TOPLINE:

Mental health disorders diagnosed within 12 months of cancer diagnosis were associated with a more than 50% increased risk for all-cause mortality in the initial 12-35 months after diagnosis. Among 371,897 patients with cancer and no prior mental health disorders, more than 10% developed new disorders within a year of diagnosis, and 35% received psychotropic medications.

METHODOLOGY:

• Cancer diagnoses often trigger psychological distress and new mental health disorders, which can lead to increased morbidity and mortality. Although prior studies have highlighted the adverse effects that newly diagnosed mental health disorders have on cancer management and survival, they were limited by small sample sizes or reliance on self-reported symptoms.
• In this study, researchers analyzed data from electronic health records from the University of California Data Discovery Platform and the University of California Health Data Warehouse, including 371,897 patients (mean age, 62.1 years) with a new cancer diagnosis between January 2013 and January 2023 and no documented mental health disorder before diagnosis.
• Early mental health disorders were defined as newly diagnosed psychotic, mood, or anxiety disorders within 12 months of cancer diagnosis. Initiation of a new psychotropic medication within 12 months was also assessed.
• The primary outcome was all-cause mortality. The median follow-up duration after cancer diagnosis was 28.2 months.
• Overall, 39,687 patients (10.6%) developed a new mental health disorder within 12 months of a cancer diagnosis; the likelihood of a new mental health disorder diagnosis rose 3 months before cancer diagnosis and peaked in the first 6 months after diagnosis. The most frequently diagnosed early mental health disorders were generalized anxiety disorder (43.0%), major depressive disorder (35.5%), and reactive/adjustment disorder (10.5%).

TAKEAWAY:

• Early mental health disorders were associated with increased all-cause mortality during the first 12-35 months (HR, 1.51; 95% CI, 1.47-1.56) after a cancer diagnosis. The association attenuated over time, with HRs of 1.17 (95% CI, 1.11-1.24) at 36-59 months and 0.95 (95% CI, 0.89-1.01) at 60-120 months.
• Among patients with early mental health disorders, 13,904 (35.0%) were newly prescribed at least one oral psychotropic medication. Benzodiazepines were the most frequently prescribed class (24.6% of all patients with cancer), followed by non-selective serotonin reuptake inhibitor antidepressants (9.4%) and selective serotonin reuptake inhibitors (8.9%).
• In patients with early mental health disorders who were prescribed psychotropic medications, the risk for all-cause mortality was highest in the first 12-35 months after a cancer diagnosis (HR, 2.67; 95% CI, 2.52-2.83), which decreased in 36-59 months (HR, 1.25; 95% CI, 1.07-1.46) and was no longer significant at 60-120 months (HR, 1.01; 95% CI, 0.82-1.25).
• The likelihood of early mental health disorders varied by cancer type and was higher in cancers with poorer prognoses. For instance, patients with pancreatic cancer (which has a 5‐year rate of overall survival of about 11%) had significantly higher odds of an early diagnosis of mental health disorders (odds ratio, 3.2; 95% CI, 2.98-3.46) than those with prostate cancer.

IN PRACTICE:

“Patients with cancer who experience a mental health condition and are prescribed psychotropic medication after their diagnosis are at an increased risk of all‐cause mortality,” the authors of the study wrote, noting that the findings “reinforce and emphasize existing recommendations for prompt screening and management of distress and mental health following a cancer diagnosis.”

SOURCE:

The study, led by Amir Ashraf Ganjouei, MD, MPH, Bakar Computational Health Sciences Institute, University of California, San Francisco, was published online in Cancer.

LIMITATIONS:

The study data lacked accurate information on severity of mental health disorders , cancer stage, and treatment modalities received and did not include information about indications for prescribing psychotropic medications. The sample size limited the ability to perform robust stratified analyses by mental health disorder subtype, and detailed cause of death data were not available. Additionally, the incidence of early mental health disorders identified likely represented an underestimation of actual psychological distress prevalence compared with estimates from direct assessments.

DISCLOSURES:

The authors did not disclose any funding information. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.