The effect of pre‐existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (<scp>VA</scp>) medical center

Wadia, Roxanne; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven Brad; Connery, Donna; Gunduz‐Bruce, Handan; Rose, Michal G.

doi:10.1002/cam4.483

Cited by 5 publications

(19 citation statements)

References 42 publications

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“…Consistent with our results, two studies in the Veteran Affairs (VA) system, a system providing care to all beneficiaries, did not observe an association between depression and treatment. A recent study in the VA system also did not find differences in the stage at diagnosis or delay in care for colorectal, urothelial, and head and neck cancer between patients with and without mental health problems(57). The authors concluded that mental health is not a barrier to cancer staging or treatment in the VA system that integrated mental health care and routine health care(57).…”

Section: Discussionmentioning

confidence: 98%

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

Lin

McGlynn

Carter

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed pre-existing mental health disorders and stage at diagnosis, receipt of cancer treatment and overall survival among non-small cell lung cancer (NSCLC) patients in the U.S. MHS. Methods The study used data from the linked database from the Department of Defense’s Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007. Results Patients with a pre-existing mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without (Adjusted Hazard ratio (HR) =1.11, 95% CI=1.03 to 1.20). Conclusions Poor survival in NSCLC in patients with a pre-existing mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment. Impact This study contributes to the current understanding that health care access is not sufficient to explain the poor survival among NSCLC patients with pre-existing mental health disorder.

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Section: Discussionmentioning

confidence: 98%

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

Lin

McGlynn

Carter

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Patients with SMI encounter barriers to care: for instance, patients with SMI are less likely than those without SMI to receive cancer screening and/or preventive care services . Moreover, cancer patients with SMI are less likely to receive definitive treatment . While numerous studies have examined the treatment and all‐cause survival of prostate cancer patients with low or intermediate grade disease, few if any have compared the treatment and cancer‐specific survival of high‐grade prostate cancer patients with and without SMI.…”

Section: Introductionmentioning

confidence: 99%

Impact of serious mental illness on the treatment and mortality of older patients with locoregional high‐grade (nonmetastatic) prostate cancer: retrospective cohort analysis of 49 985 SEER‐Medicare patients diagnosed between 2006 and 2013

Fried

Sadeghi‐Nejad

et al. 2019

Cancer Medicine

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Background The influence of serious mental illness (SMI) on the treatment and survival of patients with high‐grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer‐specific mortality of SEER‐Medicare patients with locoregional high‐grade (nonmetastatic) prostate cancer with and without preexisting SMI. Methods We identified SEER‐Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high‐grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan‐Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5‐year cancer‐specific survival. Results Among 49 985 patients with locoregional high‐grade (nonmetastatic) prostate cancer, 523 (1.1%) had SMI and 49 462 (98.9%) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95% CI: 0.49‐0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95% CI: 0.67‐0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5‐year cancer‐specific death (HR = 1.41, 95% CI: 1.06‐1.89) after accounting for competing risks of non‐cancer death. Conclusion Among SEER‐Medicare patients with locoregional high‐grade (nonmetastatic) prostate cancer, those with preexisting SMI—relative to those without these conditions—were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer‐specific survival 5 years after diagnosis.

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“…Three studies, all from the US 15,22,42 explored differences in time from cancer diagnosis to the receipt of cancer treatment between patients with and without PMHD. The first included 408 patients with an axis I mental health disorders (as defined by the Diagnostic and Statistical Manual of Mental Disorders IV, DSM-IV) at least 1 year prior to the diagnosis of colorectal, urothelial, and head/neck cancers.…”

Section: Time From Cancer Diagnosis To Cancer Treatmentsmentioning

confidence: 99%

Impact of pre‐existing mental health disorders on the receipt of guideline recommended cancer treatments: A systematic review

et al. 2023

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Objective: Disparities in cancer outcomes for individuals with pre-existing mental health disorders have already been identified, particularly for cancer screening and mortality. We aimed to systematically review the influence on the time from cancer diagnosis to cancer treatment, treatment adherence, and differences in receipt of guideline recommended cancer treatment. Methods:We included international studies published in English from 1 January 1995 to 23 May 2022 by searching MEDLINE, Embase, and APA PsycInfo.Results: This review identified 29 studies with 27 being published in the past decade. Most studies focused on breast, non-small cell lung and colorectal cancer and were of high or medium quality as assessed by the Newcastle Ottawa Scale. All studies were from high-income countries, and mostly included patients enrolled in national health insurance systems. Five assessed the impact on treatment delay or adherence, and 25 focused on the receipt of guideline recommended treatment. 20/ 25 studies demonstrated evidence that patients with pre-existing mental health disorders were less likely to receive guideline recommended therapies such as surgery or radiotherapy. In addition, there was a greater likelihood of receiving less intensive or modified treatment including systemic therapy.Conclusions: Across different cancer types and treatment modalities there is evidence of a clear disparity in the receipt of guideline recommended cancer treatment for patients with pre-existing mental health disorders. The effect of pre-existing mental health disorders on treatment delay or adherence is under-researched.Future research needs to include low-and middle-income countries as well as qualitative investigations to understand the reasons for disparities in cancer treatment.

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The effect of pre‐existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

Cited by 5 publications

References 42 publications

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

Impact of serious mental illness on the treatment and mortality of older patients with locoregional high‐grade (nonmetastatic) prostate cancer: retrospective cohort analysis of 49 985 SEER‐Medicare patients diagnosed between 2006 and 2013

Impact of pre‐existing mental health disorders on the receipt of guideline recommended cancer treatments: A systematic review

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