Meta-analysis links emotional distress to worse outcomes in advanced lung cancer

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Frontiers in Medicine Published May 21, 2026 Medically reviewed May 21, 2026 Study authors: Jia-jia Lin, Rui Zhou, Zi-yan He, Tian-lin Wang, Ze-xin Zhang, Yan-juan Zhu, Yi-han He, Xue-song Cha… DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider that emotional distress is associated with worse outcomes in advanced NSCLC, but evidence certainty is low.

This is a systematic review and meta-analysis of studies on emotional distress in patients with advanced non-small cell lung cancer receiving anti-tumor therapies. The analysis synthesized data from 911 patients, focusing on overall survival, progression, objective response rate, and progression-free survival as outcomes.

The authors found that emotional distress was significantly associated with reduced overall survival (hazard ratio 1.85, 95% CI 1.50 to 2.28) and increased risk of progression (hazard ratio 1.80, 95% CI 1.22 to 2.66). Emotional distress was also significantly associated with a lower objective response rate (odds ratio 0.55, 95% CI 0.37 to 0.80).

The authors noted that the certainty of evidence was low for overall survival and objective response rate, and very low for progression-free survival. Safety data were not reported, and the review did not include a comparator for emotional distress.

Practice relevance is limited to an association between emotional distress and poorer prognosis, contributing to reduced short-term efficacy and diminished long-term survival. The authors emphasize that causation cannot be inferred from these observational associations.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

To evaluate the association between emotional distress (ED) and the efficacy of anti-tumor therapies in advanced non-small cell lung cancer (NSCLC). Eligible studies were cohort studies investigating the association between ED and treatment outcomes in patients with advanced NSCLC receiving anti-tumor therapies. All statistical analyses were performed using RevMan 5.4, R 4.2.3, and Stata 13.0. Eight studies involving 911 patients were included, and the overall risk of bias was judged to be acceptable. Two studies involved treatment regimens based on immune checkpoint inhibitors (ICIs), another two focused solely on chemotherapy, while the remaining four included patients receiving various therapies involving chemotherapy, radiotherapy, or targeted therapy. Meta-analysis showed that ED was significantly associated with reduced overall survival (OS) (HR = 1.85, 95% CI: 1.50–2.28), an increased risk of progression (HR = 1.80, 95% CI: 1.22–2.66), and a lower objective response rate (ORR) (OR = 0.55, 95% CI: 0.37–0.80). These associations were generally consistent across treatment subgroups, without significant interaction effects. Sensitivity analysis supported the stability of the OS results. Additionally, subgroup analyses did not demonstrate statistically significant differences by age or timing of ED assessment, although the direction of effects was consistent. The certainty of evidence was low for OS and ORR, and very low for PFS. ED is significantly associated with poorer prognosis in patients with advanced NSCLC undergoing active anti-tumor therapies, contributing to both reduced short-term efficacy and diminished long-term survival. Further research should focus on elucidating the underlying mechanisms and exploring effective strategies to improve clinical outcomes in patients with advanced NSCLC and ED.