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Patients with mental health history have higher cancer mortality rates

Patients with cancer who were hospitalized for mental health problems prior to their diagnosis were more than 73% likely to die from their cancer compared with those who had no mental health history, according to a study published in the British Journal of Cancer.

“Previous work has suggested that psychiatric patients may present with higher stage disease, are less likely to be treated with appropriate surgery/radiotherapy/chemotherapy, and have poorer cancer-specific survival compared to the general population,” Zachary Klaassen, MD, of the Princess Margaret Cancer Centre in Toronto and the Institute for Health Policy at the University of Toronto, and colleagues wrote. “As more than 15% of Americans report significant mental illness, further characterization of survival outcomes for these patients when subsequently diagnosed with cancer are needed. Psychiatric service utilization can serve as a surrogate for psychiatric comorbidity, including comorbidity severity.”

To assess the effect that psychiatric service utilization before cancer diagnosis had on cancer-specific and all-cause mortality, researchers conducted a retrospective cohort study of 676,125 patients who were diagnosed with one of the 10 most common malignancies — prostate, breast, colorectal, melanoma, lung, bladder, endometrial, thyroid, kidney or oral — between January 1997 and December 2014.

Patients were then categorized based on their psychiatric utilization gradient score in the 5 years prior to cancer diagnosis, with 0 indicating no psychiatric utilization (53.2%), 1 as outpatient psychiatric utilization (45%), 2 as ED visit for psychiatric utilization (1.2%) and 3 as hospital admission for psychiatric utilization (0.6%).

Patients with cancer who were hospitalized for mental health problems prior to their diagnosis were more than 73% likely to die from their cancer.

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The researchers found that the use of psychiatric services was associated with increases in both cancer-specific mortality and all-cause mortality. For cancer-specific mortality, the HRs were 1.05 (95% CI, 1.04-1.06) for a psychiatric utilization gradient score of 1; 1.36 (95% CI, 1.3-1.42) for a score of 2; and 1.73 (95% CI, 1.63-1.84) for a score of 3. For all-cause mortality, the HRs were 1.04 (95% CI, 1.03-1.05) for a score of 1; 1.44 (95% CI, 1.39-1.49) for a score of 2; and 1.94 (95% CI, 1.86-2.02) for a score of 3.

“We think this means mental health may play a larger role in cancer outcomes than previously thought,” Klaassen said in a press release. “Major depression and stress may affect our body's immune surveillance systems, effectively hampering the ability to detect and fight cancer. A recent psychiatric history should be a red flag to all doctors and nurses treating cancer patients. It's essential we keep a close eye on these patients to make sure they're receiving the best possible care and are followed up if and when cancer appointments are missed." – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.