Addressing mental health in patients with lung cancer improves outcomes
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Mental health plays a significant role in overall health, and addressing these concerns is no less important in patients with lung cancer, according to experts.
Deepti Chopra, MBBS, MPH, assistant professor of psychiatry at The University of Texas MD Anderson Cancer Center, told Healio that there are two broad categories among patients with cancer who experience mental health symptoms: “those with preexisting mental health concerns and those who may have just developed mental health concerns because of the cancer diagnosis.”
She explained that mental health can impact patient outcomes. For instance, Chopra said, “Depression is a small but significant predictor of mortality, and it also is associated with quality of life [and] compliance with medical treatment.”
Mental health, lung cancer outcomes
In a study published in early 2022, researchers found that patients with non-small cell lung cancer whose depression symptoms became more severe after diagnosis had shorter survival compared with those whose depression symptoms improved or remained the same during treatment.
“New data show post diagnosis trajectories of psychological symptoms predicted risk of premature mortality from advanced NSCLC, even controlling for the survival benefits of immune- and targeted therapies,” Barbara L. Andersen, PhD, distinguished university professor in the department of psychology at The Ohio State University, and colleagues wrote. “Substantial evidence underscores the need for psychological therapies to address the common comorbidities of stress, depression, and anxiety with advanced NSCLC.”
Researchers enrolled patients with newly diagnosed stage IV NSCLC. Patients were excluded from participation if they had been treated with definitive chemo-radiotherapy, diagnosed more than 90 days from enrollment, received treatment for over a month or had a disabling vision, hearing or psychiatric condition.
The researchers measured patients’ depression and anxiety using the Patient Health Questionnaire-9 (PHQR9), which included a self-report scale that examines the frequency of major depressive disorder symptoms in the past 2 weeks.
Patients completed the questionnaires at baseline and bimonthly for 2 years, with 80% compliance overall.
Researchers used joint model analyses to examine the interaction between a longitudinal model of survival and patients’ psychological symptoms from the time of NSCLC diagnosis through 24 months.
They found that the 2-year trajectory of depressive symptoms was associated with cancer survival (HR per unit increase in PHQR9 = 1.09; 95% CI, 1.03-1.15).
“Without interventions, worries will remain regarding patients having suboptimal understanding of their disease and its treatment, impaired decision-making and engagement in treatment, lowered tolerance of symptoms and treatment side effects, and poor motivation to maintain functional status,” Andersen and colleagues wrote. “Attention to and improvement of patients’ psychological status may provide added benefit that prolongs a life of quality and comfort and potentially improves overall survival.
Preexisting mental health conditions
In another study, researchers linked improved cancer outcomes in patients with preexisting mental health conditions who were diagnosed with NSCLC to their participation in mental health treatment programs and housing and employment support programs .
“Our results concur with those of several prior studies that [preexisting mental health disorders] are associated with increased mortality among patients diagnosed with NSCLC,” Jacob E. Berchuck, MD, a medical oncologist in Lank Center for Genitourinary Oncology at Dana-Farber Brigham Cancer Center, and colleagues wrote.
The retrospective, population-based cohort study assessed 55,315 veterans within the Veterans Affairs Cancer Center Registry who were diagnosed with lung cancer from Sept. 30, 2000, to Dec. 31, 2011. Of these patients, 18,229 had preexisting mental health conditions, such as bipolar disorder, depressive disorder, PTSD, schizophrenia and substance use disorder.
Researchers found that, among patients with a mental health disorder, those who participated in a mental health treatment program were less likely to be diagnosed with late-stage disease (OR = 0.62; 95% CI, 0.58-0.66) and more likely to receive treatment appropriate for their stage of disease (OR = 1.55; 95% CI, 1.26-1.89).
These patients also experienced lower lung cancer mortality (adjusted HR = 0.77; 95% CI, 0.74-0.8) and lower all-cause mortality (adjusted HR = 0.74; 95% CI, 0.72-0.77) than those who did not participate in a mental health treatment program.
“Overall, we demonstrated in this large population-based study of veterans with preexisting [mental health disorders] diagnosed with NSCLC that participation in [mental health treatment programs], housing support programs, and employment support programs was associated with improved cancer-related outcomes,” Berchuck and colleagues wrote, “including a lower likelihood of being diagnosed with late-stage disease, a higher likelihood of receiving stage-appropriate treatment, and lower all-cause mortality and lung cancer–specific mortality compared with nonparticipants.”
Addressing mental health in cancer care
Chopra told Healio one thing clinicians can do in their practice is watch for “any sort of emotional distress” in patients diagnosed with lung cancer.
She explained emotional distress is “something that needs further investigation, and this distress can branch from anxiety, depression, and even confusion, so that would be something that mental health [and] health care providers can, in general, pick up on and initiate the process of [mental health] screening.”
She added, “Helping with the emotional distress will help the patient feel heard, feel valued, and then be able to process the information that’s being provided when you’re doing evaluations, treatment planning ... all of that will sink in there. If it’s something that’s not addressed, the anxiety will get worse; the depression will get worse.”
During survivorship, according to Chopra, addressing mental health concerns in patients diagnosed with lung cancer “would be helping them with quality of life [and] making sure they do not reengage in risky behaviors” such as cigarette smoking, which may worsen their outcomes.
Chopra noted that additional research is needed to evaluate the role of a more in-depth mental health treatment approach among patients with poor prognoses or who are receiving invasive treatment.
“Understanding the impact of preexisting mental health diagnoses in lung cancer outcomes and then also understanding just the impact of emotional distress that develops after the cancer diagnosis on outcomes is important,” she said. “It’s an area of research that can be expanded, and there’s opportunity there because it will help guide ... when to screen, when to refer and how to develop a plan around [mental health care] — all of that will get shaped up better.”
References:
Andersen BL, et al. Psychosom Med. 20225;doi:10.1097/PSY.0000000000001027.
Berchuck JE, et al. JAMA Oncology. 2020;doi:10.1001/jamaoncol.2020.1466.
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