Impact of Onset of Psychiatric Disorders and Psychiatric Treatment on Mortality Among Patients with Cancer

Abstract

Background. Psychiatric disorders are common in patients with cancer. The impact of both psychiatric disorders and psychiatric treatment on mortality in patients with cancer needs to be established. Materials and Methods. Nationwide claims data were analyzed. To investigate the association between psychiatric disorders and mortality, 6,292 male and 4,455 female patients with cancer who did not have a record of psychiatric disorders before cancer onset were included. To examine the association between psychiatric treatment and mortality, 1,467 male and 1,364 female patients with cancer were included. Incident psychiatric disorder and receipt of psychiatric treatment within 30 days from the onset of a psychiatric disorder were the main independent variables. Dependent variables were all-cause and cancer-related mortality. Cox proportional hazards regression with timedependent covariates was used.Results. The onset of psychiatric disorders was associated with a significantly increased risk of mortality in both male (all-cause hazard ratio [HR]: 1.55; cancer-related HR: 1.47) and female patients with cancer (all-cause HR: 1.50; cancerrelated HR: 1.44) compared with patients with cancer without psychiatric disorders. Both male and female patients who received psychiatric treatment within 30 days of diagnosis of a psychiatric disorder had a lower risk of cancerrelated mortality (males, HR: 0.73; females, HR: 0.71) compared with patients with cancer with psychiatric disorders who did not receive psychiatric treatment. Conclusion. Patients with cancer with newly diagnosed psychiatric disorders had a higher mortality rate. Among these, those who received psychiatric treatment showed lower rates of mortality. Thus, early detection and early treatment of psychiatric disorders in patients with cancer is needed. The Oncologist 2020;25:e733-e742 Implications for Practice: The current study supplements the body of evidence supporting the association of psychiatric disorders onset and treatment with cancer outcomes. Patients with cancer showed an increased risk of both all-cause and cancer-related mortality upon psychiatric disorder onset. Among patients with newly diagnosed psychiatric disorders, those who received psychiatric treatment showed lower cancer-related mortality. Thus, raising awareness of both the risk of psychiatric disorders and the positive effects of psychiatric treatment on cancer outcomes is necessary among patients with cancer, caregivers, and oncologists. Furthermore, it is necessary to adopt a multidisciplinary approach, encouraging patients with cancer to undergo a neuropsychological assessment of their mental health status and receive appropriate and timely psychological interventions.

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

“…Large studies indicated the increase in cancer related mortality to be most severe in male patients with a mental comorbidity (24% increase in females, 39% increase in males) 47 and to positively correlate with the extent of prior use of psychiatric services 48 . Similarly, patients with a first‐onset mental disorder diagnosed after the diagnosis of cancer were at increased risk of cancer‐specific mortality (HR: 1.44–1.82) 49,50 . Psychopharmacology may be seen as a less cost intensive alternative to psychological support by some health care providers 51–53 .…”

“…48 Similarly, patients with a first-onset mental disorder diagnosed after the diagnosis of cancer were at increased risk of cancer-specific mortality (HR: 1.44-1.82). 49,50 Psychopharmacology may be seen as a less cost intensive alternative to psychological support by some health care providers. [51][52][53] Based on this, we hypothesized that presence of a mental disorder or psychopharmacological medication may mislead oncological treatment teams to the assumption that no further psychological support is necessary when cancer is diagnosed, because treatment seems to be established already.…”

Predictors of mental health disorders in women with breast and gynecological cancer after radical surgery: A cross-sectional study

“…According to a recent study, cancer patients with diagnosed cancer-related psychiatric disorders were at higher risk of death. Indeed, among the studied patients, those who received psychiatric treatment had lower mortality rates [ 3 ]. Moreover, several researchers have shown higher rates of anxiety and depression in women with breast and gynecological cancer [ [4] , [5] , [6] , [7] , [8] , [9] ].…”

Cardiogenic shock caused by Takotsubo syndrome complicated with severe anxiety

“…[ 5 ] Patients with cancer and mental disorders have an increased risk of cancer-specific mortality. [ 6 ] CVD and cancer continue to be the leading causes of death worldwide, but the relationship between cancer and CVD remains unclear. [ 7 ]…”