Mental Health Screening Is Needed for Patients with Hematologic Cancers

A study presented at the 2020 ASH Annual Meeting found that about one-fifth of patients with hematologic cancers have depression and anxiety at baseline or develop these conditions within three months of cancer diagnosis. “These data suggest a critical need for systematic mental health screening and management for this patient population,” the researchers noted.

The retrospective study used Surveillance Epidemiology and End Results-Medicare data to identify 64,018 patients aged ≥67 years who were diagnosed with a hematologic malignancy (lymphoma [53.4%], myeloma [18.6%], leukemia [18.0%], or myelodysplastic syndromes [10.0%]) between 2000 and 2015 and died prior to Dec. 31, 2016.

Pre-diagnostic depression or anxiety was defined as at least one inpatient or two outpatient Medicare claims for depression or anxiety from 24 months to one month prior to a blood cancer diagnosis. The researchers also examined prevalence of cancer-association depression or anxiety, which was defined as at least one inpatient or two outpatient claims for these conditions between one month prior to and three months after a blood cancer diagnosis.

Most patients in the study were white (89.6%), and 51.0% were female. Among the cohort, 10.6% of patients had pre-diagnostic depression and 7.4% had pre-diagnostic anxiety. Cancer-associated depression and anxiety affected 4.4% and 2.8% of patients, respectively. Overall, about one-fifth of patients (20.7%) met the study’s claims-based definition of having at least one of these four mental health disorders.

Patients with cancer-associated depression, compared with those without depression, were more likely to:

  • Have pre-diagnostic anxiety (10.7% vs. 7.3%; P<0.001).
  • Have a high comorbidity score (37.5% vs. 31.8%; P<0.001).
  • Be female (56.7% vs. 50.6%; P<0.001).
  • Be unmarried (55.3% vs. 52.0%; P=0.001).

Patients with cancer-associated anxiety, compared with those without anxiety, were more likely to:

  • Have pre-diagnostic depression (18.9% vs. 10.4%; P<0.001).
  • Be female (63.2% vs. 50.5%; P<0.001).

“The fact that patients with pre-diagnostic anxiety or depression were at increased risk of developing cancer-associated depression or anxiety respectively emphasizes the importance of additional psychosocial support for patients with preexisting mental disorders,” the researchers noted.

Patients with cancer-associated depression (8.8% vs. 10.5%; P=0.005) and anxiety (7.7% vs. 10.5%; P<0.001) were less likely to be non-white. The researchers called these findings “provocative,” noting that this “suggests that either non-white patients with hematologic malignancies have a lower incidence of these disorders or that the mental health concerns of this population are less likely to be routinely captured.”

Reference

Kuczmarski TM, Jaung T, Mancuso CE, et al. Pre-Diagnostic and Cancer-Associated Depression and Anxiety Among Patients with Hematologic Malignancies in the United States. Abstract 744. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, Dec. 2-11, 2020.