Depression and Health Care Utilization at End of Life Among Older Adults With Advanced Non–Small-Cell Lung Cancer

Abstract

EOL healthcare utilization varied by timing of depression diagnosis. Those with pre-cancer depression had lower odds of high-intensity healthcare, were more likely to utilize hospice, and have longer hospice stays. Regular depression screening and treatment may help patients optimize decision-making for EOL care. Additionally, hospice providers may need additional resources to attend to mental health needs in this population.

Recurrent major depressive disorder's impact on end-of-life care of cancer: A nationwide study

“…We have also found that RMDD patients had a longer time between cancer diagnosis and death (median 426 vs. 327 days). This result is not consistent with previous studies suggesting that patients with severe mental illness may have a shorter time between diagnosis and death (Doan et al, 2016;Irwin et al, 2014;McDermott et al, 2018). This discrepancy may be due to specific factors of depression.…”

“…After matching and adjustment, RMDD patients received more palliative care, less chemotherapy, dialysis, blood transfusion, surgery, imaging, more artificial nutrition and died less in the ICU/ED than controls. These RMDD characteristics are consistent with those of American studies (Doan et al, 2016;McDermott et al, 2018) who included patients with acute depression during the 12 to 24 months prior to cancer diagnosis, without excluding dementia, bipolar disorders and psychotic depression.…”

“…The authors concluded that both pre-and post-cancer depression subjects received less high-intensity care and were more often referred to palliative care. Another American study on the same database confirmed these results on small-cell lung cancer in patients aged>67 (McDermott et al, 2018).…”

“…These diagnoses are associated with specific severity, treatment and relapsing characteristics; they have thus been excluded to homogenize the cases group. F32* (isolated depressive episodes) have not been included in the case group to avoid any confusion between RMDD and post-cancer/ EOL depression that have different impact on EOL care (McDermott et al, 2018).…”

Geriatric oncology health services research: Cancer and Aging Research Group infrastructure core

“…Geriatric oncology HSR spans the entire cancer care continuum, with patterns of care at the end of life representing another important area of investigation [60][61][62][63]. For example, using the SEER-Medicare dataset, end-of-life healthcare utilization has been shown to vary among older adults with a pre-cancer diagnosis of depression compared with a post-cancer diagnosis of depression [64]. However, robust linkages to EHR data are needed to determine if care at the end of life is aligned with patients' and families' goals and values.…”