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Anxiety, depression predict increased medical use in patients with breast, prostate cancer
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Mood and adjustment disorders, such as anxiety and depression, predicted the number of outpatient visits, hospital admissions and days spent in the hospital for patients with breast or prostate cancer, according to analysis of data from the United States Military Health System scheduled for presentation at the Quality Care Symposium.
Further, between 2007 and 2014, the incidence of mood and adjustment disorders increased from 21% to 28% among women with breast cancer and from 9% to 13% among men with prostate cancer.
“Mental health comorbidities are strong predictors of health care costs and utilization for patients with breast cancer and prostate cancer, even after controlling for other variables,” Diana Jeffery, PhD, director of the Center for Healthcare Management Studies at the U.S. Department of Defense, told HemOnc Today. “Early and frequent mental health assessments are essential, not only to improve quality of life, but also to decrease the number of hospital admissions.”
The Military Health System provides care to 9.5 million active duty and retired military personnel and their families. Researchers analyzed claims data from beneficiaries aged 18 to 64 years who had direct care following a diagnosis of breast cancer (average annual cases, n = 24,612) or prostate cancer (average annual cases, n = 13,258).
Jeffery and colleagues used regression models to identify predictors of health care cost and utilization, including sociodemographic variables, system of care, treatment modalities, and chronic disease and mental health comorbidities.
A greater proportion of women with breast cancer experienced comorbid depression (16.8%) or anxiety (14.2%) compared with men with prostate cancer (depression, 6.9%; anxiety, 6.7%).
Further, the annual cost per patient was significantly higher among women with breast cancer ($16,287 vs. $11,069; P < .001).
Having a mood or adjustment disorder increased costs by about $9,000 per year for a woman with breast cancer and about $8,000 per year for a man with prostate cancer. In total, these disorders led to 312,000 more outpatient visits per year among women with breast cancer and 169,000 visits for men with prostate cancer.
Multiple factors likely contribute to the increase in mood and adjustment disorders, including enhanced guidelines on anxiety and depression management by ASCO, the American College of Surgeons and the National Comprehensive Cancer Network, Jeffery speculated.
“The Department of Defense also implemented many programs and policies to reduce the stigma associated with mental health screening and treatment and increased the number of its professional mental health staff,” Jeffery said. “Also, it’s quite possible that the increased rates of depression, anxiety and adjustment disorder may be related to the increased economic burden suffered by our cancer patients who have been burdened by higher co-pays for chemotherapy delivered in outpatient settings.”
Women with breast cancer and mood or adjustment disorders had 9.4% more ambulatory visits (n = 312,000), 2.3% more hospital visits (n = 4,800) and 5.4% more hospital bed days (n = 72,000) than women with breast cancer with no other comorbidities.
Men with prostate cancer and mood or adjustment disorders had 6.7% more ambulatory visits (n = 169,000), 2.9% more hospital admissions (n = 2,600) and 8.4% more hospital bed days (n = 65,000) than men with prostate cancer without mood or adjustment disorders.
The strongest predictors of annual breast cancer costs included chemotherapy, surgery, and mood or adjustment disorders (P < .0001). The strongest predictors of prostate cancer costs included chemotherapy, radiation therapy, surgery, and mood or adjustment disorder (P < .0001). Mood or adjustment disorders were the strongest predictors of annual ambulatory visits, hospital admissions, and bed days for both breast and prostate cancer (P < .0001).
Researchers noted that although the study’s population consisted of individuals with all stages of cancer, advanced disease was likely to be associated with more ambulatory visits, hospital admissions and bed days, as well as increased risk for anxiety, depression and adjustment disorders.
The study was limited to administrative claims data and was missing variables such as stage of disease, out-of-pocket costs, and separation of costs and utilization due to cancer or other conditions, Jeffery noted.
It is important for mental health care providers to discern the cause of anxiety or depression by consulting with the patient’s internist or mental health provider, tailor intervention to the severity of the mood or adjustment disorder, and to provide follow-up care that includes consultations with patients’ families, Jeffery added.
“In the smaller oncology practices, it’s also important to find out what resources are available in the community and refer patients to them, including programs that are offered at no cost such as community support groups,” she said. – by Chuck Gormley
Reference:
Burke HB, et al. Abstract 18. Presented at: Quality Care Symposium; March 3-4, 2017; Orlando, Fla.
For more information:
Diana Jeffery, PhD , can be reached at diana.d.jeffery.civ@mail.mil.
Disclosure: Researchers report no relevant financial disclosures.