Women with ovarian cancer at higher risk for mental health disorders
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Women with ovarian cancer appeared to be at greater risk for anxiety, depression and adjustment disorder within the first 2 years of diagnosis than women in the general population, study results showed.
In addition, ovarian cancer survivors who had a mental health diagnosis demonstrated an 80% higher risk for mortality than survivors without a mental health diagnosis, whereas those diagnosed specifically with depression had a 94% higher mortality risk, according to the findings, presented during the virtual American Association for Cancer Research Annual Meeting.
“Mental health issues are important globally, especially for [patients with cancer] who often undergo difficult and complex treatment, have major disruptions to their life and also deal with the toxic side effects of cancer treatment,” Siqi Hu, a PhD candidate in the department of family and preventive medicine at University of Utah and Huntsman Cancer Institute, told Healio. “Mental illness can contribute to the deterioration of quality of life, difficulties in accepting cancer treatment and communicating with caregivers, increased risk for suicide, extended hospital stays and reduced survival outcomes.”
The researchers focused on ovarian cancer because women with this disease tend to be diagnosed at late stages, Hu added.
“During the past few decades, immense progress was made to decrease mortality for patients with ovarian cancer by improving surgical procedures, chemotherapy regimens and advanced radiologic imaging techniques,” Hu said. “There will be an increasing number of ovarian cancer survivors and their survivorship experience is a concern.”
For this reason, Hu and colleagues examined the incidence of and risk factors for mental health disorders among 1,689 women diagnosed with ovarian cancer between 1996 and 2012 and included in the Utah Cancer Registry. The comparison group included 7,038 women without cancer in the general population, matched by age, birth state and follow-up time. Researchers gathered data on mental health diagnoses after ovarian cancer diagnosis from electronic health records and statewide health care facilities.
According to study results, survivors of ovarian cancer had a greater risk for mental illness within the first 2 years after their cancer diagnosis than the general population (HR = 3.48; 95% CI, 2.98-4.05).
Specifically, survivors had a more than threefold higher risk for depression within the first 2 years of ovarian cancer diagnosis (HR = 3.11; 95% CI, 2.53-3.83) and a 1.67-fold higher risk 2 years to 5 years after ovarian cancer diagnosis (HR = 1.67; 95% CI, 1.17-2.38) than women without ovarian cancer.
Moreover, the risk for anxiety was more than three times higher up to 2 years after ovarian cancer diagnosis (HR = 3.54; 95% CI, 2.87-4.38) and 1.86-fold higher between 2 years and 5 years after diagnosis (HR = 1.86; 95% CI, 1.14-3.01).
Risk for adjustment disorders also appeared higher among survivors up to 2 years after diagnosis (HR = 6.64; 95% CI, 2.13-30.71) and between 2 years and 5 years after ovarian cancer diagnosis (HR = 3.96; 95% CI, 1-15.84) compared with the general population.
Factors associated with increased risk for any mental illness up to 2 years after ovarian cancer diagnosis included cancer treatment type and later year of diagnosis. Advanced-stage disease was a substantial risk factor for mental illness and depression for all time periods among cancer survivors, according to the researchers.
However, survivors with a mucinous histology subtype had a 47% lower risk for any mental illness and a 67% lower risk for depression up to 2 years after diagnosis than survivors who had a high-grade serous histology subtype.
Of note, survivors diagnosed with a mental illness demonstrated an 80% increased risk for mortality (HR = 1.8; 95% CI, 1.48-2.18) and survivors diagnosed with depression demonstrated a 94% increased risk for mortality (HR = 1.94; 95% CI, 1.56-2.4) than those without a mental health diagnosis.
Researchers acknowledged that because the study used electronic medical records data, less severe mental illnesses that did not necessitate medical care may have been underrepresented. In addition, the high mortality rate of patients with ovarian cancer may have resulted in survival bias, according to the researchers.
“Our finding emphasizes the importance of providing psychological support after ovarian cancer diagnosis and may provide new insight that may potentially contribute to prolonging the lives of ovarian cancer survivors,” Hu said. “Early identification of [patients with ovarian cancer] in need of psychological treatment is important. Mental health changes may occur during diagnosis and treatment, so patients with cancer may need regular mental health consultations.”
The researchers hope to continue to investigate depression and mental health outcomes among survivors of other cancers, Hu added.
“Future directions also include trying to obtain more detailed cancer treatment data so that we can investigate whether there are dose-response relationships between cancer treatment dose and depression risk,” Hu said.
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Hu S, et al. Abstract 900. Presented at: American Association for Cancer Research Annual Meeting (virtual meeting); April 10-15, 2021.
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