Associations Between Mental Health and Surgical Outcomes Among Women Undergoing Mastectomy for Cancer

Abstract

Following diagnosis of breast cancer, many women experience serious psychological distress, which can adversely affect their cancer care and outcomes. We conducted this study to examine the association between mental health conditions and hospital outcomes and costs among women undergoing mastectomy for invasive breast cancer. Using nationally representative data from the 2005 to 2008 Nationwide Inpatient Sample, we identified women aged ≥18 years with invasive breast cancer who underwent inpatient mastectomy (N = 40,202). Individuals with a psychiatric diagnosis (major depressive, posttraumatic stress, panic, adjustment, or generalized anxiety disorder) or substance abuse were compared with those without a mental health condition. Outcomes included risk of complications, prolonged hospitalization (>3 days), and direct costs of care. Multivariable logistic and linear regression analyses were performed to control for sociodemographic and clinical characteristics. Overall, 4.5% of patients had a mental health condition. Patients with substance abuse were more likely than those without to experience both complications (8.5% versus 4.8%; adjusted odds ratio [AOR] = 1.61 [1.30-2.00]) and prolonged hospitalization (26.4% versus 13.6%; AOR = 2.25 [1.95-2.59]), and to have higher average costs ($9,855 versus $9,128, p = 0.009). Presence of psychiatric diagnoses was also significantly associated with increased complications (5.9% versus 4.8%; AOR = 1.21 [1.10-1.34]), prolonged hospitalization (8.5% versus 4.8%; AOR = 1.40 [1.32-1.49]), and higher average costs ($9,723 versus $9,108, p < 0.001). Mental health conditions are associated with poorer outcomes and higher costs in breast cancer patients undergoing inpatient mastectomy. Greater efforts are needed to identify and manage these patients with psychiatric and substance use disorders during the perioperative period.

Clinical anxiety disorders in the context of cancer: A scoping review of impact on resource use and healthcare costs

“…Of the studies identified, only one study was conducted from a societal perspective (Sabariego et al., ) and thus included direct and indirect costs incurred by the patient and society as well as the healthcare system. A further two studies utilised direct costs from a healthcare system perspective (Fox et al., ; Lemieux et al., ). The remaining studies reported resource use with no associated costs (Henry et al., ; Mahal et al., ; Mosher et al., ).…”

“…Of the studies investigating the impact of clinical anxiety on health resource use, Fox et al. () found that for women undergoing mastectomy for breast cancer, comorbid psychopathology was associated with increased postsurgical complications (AOR = 1.24, 95% CI: 1.10–1.34), prolonged hospitalisation (AOR = 2.25, 95% CI: 1.95–2.59) and 13.1% higher average costs (USD $9,723 vs. $9,108, p < 0.001). However, although anxiety was one of a number of disorders identified, pooling of psychiatric data precluded a separate estimation of anxiety‐related costs.…”

“…Despite the high prevalence of clinical anxiety, this review identified only five studies that provided resource use or cost data and a single study that indicated patient resource use intention. Of the studies identified, three studies reported medical and mental health resource use (Fox et al., ; Henry et al., ; Mahal et al., ) and three studies were RCTs of psychological interventions that included health service utilisation or cost as an outcome measure (Lemieux et al., ; Mosher et al., ; Sabariego et al., ). All studies reported direct costs, with only one study also reporting broader societal costs.…”

Apresentação

“…E, ainda, pode ser um fator de risco a curto e longo prazo para o desenvolvimento de depressão e ansiedade em mulheres com câncer de mama (Vahdaninia, Omidvari, & Montazeri, 2010). A manifestação da fadiga, tensão e depressão podem estar associados ainda, ao abandono do tratamento, hábitos de vida nocivos, elevação dos custos com tratamento (Fox et al, 2013) (Marina, Patterson, Villasenor, Flatt, & Pierce, 2014).…”

The Measurable Cost of Complications for Outpatient Cosmetic Surgery in Patients With Mental Health Diagnoses

“…[9][10][11] These adverse outcomes may be related to poor compliance with treatment recommendations or differences in how patients with mental health conditions experience the perioperative environment. [12][13][14][15] Because a patient's contact with the health care system following outpatient cosmetic surgery is brief, difficulty coping postoperatively or the development of complications after discharge may trigger hospital-based acute care encounters such as emergency department visits or hospital admissions.…”