Association of Patient-Reported Outcomes With Subsequent Nonfatal Self-injury After a New Cancer Diagnosis

Abstract

diagnosis of cancer carries substantial emotional and psychological weight that can place patients at increased risk of psychological distress across the cancer trajectory. 1 Intentional self-injury is a severe manifestation of distress that can represent coping mechanisms to relieve stress, mental health disorders, or hopelessness. Previous work has focused on depression and the risk of suicide among patients with cancer 2-6 ; however, in patients with cancer, it is challenging to identify risk of suicide or implement effective prevention strategies. 7 Furthermore, the repercussions of psychological distress are broader than suicide. The burden of psychological distress is increased when considering severe sequelae, such as nonfatal self-injury (NFSI). [8][9][10] We previously showed that NFSI occurred in 3 out of 1000 patients after a cancer diagnosis, which was much more frequent than suicide in that population. 11 Nonfatal self-injury represents a patientcentered, objectively measured manifestation of severe distress. In addition to being more common than the narrower outcome of suicide, NFSI presents an opportunity for identification of at-risk patients and interventions for risk reduction.Recognition of distress in oncology practices is a priority for cancer agencies. 11,12 However, linking patients to appropriate psychosocial interventions based on the presence or risk of distress remains a challenge. 2,[13][14][15][16] This problem may come from a limited ability to identify patients at highest risk of harm. IMPORTANCENonfatal self-injury (NFSI) is a patient-centered manifestation of severe distress occurring in 3 out of 1000 patients after cancer diagnosis. How to identify patients at risk for NFSI remains unknown. OBJECTIVE To examine the associations between patient-reported outcome measures and subsequent NFSI in patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based matched case-control study included adults with a new cancer diagnosis reporting an Edmonton Symptom Assessment System (ESAS) score within 36 months of diagnosis in Ontario, Canada, 2007 to 2019. Data analysis was performed January 2007 to December 2019. MAIN OUTCOMES AND MEASURESCases included patients with NFSI, and controls were patients without NFSI. Cases and controls were matched 1:4. Multivariable conditional logistic regression assessed the association between moderate to severe ESAS symptom scores and total ESAS (t-ESAS, range 0-90) score with NFSI in the subsequent 180 days. RESULTSOf 408 858 patients reporting 1 or more ESAS assessments, 425 patients experienced NFSI and reported an ESAS score in the preceding 180 days. Of those, 406 cases were matched to 1624 control patients without an NFSI. Cases reported a higher proportion of moderate to severe symptoms and higher t-ESAS score than controls prior to the event. After adjustment, moderate to severe anxiety (odds ratio [

Gaps in Depression Symptom Management for Patients With Head and Neck Cancer

“…For instance, the elderly, rural residents, those without a prior mental health history, and individuals on active treatment were less likely to receive psychiatry/psychology assessment. These observations were not the primary focus of this analysis and should therefore be seen as exploratory and interpreted with caution 40 …”

“…Clinical interviews and physician judgment often leaves emotional distress unrecognized and untreated. Various guidelines recommend that cancer patients be screened for depressive symptoms using patient reported outcome measures (PROMs) 40 . Emerging evidence suggests merit to this approach 22,23,45–48 .…”

“…Covariates were measured at the time of first ESAS assessment and selected a priori based on our prior work 30,39,40 . Covariates included: age (categorical), gender (indicator), rurality (indicator), comorbidity burden using the Johns Hopkins ACG® System Aggregated Diagnosis Groups (ADGs) (indicator), deprivation quintile using the ONMARG (categorical), prior mental health history (categorical), year of diagnosis (continuous), time since cancer diagnosis (continuous), cancer subsite (categorical), or treatment modality (categorical).…”

Mental health considerations in patients undergoing complex head and neck reconstruction

“…Improved detection is needed, particularly in high-risk populations [9,31]. Various guidelines recommend cancer patients be screened for depressive symptoms using patient-reported outcome measures (PROMs) [30]. Emerging evidence suggests merit to this approach.…”

“…Key risk factors included younger age, prior history of psychiatric illness, prior self-injury, and the head and neck disease site [21]. Many of these exposures act synergistically, placing young head and neck cancer patients with a prior mental health history at highest risk [30].…”