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.”
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.