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Original Investigation
June 4, 2020

Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non–Small Cell Lung Cancer

Author Affiliations
  • 1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 2Department of Medicine, School of Medicine, University of California, San Francisco
  • 3Commonwealth Care Alliance, Boston, Massachusetts
  • 4Division of Pulmonary/Critical Care Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco
  • 5Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 6Division of Hematology/Oncology, San Francisco Veterans Affairs Medical Center, San Francisco, California
JAMA Oncol. 2020;6(7):1055-1062. doi:10.1001/jamaoncol.2020.1466
Key Points

Question  Is mental health treatment associated with improved outcomes for people with preexisting mental health disorders after they are diagnosed with cancer?

Findings  In this cohort study of 55 315 US veterans diagnosed with non–small cell lung cancer, 18 229 had a preexisting mental health disorder, among whom participation in mental health treatment programs was associated with a lower likelihood of being diagnosed with advanced cancer, a higher likelihood of receiving stage-appropriate treatment, and lower all-cause and lung cancer–specific mortality.

Meaning  The findings of this cohort study indicate that investment in mental health may be associated with improved cancer-related outcomes, but further research is needed to identify, evaluate, and implement effective interventions to improve outcomes for people with preexisting mental health disorders who are diagnosed with cancer.

Abstract

Importance  Preexisting mental health disorders (MHDs) are associated with increased mortality in people diagnosed with cancer, yet few data exist on the efficacy of interventions to mitigate this disparity.

Objective  To evaluate the association of participation in mental health treatment programs (MHTPs), housing support programs, or employment support programs with stage at cancer diagnosis, receipt of stage-appropriate treatment, and mortality among patients with a preexisting MHD.

Design, Setting, and Participants  This retrospective, population-based cohort study included 55 315 veterans in the Veterans Affairs Central Cancer Registry (VACCR) who had newly diagnosed non–small cell lung cancer (NSCLC) from September 30, 2000, to December 31, 2011. Data were analyzed from January 15, 2017, to March 17, 2020.

Exposures  Mental health disorders, including schizophrenia, bipolar disorder, depressive disorder, posttraumatic stress disorder, and substance use disorder.

Main Outcomes and Measures  Stage at cancer diagnosis, receipt of stage-appropriate cancer treatment, all-cause mortality, and lung cancer–specific mortality.

Results  Of 55 315 veterans with a new diagnosis of NSCLC included in the analysis (98.1% men; mean [SD] age, 68.1 [9.8] years), 18 229 had a preexisting MHD, among whom participation in MHTPs was associated with a lower likelihood of being diagnosed in a late stage (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), a higher likelihood of receiving stage-appropriate treatment (OR, 1.55; 95% CI, 1.26-1.89; P < .001), lower all-cause mortality (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.72-0.77; P < .001), and lower lung cancer–specific mortality (AHR, 0.77; 95% CI, 0.74-0.80; P < .001). Likewise, participation in housing and employment support programs was associated with similar improvements in all outcomes described above.

Conclusions and Relevance  In veterans with preexisting MHDs diagnosed with NSCLC, participation in MHTPs and housing and employment support programs was associated with improved lung cancer–related outcomes. This study might be the first to demonstrate significant improvement in cancer mortality for patients with MHDs who participate in MHTPs, housing support programs, or employment support programs. This work supports substantial literature that investment in mental health and social needs can improve health outcomes and highlights the importance of further research to identify, evaluate, and implement interventions to improve outcomes for patients with MHDs who are diagnosed with cancer.

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    1 Comment for this article
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    Preexisting mental health disorders in patients with non-small cell lung cancer: effective supporting programs
    Tomoyuki Kawada, MD | Nippon Medical School
    Berchuck et al. evaluated the association of mental health treatment programs (MHTPs), housing support programs, or employment support programs with stage at cancer diagnosis, receipt of stage-appropriate treatment, and mortality among non-small cell lung cancer (NSCLC) patients with a preexisting mental health disorders (MHDs) (1). Adjusted odds ratios (95% confidence intervals [CIs]) of participating programs for being diagnosed in a late stage, receiving stage-appropriate treatment were 0.62 (0.58-0.66) and 1.55 (1.26-1.89), respectively. In addition, the adjusted hazard ratios (HRs) (95% CIs) of participating programs for all-cause mortality and lung cancer-specific mortality were 0.74 (0.72-0.77) and 0.77 (0.74-0.80), respectively. The authors concluded that MHTPs and two supporting programs were effective for NSCLC patients with preexisting MHDs. I have a comment about their study.

    Lin et al. assessed preexisting MHDs and stage at diagnosis, receipt of cancer treatment, and overall survival among patients with NSCLC (2). The adjusted HR (956% CI) of preexisting MHDs for mortality was 1.11 (1.03-1.20). But patients with a preexisting MHDs did not present more advanced NSCLC and they received the same cancer treatments. This means that MHTPs and two supporting programs should be recommended to improve MHDs, which would lead to better prognosis of NSCLC.


    References
    1. Berchuck JE, Meyer CS, Zhang N, et al. Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non-Small Cell Lung Cancer. JAMA Oncol. 2020 Jul 1;6(7):1055-1062.
    2. Lin J, McGlynn KA, Carter CA, et al. The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System. Cancer Epidemiol Biomarkers Prev. 2016 Dec;25(12):1564-1571.
    CONFLICT OF INTEREST: None Reported
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