Presenter(s)
E. M. Qiao1, B. J. Jacobs2, S. R. Chintala1,3, K. M. Morgan1,4, D. Sabater Minarim1,4, H. Nguyen1, S. Rajan3,5, R. R. Mckay6,7, T. M. Seibert1,8, M. Banegas1,9, and B. S. Rose1,4; 1Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 2Department of Radiation Medicine and Applied Sciences, University of California - San Diego, La Jolla, CA, 3Center for Health Equity Education & Research, University of California San Diego, San Diego, CA, 4Center for Health Equity, Education and Research, University of California San Diego, La Jolla, CA, 5UCSD School of Public Health, San Diego, CA, 6Division of Hematology Oncology, University of California San Diego, La Jolla, CA, 7University of California, San Diego, La Jolla, CA, 8Research Service, VA San Diego Healthcare System, San Diego, CA, 9UCSD Center for Health Equity, Education, and Research, San Diego, CA
Purpose/Objective(s): Depressive disorders affect 20% of cancer patients and are associated with poorer cancer outcomes, yet depression remains frequently underrecognized and undertreated in oncology settings. We examined associations between preexisting depression and cancer-specific mortality (CSM) in a mixed-tumor cohort and whether early mental health intervention is associated with lower CSM in patients with depression.
Materials/Methods: From Surveillance, Epidemiology, and End Results (SEER)-Medicare, we selected patients age 66+ years with prostate, breast, colorectal, non-small cell lung, or bladder cancer from 2010-2017. International Classification of Diseases (ICD)-9/ICD-10 codes defined depression. Current Procedural Terminology codes identified psychotherapy and Medicare Part D claims identified antidepressants. Multivariate Fine Gray competing risk models with noncancer death as a competing risk assessed the impact of preexisting depression on CSM. In patients with depression, multivariate Fine Gray models examined whether earlier psychotherapy or antidepressant use (within 1, 2, 4, or 8 weeks of cancer diagnosis) were associated with CSM.
Results: Among 254,029 patients (mean [standard deviation] age, 75.4 [7.0] years), 55,634 (22%) had preexisting depression. Patients with depression had 24% higher risk of CSM (subdistribution hazard ratio [SHR]: 1.24, 95% confidence interval [CI]: 1.22-1.26, p<0.001). Among patients with depression, 62% received no treatment within 8 weeks of cancer diagnosis, 4% received psychotherapy, and 36% received antidepressants. Psychotherapy within 1 week of cancer diagnosis was associated with 27% lower risk of CSM (SHR: 0.73, 95% CI: 0.64-0.84, p<0.001) and antidepressants with 7% lower risk (SHR: 0.93, 95% CI: 0.90-0.97, p<0.001). Effects attenuated with longer time interval from cancer diagnosis; at 8 weeks, psychotherapy was associated with 14% lower CSM risk (SHR, 0.86; 95% CI, 0.80-0.93; p<0.001), and antidepressants were no longer significant (Table 1).
Conclusion: Cancer patients with preexisting depression face significantly higher risk of CSM. Early psychotherapy and antidepressant use are associated with lower CSM, with larger effects for psychotherapy. While timely management of comorbid depression is a modifiable strategy to potentially mitigate CSM disparities, mental health interventions remain substantially underused in the cancer population.
Abstract 195 - Table 1: Multivariate Output for Psychotherapy/Antidepressant Effect on Cancer Mortality, by Time Relative to Cancer Diagnosis. SHR: Subdistribution hazard radio; CI: confidence interval; p: p-value| Time, weeks | Pyschotherapy: SHR 95% CI | p | Antidepressant: SHR 95% CI | p |
| 1 | 0.73 [0.64-0.84] | <0.001 | 0.93 [0.90-0.97] | <0.001 |
| 2 | 0.74 [0.66-0.83] | <0.001 | 0.93 [0.90-0.96] | <0.001 |
| 4 | 0.77 [0.71-0.84] | <0.001 | 0.96 [0.93-0.98] | 0.002 |
| 8 | 0.86 [0.80-0.93] | <0.001 | 0.99 [0.96-1.01] | 0.27 |