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Original Investigation
February 28, 2019

Association of Head and Neck Cancer With Mental Health Disorders in a Large Insurance Claims Database

Author Affiliations
  • 1Medical student at College of Medicine, Pennsylvania State University, Hershey
  • 2Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey
  • 3Department of Neurosurgery, College of Medicine, Pennsylvania State University, Hershey
  • 4Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, College of Medicine, Pennsylvania State University, Hershey
JAMA Otolaryngol Head Neck Surg. 2019;145(4):339-344. doi:10.1001/jamaoto.2018.4512
Key Points

Questions  What are the changes in prevalence of mental health disorders in patients after diagnosis of head and neck cancer, and what are the associated risk factors?

Findings  In this cohort study of 52 641 patients with a diagnosis of head and neck cancer, the proportion with mental health disorders was 29.9% vs 20.6% before the cancer diagnosis.

Meaning  Patients with head and neck cancer should be monitored for mental health disorders.

Abstract

Importance  Although a few studies have shown that mental health disorders (MHDs) are strongly associated with the 5-year survival and recurrence rates in patients with head and neck cancer (HNC), none have been replicated in a large-scale study.

Objective  To describe the prevalence of MHDs in patients with HNC and the potential associations with survival and recurrence using a large insurance claims database.

Design, Setting, and Participants  This retrospective cohort study assessed data queried from the MarketScan database from January 1, 2005, through December 31, 2014, for 52 641 patients with a diagnosis of HNC. To exclude patients with a preexisting HNC diagnosis or those with incomplete data, patients were included if they were in the database for at least 12 months before the index diagnosis and continuously enrolled. Data were analyzed from February 20, 2017, through January 22, 2019.

Main Outcomes and Measures  To compare the frequency of MHDs before and after diagnosis of HNC, χ2 tests for independence were used. Adjusted adds ratios (aORs) were obtained using multivariable logistic regression by comparing the prevalence of MHDs in patients with oral cavity cancer and those with other cancer sites in the head and neck.

Results  Among the 52 641 patients included in the analysis (mean [SD] age, 51.31 [9.79] years), men (58.5%), patients aged 55 to 64 years (46.6%), and those from the South (40.3%) were most commonly affected by HNC. Oral cavity cancers (40.4%) were the most common type, followed by cancers of the oropharynx (19.2%) and larynx (15.5%). Of the various cancer sites, the OR for MHD prevalence was significantly increased in patients with cancers of the trachea compared with the oral cavity (2.11; 95% CI, 1.87-2.38). The prevalence of MHDs in patients with HNC increased to 29.9% compared with 20.6% before the cancer diagnosis. Specifically, women (adjusted OR, 1.58; 95% CI, 1.49-1.67) and patients with a history of tobacco use (adjusted OR, 1.42; 95% CI, 1.34-1.50) and alcohol use (adjusted OR, 1.56; 95% CI, 1.38-1.76) had significantly higher odds of MHDs after the diagnosis of HNC.

Conclusions and Relevance  Although the baseline MHD prevalence of 20.6% before the cancer diagnosis was close to the national average (17.9% according to the National Survey on Drug Use and Health), results of this study showed that it increased to 29.9% after the cancer diagnosis. Women and patients with a history of tobacco and alcohol use were most susceptible to being diagnosed with an MHD. There is an association between patients with HNC and an increased prevalence of MHDs after treatment compared with the general population.

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