Prioritizing Mental Health Research in Cancer Patients and Survivors

Martinez, Monica R; Pasha, Amirala S.

doi:10.1001/journalofethics.2017.19.5.msoc2-1705

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…Rates of receipt of mental health and substance abuse preventive services did not differ between cancer survivor and patients with no history of cancer. Cancer survivors have been observed to have increased rates of anxiety, depression, and suicide risk, including being more than twice as likely to have disabling psychological problems as adults without a previous cancer diagnosis [20][21][22][23][24][25]. Overall, less than a quarter of cancer survivors were screened for depression or substance abuse.…”

Section: Discussionmentioning

confidence: 99%

Preventive service utilization among low-income cancer survivors

et al. 2021

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Purpose Adequate access to and utilization of preventive services are vital among cancer survivors. This study examined preventive service utilization of cancer survivors compared to matched patients with no history of cancer among patients seeking care at community health centers (CHCs). Methods We utilized electronic health record data from the OCHIN network between 2014 and 2017. Cancer survivors (N = 20,538) ages ≥ 18 years were propensity score matched to three individuals with no history of cancer (N = 61,617) by age, sex, region, urban/rural, ethnicity, race, BMI, and Charlson Comorbidity Index. Preventive screenings included cancer, mental health and substance abuse, cardiovascular, and infectious disease screenings, and vaccinations. Patient-level preventive service indices were calculated for each screening as the total person-time covered divided by the total person-time eligible. Preventive service rate ratios comparing cancer survivors to patients with no history of cancer were estimated using negative binomial regression. Results Cancer survivors had higher overall preventive service utilization (incidence rate ratio = 1.11, 95% confidence interval = 1.09–1.13) and higher rates of cancer screenings (IRR = 1.16, 95% CI = 1.12–1.20). There was no difference between the two groups in mental health screenings. Conclusions Cancer survivors were more likely to be up-to-date with preventive care than their matched counterparts. However, mental health and substance abuse screenings were low in both groups, despite reports of increased mental health conditions among cancer survivors. Implications for Cancer Survivors With the growing number of cancer survivors in the USA, efforts are needed to ensure their access to and utilization of preventive services, especially related to behavioral and mental healthcare.

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Section: Discussionmentioning

confidence: 99%

Preventive service utilization among low-income cancer survivors

et al. 2021

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“…Distress and depression have been recognized as significant burdens in patients with cancer, negatively impacting engagement, compliance, quality of life, and health care services utilization . Routine screening using validated instruments, rather than inconsistent clinicians’ judgment, has been recommended and implemented by cancer programs . Such screening programs, most often using patient-reported outcomes, could potentially support the identification of distress and risk of NFSI.…”

Section: Discussionmentioning

confidence: 99%

“…A diagnosis of cancer often brings significant emotional and psychological distress . Risk of death and the repercussions of therapy can lead to protracted periods of stress.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada

et al. 2021

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IMPORTANCE Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. OBJECTIVE To examine the risk of NFSI after a cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada. EXPOSURES Demographic and clinical factors. MAIN OUTCOMES AND MEASURESCumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. RESULTSIn total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (<0.1%) died by suicide. The 5-year cumulative incidence of NFSI was 0.27% (95% CI, 0.25%-0.28%). After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care (subdistribution hazard ratio [sHR], 12.6; 95% CI, 10.5-15.2) or outpatient care (sHR, 7.5; 95% CI, 6.5-8.8), and prior self-injury (sHR, 6.6; 95% CI, 5.5-8.0) were associated with increased risk of NFSI.Young adults (age 18-39 years) had the highest NFSI rates relative to individuals aged 70 years or older (sHR, 5.4; 95% CI, 4.5-6.5). The magnitude of association between prior inpatient psychiatric illness and NFSI was greatest for young adults (sHR, 17.6; 95% CI, 12.0-25.8). Certain cancer subsites were also associated with increased risk, including head and neck cancer (sHR, 1.5; 95% CI, 1.2-1.9). CONCLUSIONS AND RELEVANCEIn this study, patients with cancer had a higher incidence of NFSI than suicide after diagnosis. Younger age, history of severe psychiatric illness, and prior self-injury were independently associated with risk of NFSI. These exposures appeared to act synergistically, placing young adults with a prior mental health history at the greatest risk of NFSI. These factors should be used to identify at-risk patients.

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“…Recognition of distress in oncology practices is a priority for cancer agencies . However, linking patients to appropriate psychosocial interventions based on the presence or risk of distress remains a challenge . This problem may come from a limited ability to identify patients at highest risk of harm.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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 [

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Prioritizing Mental Health Research in Cancer Patients and Survivors

Cited by 10 publications

References 10 publications

Preventive service utilization among low-income cancer survivors

Preventive service utilization among low-income cancer survivors

Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada

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

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