Comparing patients with breast and prostate cancer in terms of their mental health comorbidities as predictors of cost and utilization.

Abstract

18 Background: We compared the role played by mental health comorbidities in the health care cost and utilization of non-elderly patients with breast and prostate cancer. Methods: The Military Health System affords its beneficiaries equal access to medical care. We performed a cross-sectional analysis using administrative data of all 9.5 million beneficiaries, ages 18-64, with direct care and a primary diagnosis of either invasive breast or prostate cancer during FY2007–FY2014. We used regression models to identify predictors of cost and utilization, including sociodemographic variables, system of care, treatment modalities, chronic disease comorbidities, and mental health comorbidities. Results: On average,annuallythere were 23,800 and 13,300 patients with breast or prostate cancer, respectively. More comorbid depression (16.8%) or anxiety (14.2%) occurred among breast cancer patients than prostate cancer patients (6.9%, 6.7%). Annual cost per patient (inc. pharmacy) was significantly higher for breast cancer ($16,287 vs. $11,069, p < 0.001). The strongest predictors of annual breast cancer costs were (in order from highest predictive value) chemotherapy, surgery, and mood or adjustment disorder (p < 0.0001); the strongest predictors for prostate costs were chemotherapy, radiation therapy, surgery, and mood or adjustment disorder (p < 0.0001). Mood and adjustment disorders were strong predictors of the annual number of ambulatory visits, hospital admissions, and bed days for both breast and prostate cancer (p < 0.0001). Conclusions: Mental health comorbidities play a significant role in health care costs and utilization of non-elderly adults who are breast and prostate cancer patients. An unexpected finding was that, although different in frequency, mental health comorbidities were important predictors of cost and utilization for both patients with breast and prostate cancer. For both breast and prostate cancer, routine screening and treatment for mental health disorders should be part of quality cancer care.

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

“…Meta-regression between the gap in screeing rates between the general population and subjects with mental illness, and the screening rates in the general population. (116) no data available Aggarwal, 2010 (117) no data available Andreassen, 2019 (118) no data available Baughman, 2016 (119) no data available Bires, 2016 (120) no data available Burke, 2017 (121) no data available Caruso, 2012 (122) no data available…”

Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer

“…To our knowledge, this is the first study to observe that depressive symptoms documented in the medical record are associated with longer hospital LOS in patients with advanced cancer. Prior studies in the general medicine literature and among patients with cardiovascular and pulmonary disease have shown associations between psychological distress and increased use of health care services , yet relatively few studies from the oncology setting have linked depression with increased health care utilization . Explanations for the association between depressive symptoms and prolonged hospital LOS include the potential effects of patients’ psychological symptoms on their treatment adherence, health‐seeking behaviors, and physical symptoms such as pain or fatigue .…”

“…Recently, research has demonstrated that depressive symptoms are associated with greater health care utilization in patients with cancer, particularly longer hospital length of stay (LOS) . However, although therapies are available to help address depressive symptoms in patients with cancer, prior studies have not investigated the potential impact of such therapies on the use of health care services.…”