Study Identifies Mortality, Diagnosis Trends in Patients Diagnosed with Cancer, Mental Health Conditions

Patients with cancer who are diagnosed with a mental health condition and are prescribed a medication to treat it in the immediate aftermath of their cancer diagnosis are at an increased risk of early all-cause mortality, according to recently published study results.

Moreover, the data also showed that patients with cancer of a minority race were less likely to receive a diagnosis of a mental health condition, receive a prescription for a psychopathic medication and participate in a mental health-related visit.

These decreased odds, according to the study authors, may represent a missed opportunity for addressing issues of cancer-related distress and mental health conditions in minority patient populations.

Dr. William Chen, the study’s lead author and a resident physician at University of California, San Francisco (UCSF), told CURE® that it’s important that health care professionals identify mental health distress in patients with cancer since that distress may later turn into a mental health condition. He added that identifying a patient’s needs can help improve their quality of life, as well as their health outcomes.

Dr. Julian Hong, a co-author on the study and medical director of radiation oncology informatics at UCSF, said that historically, mental health diagnoses after cancer has been an understudied area. However, he explained that there recently has been an increasing appreciation for what negative effects are associated with mental health conditions.

“There have been more recent data evaluating how mental health diagnoses interact with patients undergoing treatment, and their cancer outcomes as well,” Hong said in the interview. “One of the bigger efforts, I think, both at our institution and at others, has been to try to improve (the) multidisciplinary care (of) mental health diagnoses in patients with cancer.”

Underestimating Prevalence of Mental Health Conditions

The study consisted of 58,062 adults with cancer who had a pervious diagnosis of a mental health condition, and 54,852 adults with cancer who did not have a previous diagnosis of a mental health condition.

A total of 4,476 patients (8.2%) received a mental health diagnosis after a cancer diagnosis. However, Chen speculated that this number may be a little low.

“So, I would actually speculate that the 8% number is underestimating the true prevalence of mental distress and mental health conditions,” Chen noted.

He explained that previous interview studies indicated that the prevalence is around 20 to 40%. This gap comes from a neglect in routine care, as well as the fact that instances of mental distress may not be picked up on by physicians due to pressed time during a visit, or there may not be enough screening methods in place to catch these diagnoses, he said.

Higher-Risk of All-Cause Mortality

The study results also revealed that a mental health diagnosis along with a psychotropic medication prescription following a cancer diagnosis was associated with a higher risk of all-cause mortality in the first 12 to 24 months. This trend, however, declined at 24 to 36 months after the diagnosis.

Among mental health diagnoses, a diagnosis of an adjustment disorder (an emotional or behavioral reaction to a stressful event or change in a person’s life) was mostly associated with all-cause mortality. A diagnosis of generalized anxiety, however, was not associated with mortality.

Additionally, patients with a cancer diagnosis that traditionally tends to be associated with a worse survival outcome (such as lung, pancreatic or liver cancer) appeared to be more likely to be diagnosed with a new mental health disorder.

Overall, Chen hypothesized why a new mental health diagnosis along with a prescription medication may be associated with a greater risk for all-cause mortality in the short-term following a cancer diagnosis.

“The speculation is that (the) rise in all-cause mortality in the short term is probably related to those patients having worse disease or worse cancer, experiencing more distress as a result and having more of these mental health conditions with psychotropic medications as a result,” he said. “And that would explain why the rise in mortality isn’t seen later because cancer mortality usually happens within a few years of diagnosis.”

Additionally, 2,007 patients (3.7%) had one or more mental-health related visits, and 17,027 (31%) received one or more prescriptions for oral psychotropic medications, after a cancer diagnosis.

Gap in Mental Health Diagnoses

Of note, the study results demonstrated that patients of minority race were significantly less likely to receive a mental health diagnosis, psychotropic medication prescription or have a mental health-related visit, after a cancer diagnosis.

The study included 62.6% non-Hispanic White patients, 10.8% Asian patients, 9.8% Hispanic patients and 3.5% Black patients.

When compared with non-Hispanic White patients, all minority patients were less likely to receive a generalized anxiety diagnosis, as well as receive a psychotropic medication prescription. And, specifically, Asian patients were significantly less likely to receive a diagnosis of depression, and Hispanic patients were significantly less likely to receive an adjustment disorder diagnosis.

Dr. Lauren Boreta, a study co-author and lead of the palliative radiation program at UCSF, said that, historically, patients of racial and ethnic minority backgrounds are systematically underdiagnosed with a mental health condition. She also explained that this disparity is observed in cancer-related pain, and that other data has demonstrated that non-White patients are chronically undertreated for pain — often due to physician communication problems, or access issues.

“This is just another study demonstrating that it appears that there’s and underdiagnosis or a need that’s not being met in our field,” she noted. “(There is) kind of ongoing systematic institutional racism in medicine, honestly. And it does a total disservice to our patients.”

Speak Up

Hong suggested that any patient with cancer who is struggling with mental health should be proactive and let their provider know. He explained that fora provider needs to know everything that is going on to ensure that a patient is getting the best and most appropriate care.

“I think sometimes it can be a sensitive topic but it’s important to discuss it with your providers,” he concluded.

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