Anxiety trajectories in cancer patients during active treatments: Clusters, influencing factors, and impact on quality of life and health service utilization

J Affect Disord. 2026 Apr 29:121900. doi: 10.1016/j.jad.2026.121900. Online ahead of print.

ABSTRACT

BACKGROUND: Among individuals with cancer, anxiety develops differently and does not follow a uniform course across the cancer trajectory. We examined distinct anxiety trajectories across four time points among patients with high symptom burden during active treatment and tested predictors and potential consequences associated with each trajectory.

METHODS: In this secondary longitudinal study (PCORI: CE-12-11-4025), participants (N = 534) were cancer patients with high symptom burden during active treatment. We used the growth mixture modeling approach to identify the latent classes of anxiety assessed at four time points and applied a 3-step method to test the predictors and consequences of the anxiety trajectories.

RESULTS: Three classes of anxiety trajectories emerged: low anxiety class (n = 54, 10.3%), high anxiety high heterogeneity class (n = 339, 64.1%), and medium stable class (n = 135, 25.6%). Younger age, higher depression, nausea, difficulty concentrating, higher number of symptoms, and more symptom communication barriers predicted the high anxiety class. Higher coping self-efficacy predicted the low anxiety trajectory. Further, the high anxiety class had a lower quality of life, more frequent Emergency Department visits and hospitalizations, and more hospital resource usage.

CONCLUSIONS: Our growth mixture modeling approach was able to capture the dynamic variability in the anxiety growth pattern. These findings are consistent with prior research identifying heterogeneous anxiety trajectories among patients undergoing active cancer treatment, while extending the literature by linking these trajectories to symptom and psychological profiles as well as downstream adverse outcomes, including poorer quality of life and greater healthcare utilization.

PMID:42066851 | DOI:10.1016/j.jad.2026.121900