Behavioral health disorders have a ‘big impact’ on cancer surgery outcomes
Click Here to Manage Email Alerts
Key takeaways:
- One in 15 patients with cancer on Medicare had one or more behavioral health disorders.
- Behavioral health disorders resulted in more surgical complications, longer hospital stays and increased cost of care.
Medicare recipients with various cancer types had more frequent surgical complications when they also had at least one behavioral health disorder, according to study results published in Journal of the American College of Surgeons.
Older patients with behavioral health disorders, which encompassed substance abuse as well as eating and sleep disorders, also had higher rates of readmission, longer hospital stays and higher health care costs.
“This study clearly demonstrates that the prevalence of this is not insignificant. It’s in the range of about one in 15 patients,” Timothy M. Pawlik, MD, PhD, MPH, the Urban Meyer III and Shelley Meyer Chair for Cancer Research at The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, told Healio.
“Providers need to be aware that behavioral health disorders are relatively common,” he added. “They need to screen for it. They need to understand that, as surgeons, we try to minimize risk and postoperative complications around things that we do in the operating room and the care that we deliver in the perioperative setting, but it’s also important to remember that these social determinants of health and other comorbidities like behavioral health disorders can have a big impact on [the] chance of a complication and the patient’s chance of having a good outcome.”
‘An access to care issue’
Between 1.3% and 3.1% of adults deal with substance abuse, eating or sleeping disorders in the U.S., according to background information provided by researchers.
Prevalence of substance abuse (2.6% to 6.5%) is higher in patients with cancer and those undergoing surgery.
“Mental health issues can also impact access to care and outcomes after care,” Pawlik said.
Pawlik and colleagues examined the impact of behavioral health disorders on Medicare beneficiaries (aged 65 years and older) diagnosed with lung, esophageal, gastric, liver, pancreatic or colorectal cancer between 2018 and 2021.
Researchers evaluated postoperative “textbook outcomes,” which include no complications, extended hospital stays, 90-day readmission or 90-day mortality. They also assessed in-hospital expenditures and OS.
The study cohort consisted of 694,836 individuals identified from inpatient claims data within Medicare Standard Analytic Files. Patients with a behavioral health disorder (6.7%) had a lower median age compared with those who did not (71 vs. 75 years), consisted of a higher rate of men (65.6% vs. 49.6%) and more often resided in high social-vulnerability areas (34.5% vs. 33.1%).
Individuals with a behavioral health disorder underwent surgical resection less often (20.3% vs. 23.4%) and received other therapies like chemotherapy and radiation more often.
“I think it’s an access to care issue,” Pawlik said.
“In general, surgery is a treatment modality for patients with early- to mid-stage cancers, whereas patients with late-stage cancers frequently aren’t treated with surgery but with other modalities,” he added. “It’s my impression that patients with behavioral health disorders just have more barriers getting into the health care system with regard to being diagnosed earlier on with their cancer, and then getting appropriately referred to surgery.”
More patients with a behavioral health disorder who underwent surgery had complications compared with those who did not (31.5% vs. 24.4%). They also more often had extended hospital stays (28.5% vs. 21.2%) and higher 90-day readmission rates (31.4% vs. 22.1%).
“The odds of a complication, prolonged length of stay or 90-day readmission was about 30% to 50% higher among patients with behavioral health disorders, even controlling for other factors like treatment at low-volume hospitals,” Pawlik said.
“This was higher than one might have expected,” he continued, adding that he might have estimated less than 10% at the start of investigation.
Addressing body and mind
Older patients with behavioral health disorders also had worse long-term OS (37.1 vs. 46.6 months; HR = 1.26; 95% CI, 1.22-1.31) and spent 7.76% more money on their hospital and post-discharge care.
“That information around costs and health care expenditures is important, perhaps not so much around patients who are ... insured by Medicare, but younger patients who may have behavioral health disorders and encounter similar barriers, especially as insurance payers are increasing out-of-pocket expenses and deductibles,” Pawlik said. “That may have an adverse effect on patients with behavioral health disorders by increasing financial toxicity and further discouraging them from seeking care.”
Pawlik stressed physicians need to understand the negative correlation behavioral health disorders have on post-surgical outcomes.
“Just as we ask patients about medical history relative to diabetes or hypertension, we need to be more specific in our screening of behavioral health disorders around substance abuse, sleeping disorders and eating disorders,” he said.
Pawlik said individuals living in vulnerable areas need better access to mental health and suggested incentivizing professionals to serve those communities.
He also noted the importance of collaborative care models between primary care doctors, oncologists, surgeons, case managers, social workers, community health workers and mental health professionals.
“If I, as a surgeon, cannot address their depression or their addiction challenges, I am putting them in touch with providers and resources that can do that,” Pawlik said.
“This is something that is more and more on individuals’ radars ... but more needs to be done,” he added. “[It is] important to treat a patient’s body, but also their mind, and realize that both need to be addressed in order to achieve optimal outcomes.”
For more information:
Timothy M. Pawlik, MD, PhD, MPH, can be reached at tim.pawlik@osumc.edu.
Collapse
Click Here to Manage Email Alerts