Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr;120(8):840-847.
doi: 10.1038/s41416-019-0390-0. Epub 2019 Mar 6.

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

Zachary Klaassen  1   2   3 , Christopher J D Wallis  1 , Hanan Goldberg  1 , Thenappan Chandrasekar  1 , Rashid K Sayyid  3 , Stephen B Williams  4 , Kelvin A Moses  5 , Martha K Terris  3 , Robert K Nam  2   6   7 , David Urbach  2   7   8 , Peter C Austin  2   7 , Paul Kurdyak  2   7   9 , Girish S Kulkarni  10   11   12
Affiliations

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

Zachary Klaassen et al. Br J Cancer. 2019 Apr.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence function for cancer-specific mortality among patients with cancer (a) stratified by psychiatric utilisation gradient (PUG) score (b)
Fig. 2
Fig. 2
Product-limit survival estimate for overall survival among patients with cancer (a) stratified by psychiatric utilisation gradient (PUG) score (b)
See this image and copyright information in PMC

Comment in

References

    1. Massie MJ. Prevalence of depression in patients with cancer. J. Natl. Cancer Inst. Monogr. 2004;32:57–71. doi: 10.1093/jncimonographs/lgh014. - DOI - PubMed
    1. Kisely S, Crowe E, Lawrence D. Cancer-related mortality in people with mental illness. JAMA Psychiatry. 2013;70:209–217. doi: 10.1001/jamapsychiatry.2013.278. - DOI - PubMed
    1. Chang CK, et al. A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival. BMJ Open. 2014;4:e004295. doi: 10.1136/bmjopen-2013-004295. - DOI - PMC - PubMed
    1. Lawrence D, Holman CD, Jablensky AV, Threlfall TJ, Fuller SA. Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates. Acta Psychiatr. Scand. 2000;101:382–388. doi: 10.1034/j.1600-0447.2000.101005382.x. - DOI - PubMed
    1. Kisely S, Sadek J, MacKenzie A, Lawrence D, Campbell LA. Excess cancer mortality in psychiatric patients. Can. J. Psychiatry. 2008;53:753–761. doi: 10.1177/070674370805301107. - DOI - PubMed

Publication types