Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study.

in The Lancet. Haematology by Thomas M Kuczmarski, Angela C Tramontano, Lee Mozessohn, Ann S LaCasce, Lizabeth Roemer, Gregory A Abel, Oreofe O Odejide

TLDR

  • The study found that people with depression, anxiety, or both before being diagnosed with a type of cancer called diffuse large B-cell lymphoma (DLBCL) had a lower chance of surviving 5 years compared to people without these mental health disorders. The study also found that people with depression had the worst survival compared to those with no mental health disorder. The study suggests that mental health disorders can affect the survival of people with cancer and that early identification and management of these disorders could improve their prognosis and quality of life. The study also highlights the need for universal and systematic mental health screening for people with cancer to identify and manage these disorders.

Abstract

Mental health disorders can potentially decrease quality of life and survival in patients with cancer. Little is known about the survival implications of mental health disorders in patients with diffuse large B-cell lymphoma (DLBCL). We aimed to evaluate the effect of pre-existing depression, anxiety, or both on survival in a US cohort of older patients with DLBCL. Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we identified patients aged 67 years or older, diagnosed with DLBCL in the USA between Jan 1, 2001, and Dec 31, 2013. We used billing claims to identify patients with pre-existing depression, anxiety, or both before their DLBCL diagnosis. We compared 5-year overall survival and lymphoma-specific survival between these patients and those without pre-existing depression, anxiety, or both using Cox proportional analyses, adjusting for sociodemographic and clinical characteristics, including DLBCL stage, extranodal disease, and B symptoms. Among 13 244 patients with DLBCL, 2094 (15·8%) had depression, anxiety, or both disorders; 6988 (52·8%) were female, and 12 468 (94·1%) were White. The median follow-up for the cohort was 2·0 years (IQR 0·4-6·9 years). 5-year overall survival was 27·0% (95% CI 25·1-28·9) for patients with these mental health disorders versus 37·4% (36·5-38·3) for those with no mental health disorder (hazard ratio [HR] 1·37, 95% CI 1·29-1·44). Although survival differences between mental health disorders were modest, those with depression alone had the worst survival compared with no mental health disorder (HR 1·37, 95% CI 1·28-1·47), followed by those with depression and anxiety (1·23, 1·08-1·41), and then anxiety alone (1·17, 1·06-1·29). Individuals with these pre-existing mental health disorders also had lower 5-year lymphoma-specific survival, with depression conferring the greatest effect (1·37, 1·26-1·49) followed by those with depression and anxiety (1·25, 1·07-1·47) and then anxiety alone (1·16, 1·03-1·31). Pre-existing depression, anxiety, or both disorders present within 24 months before DLBCL diagnosis, worsens prognosis for patients with DLBCL. Our data underscore the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival. American Society of Hematology, National Cancer Institute, Alan J Hirschfield Award.

Overview

  • The study aimed to evaluate the effect of pre-existing depression, anxiety, or both on survival in a US cohort of older patients with diffuse large B-cell lymphoma (DLBCL).
  • The study used the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database to identify patients aged 67 years or older, diagnosed with DLBCL in the USA between Jan 1, 2001, and Dec 31, 2013. Pre-existing depression, anxiety, or both disorders were identified using billing claims before DLBCL diagnosis. The study compared 5-year overall survival and lymphoma-specific survival between these patients and those without pre-existing depression, anxiety, or both using Cox proportional analyses, adjusting for sociodemographic and clinical characteristics, including DLBCL stage, extranodal disease, and B symptoms. The median follow-up for the cohort was 2.0 years (IQR 0.4-6.9 years).
  • The primary objective of the study was to determine the effect of pre-existing depression, anxiety, or both on survival in patients with DLBCL.

Comparative Analysis & Findings

  • The study found that patients with pre-existing depression, anxiety, or both disorders had a lower 5-year overall survival compared with those with no mental health disorder (hazard ratio [HR] 1.37, 95% CI 1.29-1.44).
  • Individuals with pre-existing depression, anxiety, or both disorders also had lower 5-year lymphoma-specific survival, with depression conferring the greatest effect (1.37, 1.26-1.49) followed by those with depression and anxiety (1.25, 1.07-1.47) and then anxiety alone (1.16, 1.03-1.31).
  • The study also found that pre-existing depression, anxiety, or both disorders present within 24 months before DLBCL diagnosis worsened prognosis for patients with DLBCL.

Implications and Future Directions

  • The study highlights the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival. The study also suggests that early identification and management of mental health disorders in patients with DLBCL could improve their prognosis and quality of life. Future research should focus on developing interventions to improve mental health outcomes in patients with DLBCL and evaluate the effectiveness of these interventions in improving survival and quality of life. Additionally, studies should investigate the impact of different types of mental health disorders on survival in patients with DLBCL and explore potential interactions between mental health disorders and other comorbidities in this population.
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