Anxiety and Depression in Patients with Histiocytic Neoplasms and their Associated Clinical Features

• One in three patients with histiocytic neoplasms report anxiety or depression and 1 in 7 report moderate or severe anxiety or depression.

• Anxiety and depression are stable over time and correlated with financial burden, symptom severity, and health-related quality of life.

Anxiety and depression are common in many cancers but have not been systematically studied in patients with histiocytic neoplasms (HN). We sought to estimate rates of anxiety and depression and identify clinical features and patient-reported outcomes (PROs) associated with anxiety and depression in patients with HN. A registry-based cohort of patients with HN completing PROs including the Hospital Anxiety and Depression Scale (HADS) from 2018-2023 was identified. Moderate or severe anxiety or depression were respectively defined as a score of 11+ on the HADS anxiety or depression subscales. Associations of variables, including other validated PROs, with moderate or severe anxiety or depression were modeled with logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). In 215 patients, approximately 1 in 3 met the criteria for anxiety or depression and 1 in 7 met the criteria for moderate or severe anxiety or depression. These estimates remained stable over a twelve-month trajectory. Rates of depression, but not anxiety, significantly differed across HN types with patients with Erdheim-Chester Disease experiencing the highest rate. In addition, neurologic involvement, unemployment, and longer undiagnosed illness interval were significantly associated with increased risk of depression. Financial burden, financial worry, and severe disease-related symptoms were correlated with increased risk of both anxiety and depression. Conversely, increased general and cognitive health-related quality of life (HRQoL) were correlated with decreased risk of both anxiety and depression. In patients with HN, anxiety and depression are prevalent, stable over time, and correlated with financial burden, symptom severity, and HRQoL.