN: 1 SPEZ: 3 SOZ: 1
Payne 1999 [160] USA	c	SCID (DSM-III-R)	A	31	100 %	Ge-samt: 58	NB	Brust	Gesamt: I: 11 %, II: 31 %, III:7 %, IV: 51 %	NB	D: 0 PAN: 7 Agoraph.: 3 SPEZ: 3 ANP-A: 10 ANP-D: 16	D: 13
Pirl 2002 [161] USA	NB	SCID (DSM-IV)	A	45	0 %	69,4	7,4	Prostata	IV: 26,3 %	NB	D: 12,8
Pirl 2009 [162] USA	r	CIDI (DSM-IV)	NB	243	59,7 %	63,2	NB	Brust: 24,9; Gynäkol.: 20,4 %; Haut: 20,3 %; Prostata: 10,0 %	NB	M= 15,93 Jahre		D: 5,4 (12-Mon.-Präv.)
Popoola 2012 Nigeria	k	SCID (DSM-IV)	S	124	100%	NB	NB	Brust	I: 8,9 %; II: 25,8 %; III: 50,8 %; IV: 14,5 %	> 3 Mon.	D: 16,9 Aff. St.: 40,3
Prieto 2002 [163] Spanien	k	DSM-IV-Checklist	S	220	41,4 %	38,4	NB	Hämatol.	NB	Md=13 Mon. (Range=3-130)	D: 12,3 DYS: 0,9 GAD: 1,8 PAN: 1,4 Phobien: 1,8 ANP-M: 8,6 ANP-A: 6,8 ANP-D: 7,3
Qui 2012 China	k	MINI (DSM-IV)	S	505	100%	52,02	4,55	Brust	I: 49,9 %; II: 35,8 %; III & IV: 14,3 %	6-36 Monate nach der OP	D : 20,6
Rasic 2008 [164] Kanada	r	CIDI (DSM-IV)	G	863	56,5 %	15-54 J.: 30,3 %; 55-74 J: 48,3 %; >75 J.: 21,4 %	NB	NB	NB	NB		(12-Mon.-Präv.) D: 5,2 Manie: 0,8 PAN: 8,6 Agoraph.: 0,7 SOZ: 4,3 ALK-A: 1,4 And. Suchterkr.: 0,2
Reuter 2001 [165] Deutschland	k	CIDI (DSM-IV)	G	188	73 %	54	12,1	Brust: 42 %; gastrointest: 15 %; gynäkol.: 14 %; hämatol.: 12 %	IV: 64 %	M=2,7 J. (SD=4,1 J.)	D: 5 DYS: 3 Aff. St. med. KHF: 2 Aff. St.: 10 PAN:2 Phobien: 3 ZWA: 1 PTSD: 1 Angstst. NOS: 1 Angstst: 7 Somatoforme Schmerzst.: 3 Suchterkr.: 3 ESS: 1
Reuter 2007 [166] Deutschland	k	CIDI (DSM-IV)	G	Inter-view: 52; Ge-samt: 132	100 %	Ge-samt: 54	NB	Gesamt: Brust: 70 %; Gynäkol.: 30 %	Gesamt: IV: 42 %	Gesamt: M=2,6 J. (Range=1 Mon.-22 J.)	Aff. St.: 6,2 Angstst.: 7,9 Somatoforme St.: 0 Suchterkr.: 5,5	12-Mon.Präv. LZP Aff. St.: 13,6; 25,0** Angstst.: 17,4; 30,5 Somatof. St.: 6,2; 16,7** Suchterkr.: 7,8; 17,2*
Ryan 2012 Irland	k	SCID (DSM-IV)	S	205	49,3 %	61,6	12,9	Brust : 17,1 %; Kolon: 14,1 %; Lunge: 16,6 %; Knochen: 11,2 %; gynäkol: 7,8 %; andere 33%	NB	> 1 Mon.	D: 4,4 GAD: 2 PAN: 2 PTSD: 1,5 ANP: 5,9
Saracino 2017 USA	k	SCID (DSM-IV)	S	201	50,7 %	77	4,84	Brust: 50,7 % Prostata: 49,3 %	NB	NB	D: 3
Shim 2018 Südkorea	k	SCID (DSM-IV)	G	399	59,1%	51,2	11,58	Brust: 30,5 %; gastronint.: 14 %; Leber: 3,6 %; Lunge: 10,4 %; Kolon: 12,7 %; Zevix: 4,6 %; andere 24,4 %	0: 3,6 %; I: 14,6 %; II: 21,9 %; III: 24,2 %; IV: 14,3 %	NB	D: 10,8 Aff. St.: 16 GAD: 6,8 PAN: 0,8 AGO: 2,5 SPE: 3,0 SOZ: 4,5 ZWA: 2,3 PTSD: 1,5 Angstst.: 17,1
Singer 2007 [65] Deutschland	k	SCID (DSM-IV)	S	689	41,4 %	60-69: 34,7 %; 50-59: 23,1 %	NB	Gastrointest: 19,4 %; Prostata: 17,3 %; Gynäkol.: 14,2 %; Brust: 11 %; Urolog.: 13,1 %	0: 1,9 %; I: 17,7 %; II: 21,5 %; III: 18,0 %; IV: 10,3 %	NB	D: 9,6 DYS: 2,0 GAD: 5,7 PAN: 2,9 SPEZ: 6,4 SOZ: 0,6 PTSD: 4,2 ASD: 3 ANP: 6,8 ALK-A: 5,1 TAB-M: 8,7 And. Suchterkr.: 5,1
Singer 2008 [167] Deutschland	r	SCID (DSM-IV)	A	250	9 %	64 % 50-69 J.	NB	Kehlkopf	I: 38 %, II: 18 %, III: 16 %, IV: 26 %	M=5 J. (Range=0-25)	D: 5,2 DYS: 4,5 GAD: 1,9 SOZ: 0,3 PTSD: 0,3 ANP: 4,5 ALK-A: 2,9
Singer 2010 [168] Deutschland	k	SCID (DSM-IV)	S	329	41 %	60	NB	Prostata: 12,2 %; Rektum: 10,9 %; Brust: 33 %; Hirn: 8,8 %	I: 19 %; II: 15 %; III: 17 %; IV: 12 %	NB	D: 8,5
Singer 2013 Deutschland	k	SCID (DSM-IV)	G	502	46,6 %	NB	NB	Prostata: 17,3 %; Brust: 15,7 %; Zervix: 15,7 %; Kopf-/Hals: 14,3 %; Andere: 37%	NB	NB	D: 6,2 DYS: 1,8 Aff. St.: 7,6 GAD: 2,6 PAN: 3,4 SPE: 4 SOZ: 0,2 PTSD: 0,4 ASD: 3,2 Angstst.: 8,4 ANP: 16,7 ALK-A: 3,4
Spencer 2010 [169] USA	NB	SCID (DSM-IV)	G	635	49,8 %	59,7	13,1	Lunge: 23,4 %; Kolon: 12,1 %; Brust: 12,1 %; Pankreas: 8 %	IV: 100 %	NB	GAD: 3 PAN: 3 PTSD: 3,2 Angstst.: 7,6
Stark 2002 [170] Groß-britannien	NB	SCAN⁴(ICD-10)	A	178	39,9 %	54,9	13,2	NB	IV: 38,8 %	M=34,8 Mon. (Range=1,2-84)	D: 15 GAD: 8,4 PAN: 9 Phobien: 13,5 Angstst.: 18
Su 2017 Taiwan	NB	MINI (DSM-IV)	S	300	100 %	48,16	9,07	Brust	I-III: 96,5 %; IV: 3,5%	NB	D: 8,3
Tabei 2006 [171] Südiran	NB	SCID (DSM-IV)	NB	177	29,9 %	58,1	14,0	Magen	NB	NB	TAB-A: 50,9 Opioid-A: 5,7
Tan 2017 Singapur	k	MINI (DSM-IV)	S	315	58,1%	NB	NB	NB	I: 5,1 %; II: 5,7 %; III: 10,2 %; IV: 53,2 %	0-60 Mon.	D: 16,8 GAD: 9,5
Uchitomi 2003 [172] Japan	k	SCID (DSM-III-R)	S	212	39,6 %	62,1	10,8	Lunge	I: 77,8 %; II: 15,6 %; IIIA: 6,6 %	1 Mon. nach OP	(T2: 3 Mon. n. OP; T3: 12 Mon. n. OP) D: 4,7 (T1); 2,8 (T2); 1,4 (T3)	TAB-A: 42
Voigt 2017 Deutschland	k	SCID (DSM-IV)	NB	150	100 %	50,4	9,1	Brust	NB	T1 vor Chemoth.	(T2 : nach Chemoth.; T3 1 Jahr nach T1) PTSD: 3,6 (T1) ; 1,9 (T2) ; 2,0 (T3)
Walker 2007 [173] Groß-britannien	k	SCID (DSM-IV)	A	361	76,5 %	61,7	12,1	Brust: 63,8 %; Prostata: 12,5 %; gynäkol.: 9,1 %; kolorektal: 9,1 %	IV: 10,5 %	NB	D: 8,3
Walker 2014 Großbritanien	k	SCID (DSM-IV)	A	Inter- view: 4365 Ge- samt: 21151	Ge- samt: 71%	Ge- samt: 64,4	Ge-samt: 11,9	Brust: 40 %; Lunge: 20 %; Kolon: 16 %; gynäkol.: 14 %; urol.: 9 %	NB	NB	D: 9,2
Widows 2000 [174] USA	k	SCID (DSM-IV)	NB	102	79 %	45,0	10,7	Brust:49 %; hämatol.: 25 %	NB	NB	Aff. St.: 4 PTSD: 5 And. Angstst.: 11 ANP: 2	Aff. St.: 30 PTSD: 6 And. Angstst.: 6
Wilson 2007 [175] Kanada	k	PRIME-MD¹¹ (DSM-IV)	G	381	55,6 %	67,2	12,9	Lunge: 23,9 %; urogenital: 19,9 %; gastro-intestinal: 18,3 %; Brust: 9,7 %	Palliativ	NB	D: 17,8 DYS: 4,5 GAD: 5,8 PAN: 5,5 Angstst. NOS: 4,7 Angstst. med. KHF: 1,8 Angstst: 13,9
Wu 2016 Taiwan	k	SCID (DSM-IV)	S	93	14%	52,7	9,6	Kopf-/Hals	I-II: 35,5 %; III-IV: 64,5 %	NB	(T2 3 Mon. nach T1; T3 6 Mon. nach T1) Aff.St.: 8,5 (T1); 24,5 (T2); 14 (T3) Angstst.: 27,3 (T1); 6,4 (T2); 3,3 (T3) ALK: 18,9 (T1); 21,3 (T2); 20,4 (T3)
Yadav 2019 Indien	k	MINI (DSM-IV)	G	100	36 %	50	11,8	Kopf-/Hals	NB	NB	D: 10,9 DYS: 10
Zhao 2014 China	k	MINI (DSM-IV)	S	460	50,9%	59,4	12,0	Lunge: 28,3 %,; gastroint.: 21,3 %; Andere: 50,4%	NB	NB	D: 12,6 DYS: 9,1 Aff.St.: 25,9
Zwahlen 2008 [176] Schweiz	NB	MINI (ICD-10)	NB	31	0 %	58,2	10,1	Mundhöhle	I/I: 54,8 %; III/IV: 45,2 %	NB	D: 3,2 DYS: 3,2 SOZ: 3,2 ALK-A: 12,9
Legende/Abkürzungen: NB=nicht beschrieben, k=konsekutiv, c=convenience, r=repräsentativ, A=Ambulant, S=Stationär; G=Gemischt^{, 1}=CAGE Alkoholismus Screeningfragebogen, ²=Schedule for Affective Disorders and Schizophrenia, ³=Research Diagnostic Criteria, ⁴=Schedules for Clinical Assessment in Neuropsychiatry, ⁵=Diagnostic Interview Schedule, ⁶=Monash Interview for Liaison Psychiatry, ⁷=Present State Examination, ⁸=Acute Stress Disorder Structured Interview, ⁹=Clinician Administered PTSD Scale, ¹⁰=Clinical Interview Schedule-Revised, ¹¹=Primary Care Evaluation of Mental Disorders D=Depression, DYS=Dysthymie, BIP=Bipolare Störung, Aff.St.=Affektive Störungen, insgesamt, GAD=Generalized Anxiety Disorder, PAN=Panikstörung, AGO=Agoraphobie, SOZ=Soziale Phobie, ZWA=Zwangsstörung, PTSD=Posttraumatische Belastungsstörung, ASD=Akute Belastungsreaktion, Angstst.=Angststörungen, insgesamt, ANP-M=Anpassungsstörung, gemischte Symptomatik, ANP-A=Anpassungsstörung, Angstsymptomatik, ANP-D=Anpassungsstörung, depressive Symptomatik, ANP=Anpassungsstörungen, insgesamt, ALK-M=Alkoholmissbrauch, ALK-A=Alkoholabhängigkeit, ALK=Alkoholmissbrauch oder –abhängigkeit, TAB-M=Tabakmissbrauch, TAB-A=Tabakabhängigkeit, TAB=Tabakmissbrauch oder –abhängigkeit, Suchterkr.=Suchterkrankungen, insgesamt, ESS=Essstörungen, insgesamt, med. KHF=medizinischer Krankheitsfaktor, NOS=Not otherwise specified, SPEZ=spezifisch

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