The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies.

Authors:
Zachary Klaassen
Zachary Klaassen
School of Medicine
United States
Hanan Goldberg
Hanan Goldberg
Tel Aviv University
Israel
Thenappan Chandrasekar
Thenappan Chandrasekar
University of California Davis
Rashid K Sayyid
Rashid K Sayyid
University Health Network
Stephen B Williams
Stephen B Williams
Brigham and Women's Hospital
United States
Kelvin A Moses
Kelvin A Moses
Memorial Sloan-Kettering Cancer Center
New York | United States
Martha K Terris
Martha K Terris
Duke University School of Medicine
United States

Br J Cancer 2019 Apr 6;120(8):840-847. Epub 2019 Mar 6.

Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada.

Background: Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes.

Methods: All residents of Ontario diagnosed with one of the top 10 malignancies (1997-2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM).

Results: A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04-1.06), PUG 2 h 1.36 (95% CI 1.30-1.42), and PUG 3 h 1.73 (95% CI 1.63-1.84). Increasing PUG score was also associated with worse ACM.

Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

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http://dx.doi.org/10.1038/s41416-019-0390-0DOI Listing
April 2019
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