The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies

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Abstract

Background

Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes.

Methods

All residents of Ontario diagnosed with one of the top 10 malignancies (1997–2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM).

Results

A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04–1.06), PUG 2 h 1.36 (95% CI 1.30–1.42), and PUG 3 h 1.73 (95% CI 1.63–1.84). Increasing PUG score was also associated with worse ACM.

Conclusions

Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

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Most cited references 22

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Prevalence of depression in patients with cancer.

Mary Jane Massie (2004)

Depression is the psychiatric syndrome that has received the most attention in individuals with cancer. The study of depression has been a challenge because symptoms occur on a broad spectrum that ranges from sadness to major affective disorder and because mood change is often difficult to evaluate when a patient is confronted by repeated threats to life, is receiving cancer treatments, is fatigued, or is experiencing pain. Although many research groups have assessed depression in cancer patients since the 1960s, the reported prevalence (major depression, 0%-38%; depression spectrum syndromes, 0%-58%) varies significantly because of varying conceptualizations of depression, different criteria used to define depression, differences in methodological approaches to the measurement of depression, and different populations studied. Depression is highly associated with oropharyngeal (22%-57%), pancreatic (33%-50%), breast (1.5%-46%), and lung (11%-44%) cancers. A less high prevalence of depression is reported in patients with other cancers, such as colon (13%-25%), gynecological (12%-23%), and lymphoma (8%-19%). This report reviews the prevalence of depression in cancer patients throughout the course of cancer.

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Cancer-related mortality in people with mental illness.

Stephen Kisely, Elizabeth Crowe, David Lawrence (2013)

CONTEXT There is a 30% higher case fatality rate from cancer in psychiatric patients even though their incidence of cancer is no greater than in the general population. The reasons are unclear, but if increased cancer mortality were due to lifestyle only, cancer incidence should be similarly increased. Other hypotheses include delays in presentation, leading to more advanced staging at diagnosis, and difficulties in treatment access following diagnosis. OBJECTIVE To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it. DESIGN, SETTING, AND PATIENTS A population-based record-linkage analysis compared psychiatric patients with the Western Australian population, using an inception cohort to calculate rates and hazard ratios. Mental health records were linked with cancer registrations and death records from January 1, 1988, to December 31, 2007, in Western Australia. MAIN OUTCOME MEASURES Metastases, incidence, mortality, and access to cancer interventions. RESULTS There were 6586 new cancers in psychiatric patients. Cancer incidence was lower in psychiatric patients than in the general population in both males (rate ratio = 0.86; 95% CI, 0.82-0.90) and females (rate ratio = 0.92; 95% CI, 0.88-0.96), although mortality was higher (males: rate ratio = 1.52; 95% CI, 1.45-1.60; females: rate ratio = 1.29; 95% CI, 1.22-1.36). The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients (7.1%; 95% CI, 6.5%-7.8%) than in the general population (6.1%; 95% CI, 6.0%-6.2%). Psychiatric patients had a reduced likelihood of surgery (hazard ratio = 0.81; 95% CI, 0.76-0.86), especially resection of colorectal, breast, and cervical cancers. They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions. CONCLUSIONS Although incidence is no higher than in the general population, psychiatric patients are more likely to have metastases at diagnosis and less likely to receive specialized interventions. This may explain their greater case fatality and highlights the need for improved cancer screening and detection.

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Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada.

Walter P Wodchis, David Anderson, Carl van Walraven … (2011)

Administrative healthcare databases are increasingly used for health services and comparative effectiveness research. When comparing outcomes between different treatments, interventions, or exposures, the ability to adjust for differences in the risk of the outcome occurring between treatment groups is important. Similarly, when conducting healthcare provider profiling, adequate risk-adjustment is necessary for conclusions about provider performance to be valid. There are limited validated methods for risk adjustment in ambulatory populations using administrative healthcare databases. To examine the ability of the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) to predict mortality in a general ambulatory population cohort. Retrospective cohort constructed using population-based administrative data. All 10,498,413 residents of Ontario, Canada between the ages of 20 and 100 years who were alive on their birthday in 2007. Subjects were randomly divided into derivation and validation samples. Death within 1 year of the subject's birthday in 2007. A logistic regression model consisting of age, sex, and indicator variables for 28 of the 32 ADG categories had excellent discrimination: the c-statistic (equivalent to the area under the receiver operating characteristic curve) was 0.917 in both derivation and validation samples. Furthermore, the model showed very good calibration. In comparison, the use of the Charlson comorbidity index or the Elixhauser comorbidities resulted in a minor decrease in discrimination compared with the use of the ADGs. Logistic regression models using age, sex, and the John Hopkins ADGs were able to accurately predict 1-year mortality in a general ambulatory population of subjects.

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Author and article information

Contributors

Girish S. Kulkarni: +416-946-2246 , girish.kulkarni@uhn.ca

Journal

Journal ID (nlm-ta): Br J Cancer

Journal ID (iso-abbrev): Br. J. Cancer

Title: British Journal of Cancer

Publisher: Nature Publishing Group UK (London )

ISSN (Print): 0007-0920

ISSN (Electronic): 1532-1827

Publication date (Electronic): 6 March 2019

Publication date (Print): 16 April 2019

Volume: 120

Issue: 8

Pages: 840-847

Affiliations

[1 ]ISNI 0000 0001 2150 066X, GRID grid.415224.4, Department of Surgery, Division of Urology, University of Toronto, University Health Network, , Princess Margaret Cancer Centre, ; Toronto, ON Canada

[2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Institute for Health Policy, Management and Evaluation, , University of Toronto, ; Toronto, ON Canada

[3 ]ISNI 0000 0001 2284 9329, GRID grid.410427.4, Division of Urology, , Medical College of Georgia–Augusta University, ; Augusta, GA USA

[4 ]ISNI 0000 0001 1547 9964, GRID grid.176731.5, Division of Urology, , The University of Texas Medical Branch at Galveston, ; Galveston, TX USA

[5 ]ISNI 0000 0004 1936 9916, GRID grid.412807.8, Department of Urological Surgery, , Vanderbilt University Medical Center, ; Nashville, TN USA

[6 ]ISNI 0000 0000 9743 1587, GRID grid.413104.3, Division of Urology, , Sunnybrook Health Sciences Centre, ; Toronto, ON Canada

[7 ]ISNI 0000 0000 8849 1617, GRID grid.418647.8, Institute for Clinical Evaluative Sciences, ; Toronto, ON Canada

[8 ]ISNI 0000 0004 0474 0188, GRID grid.417199.3, Department of Surgery, University of Toronto, , Women’s College Hospital, ; Toronto, ON Canada

[9 ]ISNI 0000 0000 8793 5925, GRID grid.155956.b, Institute for Mental Health Policy Research, , Centre for Addiction and Mental Health, ; Toronto, ON Canada

Author information

Christopher J. D. Wallis http://orcid.org/0000-0002-5990-4026

Article

Publisher ID: 390

DOI: 10.1038/s41416-019-0390-0

PMC ID: 6474265

PubMed ID: 30837680

SO-VID: db627b61-ad9d-44c9-9f88-c91476b6f91a

License:

This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

History

Date received : 19 August 2018

Date revision received : 11 December 2018

Date accepted : 14 January 2019

Funding

Funded by: FundRef https://doi.org/10.13039/100008469, Canadian Urological Oncology Group (Canadian Urologic Oncology Group);

Award ID: N/A

Award Recipient : Zachary Klaassen Girish S. Kulkarni

Funded by: Full name of funder: CUA-CUOG-Astellas

Funded by: Full grant name: CUA-CUOG-Astellas

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer epidemiology,cancer therapy

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer epidemiology, cancer therapy

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The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies

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Most cited references 22

Prevalence of depression in patients with cancer.

Cancer-related mortality in people with mental illness.

Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada.

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