Rare cancer patients are almost three times more likely to develop anxiety and depression than regular cancer patients

A recent study of the psychological outcomes of over 57,470 patients with rare forms of cancer found that they have a greater risk of developing psychological problems than patients with common forms of cancer.

The systematic review and meta-analysis of these patient cases, led by Associate Professor Valerie Yang, Consultant Medical Oncologist at the National Cancer Centre Singapore (NCCS) and Joint Research Clinician and Group Leader at the A*STAR Institute of Molecular and Cell Biology (IMCB), found that patients with rare cancers are significantly more likely to develop anxiety and depression, and are more likely to commit suicide and have post-traumatic stress disorder (PTSD).

Rare cancers, defined as cancers that affect fewer than 6 out of 100,000 people per year, often present unique challenges for diagnosis, treatment, and research. Because the incidence of each type of rare cancer is low, there is often a lack of awareness among the public and medical professionals about these diseases, leading to delayed diagnoses and limited treatment options. Due to the lack of support and resources tailored to their specific condition, patients with rare cancers can experience isolation, which can negatively impact their mental health.

Although there have been numerous studies of the psychological outcomes of patients with common cancers, this was the first study to systematically examine the psychological impact of having a rare cancer compared to a common cancer. Because there are fewer individuals with rare cancers, clinicians may also be less attuned to the psychological challenges these patients face.

This study, published in eClinical Medicineshowed that patients with rare cancers are almost three times more likely to develop anxiety and depression compared to patients with common cancers.

This group also has a high incidence of suicide (over 300 per 100,000 people) and post-traumatic stress disorder (18%). Importantly, the authors identified specific risk factors in patients with rare cancers that may develop these negative psychological outcomes. These include having advanced disease, chemotherapy treatment, lower income and social status.

“The prevalence of poor mental health in patients with rare cancers highlights the need for early identification and intervention. Increased awareness among healthcare professionals is crucial to identify patients with psychological problems and to monitor patients’ mental well-being during their treatment.

“While each individual diagnosis may be rare, rare cancers account for 25% of all cancers overall. This, combined with the increasing burden of rare cancers globally, highlights the urgent need for more support for this patient group,” said Dr. Yang.

Mr. Soh Kim Hai, a patient of Dr. Yang who was diagnosed with Stage IV Soft Tissue Sarcoma in July 2022, is a patient who struggled to cope with the disease. After the diagnosis, he lost his job and a place to live that he was given by his employer. The resulting fear and uncertainty severely impacted his mental health. He was supported by medical social workers at NCCS for help and emotional support.

During the sessions, he shared his stress about his living conditions and was helped to find a new place to live. After the move, he took up painting, at the suggestion of his brother, which provided a much-needed cathartic outlet for his emotions and improved his mental well-being.

Despite the current lack of treatments for patients with rare cancers, new approaches in translational research and personalized medicine are gradually improving outcomes for patients with rare cancers, offering hope for more effective treatments and improved quality of life.

Dr. Yang also leads the Translational Precision Oncology Laboratory at IMCB, in close clinical collaboration with NCCS and Singapore General Hospital (SGH), as well as scientific collaborations with the National University of Singapore (NUS) and A*STAR’s Bioinformatics Institute (BII) and Singapore Immunology Network (SIgN). The collaborative team has established a translational research program to find better ways to treat these patients.

The research team is now working closely with the clinical team to develop strategies, such as early identification of patients for referral to medical social workers, to better support patients with rare cancers. These strategies, if successful, could then be applied to manage the psychological needs of all vulnerable patient populations.