<b>Assessment of Musculoskeletal Conditions in Association with Anxiety and Depression in Cancer Patients</b>

Background: Cancer and its treatment can produce persistent musculoskeletal symptoms that coexist with psychological distress and may adversely affect physical function and quality of life. Objective: To assess musculoskeletal conditions in cancer patients and examine their association with anxiety and depression in tertiary care hospitals of Lahore, Pakistan. Methods: This cross-sectional observational study included 292 cancer patients aged 45 to 65 years receiving treatment for at least six months at five tertiary care hospitals. Data were collected using the Hospital Anxiety and Depression Scale and the Nordic Musculoskeletal Questionnaire. Descriptive statistics were reported as frequencies and percentages, and associations among anxiety, depression, and musculoskeletal conditions were examined using chi-square testing in SPSS version 21. Results: Females comprised 57.8% of the sample, and 61.3% of participants were aged 56 to 65 years. Borderline anxiety was present in 44.7% of patients and abnormal anxiety in 28.0%, while borderline depression was observed in 60.6% and abnormal depression in 15.1%. The most commonly affected regions were knees (51.4%), lower back (49.7%), and hips/thighs (46.5%). Lower back symptoms were associated with the highest activity limitation (59.9%) and physician consultation (62.3%). A significant association was found among anxiety, depression, and musculoskeletal conditions (Pearson chi-square = 122.3, df = 4, p < 0.001). Conclusion: Musculoskeletal morbidity and psychological distress were highly prevalent and significantly associated in cancer patients, supporting the need for integrated musculoskeletal and mental health assessment in oncology care.