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Author Notes:

Lindsay J Collin, Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Room 4746, Salt Lake City UT, 84112; phone: (530) 386-3341. Email: lindsay.collin#hci.utah.edu

LJC, TPA, JLG, and HTS conceptualized the research question and developed the methodologic approach; HTS, JLG, and TPA facilitated the data acquisition; KV conducted the formal analyses; LJC, TPA, JLG, TLL, and HTS provided feedback on results and methodologic considerations; HTS and TLL provided supervision; LJC drafted the initial manuscript; all authors provided feedback and approved the final manuscript.

The authors declare no conflicts of interest.


Research Funding:

This work was supported by the National Centre for Advancing Translational Sciences of the National Institutes of Health (TL1TR002540 to L.J.C), the National Institute of Mental Health (R01MH110453 to J.L.G.), and the National Institute of General Medical Sciences (P20GM103644 to T.P.A.).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • cancer survivorship
  • neoplasms
  • prognosis
  • stress-related disorders
  • trauma
  • RISK

Preexisting stress-related diagnoses and mortality: A Danish cancer cohort study


Journal Title:



Volume 128, Number 6


, Pages 1312-1320

Type of Work:

Article | Post-print: After Peer Review


Background: This study evaluated the association between preexisting stress-related diagnoses and mortality in a Danish population–based cancer cohort. Methods: This study included Danish patients with cancer diagnosed in 1995-2011 who had a stress-related diagnosis before their cancer diagnosis. Cancer patients without a prior stress-related diagnosis were matched 5:1 to the stress disorder cohort by cancer site, age group, calendar period, and sex. The 5-year cumulative incidence of cancer-specific and all-cause mortality was computed by stress-related diagnosis category. Hazard ratios and 95% confidence intervals (CIs) associating stress-related diagnoses with mortality were computed by follow-up time, stress-related diagnosis category, stage, comorbidity status, and cancer type. Results: This study identified 4437 cancer patients with a preexisting stress-related diagnosis and 22,060 matched cancer cohort members. The 5-year cumulative risk of cancer-specific mortality was 33% (95% CI, 32%-35%) for those with a preexisting stress-related diagnosis and 29% (95% CI, 28%-29%) for those without a prior stress-related diagnosis. Cancer patients with a preexisting stress-related diagnosis had a 1.3 times higher cancer-specific mortality rate than the comparison cohort members (95% CI, 1.2-1.5). This increase persisted across categories of stress-related diagnosis. The association varied by stage and cancer type, with more pronounced associations found among those with a late stage at diagnosis and hematological malignancies. Conclusions: Cancer patients with preexisting stress-related diagnoses had increased rates of cancer-specific and all-cause mortality. The results suggest that psychiatric comorbidities may be an important consideration for cancer prognosis, and cancer treatment informed by a patient's history may improve outcomes.
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