Palliative care, mental health services underutilized in pancreatic cancer
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Individuals with pancreatic cancer underutilized palliative care and mental health services, according to a retrospective analysis.
Researchers from Saint Louis University used electronic health record data from Optum’s Integrated Claims-Clinical Data set to identify 4,029 patients with newly diagnosed pancreatic cancer.
The investigators then used ICD-9/10 codes to identify subsequent diagnoses of anxiety and depression, as well as palliative care consultations.
They used multiple logistic regression to quantify adjusted associations of mental health treatment with palliative care and patient characteristics.
Results showed higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%) among patients who had palliative care consultations than those who did not have documented consultations.
Investigators observed variation in mental health service utilization and pharmacotherapy, with the highest utilization seen among those with both anxiety and depression.
Age also influenced treatment patterns (adjusted OR = 1.83 for those aged under 55 years vs. those aged 65 to 70 years).
Palliative care consultations did not exhibit significant effects on the likelihood of documented treatment.
“With pancreatic cancer or any advanced cancer with a similarly poor prognosis, patients are experiencing so much fear of death and the sudden decline in their health — it’s an extreme health shock,” Zidong Zhang, PhD, MPH, MS, a biostatistician at Saint Louis University School of Medicine’s AHEAD Institute, told Healio. “Oftentimes, the priority is to preserve the patient’s life or manage pain. Sometimes, mental health is forgotten.”
Healio spoke with Zhang and Divya S. Subramaniam, PhD, MPH, associate professor of health and clinical outcomes research at Saint Louis University’s School of Medicine, about the need to close this care gap and discussed one of the study’s unexpected findings.
Healio: Prior to your study, what was known about the use of palliative care in pancreatic cancer?
Subramaniam: Palliative care has long been shown to improve quality of life for patients with cancer, yet for patients with pancreatic cancer — a group with complex, late-stage diagnoses and intense symptom burdens — palliative care use has remained surprisingly low and usually is not started until symptoms are beyond control. Despite high levels of anxiety and depression following cancer diagnosis, mental health support in this setting is not fully understood or utilized.
Healio: Why is palliative care so important in difficult-to-treat cancers?
Subramaniam: In complex cases like pancreatic cancer, palliative care is essential because it goes beyond physical symptom relief to address emotional, mental and social needs. This holistic approach is a lifeline, helping patients manage symptoms and feel more supported through the challenges of their illness, even when curative treatments are no longer an option.
Zhang: Palliative care also can reduce unnecessary treatments and the total cost of care, thus improving the value of care.
Healio: What motivated you to conduct this study?
Subramaniam: “Cancer” is a word that evokes profound fear and anxiety. For those diagnosed, the initial shock and distress can be overwhelming, leaving them and their loved ones grappling to absorb the life-altering news. Pancreatic cancer, in particular, has touched many lives, as almost everyone knows someone affected by this challenging disease. Hence, we were motivated by the clear need to better understand how mental health and palliative care can intersect for these patients. Although palliative care is transformative for many in numerous ways, we wanted to dig into how it specifically impacts mental health support for patients with pancreatic cancer, where anxiety and depression often intensify the struggle.
Healio: How did you conduct the study, and what did you find?
Zhang: Using a robust dataset from a national integrated EHR database, we analyzed records of over 4,000 patients with newly diagnosed pancreatic cancer to uncover trends between palliative care, new-onset anxiety, depression and treatment.
Subramaniam: We found that whereas palliative care consultations correlated with increased diagnoses of mental health issues, they didn’t lead to significant boosts in treatment rates, raising important questions about the focus of these consultations.
Healio: Did any of your findings surprise you?
Subramaniam: It was unexpected to see that palliative care consultations, despite identifying higher levels of anxiety and depression, did not increase treatment rates for these mental health conditions. This suggests mental health might not yet be a central focus in palliative consultations, which often concentrate on managing physical symptoms.
Healio: What are the potential implications of this research?
Zhang: What is important to me is that palliative care can avoid neglected detection of anxiety and depression at early times in patients with cancer, so it helps early detection and management of mental health issues. This entails better holistic management of patient outcomes.
Subramaniam: By addressing mental health as a core part of palliative services, we can provide more comprehensive support for patients facing difficult prognoses.
Healio: What are the next steps in your research?
Subramaniam: We’re excited to dig deeper into understanding the barriers to mental health treatment within palliative care and how we can work toward better integration of these services. Addressing these barriers could make a meaningful difference in care quality and patient outcomes.
Healio: Is there anything else you would like to mention?
Subramaniam: This study highlights the need for greater attention to mental health within palliative care for patients with pancreatic cancer. By advocating for a more inclusive approach to patient care, we can aim to improve quality of life on all fronts — not just physically, but emotionally and psychologically as well.
References:
- SLU Study: Integrative palliative care critical to improve mental health among pancreatic cancer patients (press release). Available at https://www.slu.edu/news/2024/november/palliative-care-mental-health.php. Published Nov. 5, 2024. Accessed Nov. 20, 2024.
- Subramaniam DS, et al. Healthcare (Basel). 2024;doi:10.3390/healthcare12080842.
For more information:
Divya S. Subramaniam, PhD, MPH, can be reached at divya.subramaniam@health.slu.edu.
Zidong Zhang, PhD, MPH, MS, can be reached at zidong.zhang@health.slu.edu.
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