Mental Health Screening Is Needed in Blood Cancer Space

Thomas Kuczmarski, MD

Data from a recent analysis demonstrated that more than one in five people experienced depression or anxiety, either before or not long after receiving a blood cancer diagnosis, highlighting the need for further mental health screening in these individuals.

“(This study) highlights the critical need for systematic mental health screening and management for individuals with hematologic malignancies,” said Dr. Thomas M. Kuczmarski during a virtual presentation of the data at the ASH Annual Meeting and Exposition.

Historically, according to Kuczmarski, most of the available data detailing the impact of depression and anxiety on individuals with cancer involve patients with solid tumors. In fact, there are very little data assessing mental health disorders in those with blood cancers.

“These mental health disorders can decrease the quality of life, delay onset of cancer therapy and even decrease overall survival,” Kuczmarski, a resident physician at Brigham and Women’s Hospital, said.

As a result, Kuczmarski and colleagues wanted to evaluate the prevalence of mental health disorders in a cohort of patients with blood cancers who were aged 67 years and older.

Using data from the Surveillance Epidemiology and End Results (SEER) Medicare database, the researchers identified a large cohort of patients who were diagnosed with a blood cancer between 2000 and 2015. Patients were included in the analysis if they had died between 2000 and 2016, but were excluded if they did not survive greater than 30 days from when they were first diagnosed.

Researchers measured a patient’s depression or anxiety prior to diagnosis, which was defined as one or more inpatient, or two or more outpatient claims for either mental health disorder 24 months to one month prior to blood cancer diagnosis. Moreover, researchers analyzed cancer-associated depression or anxiety, which consisted of either one or more inpatient, or two or more outpatient claims for either disorder one month prior to, or three months after, cancer diagnosis.

More than half of the 64,018 patients included in the analysis were diagnosed with lymphoma (53.4%). The remaining patients were either diagnosed with myeloma (18.6%), leukemia (18%) or myelodysplastic syndromes (10%).

Among the entire patient cohort, 20.7% had at least one of the assessed mental health disorders. Some of the patients (10.6%) had depression prior to their blood cancer diagnosis, and an additional 4.4% developed depression that was associated with their cancer. Additionally, 7.4% of the cohort had pre-diagnostic anxiety, and an additional 2.8% developed the mental health disorder after their cancer diagnosis.

Following a univariable analysis, patients with cancer-associated depression were more likely to have had pre-diagnostic anxiety (10.7%) compared with patients who did not have cancer-associated depression (7.3%). Patients with cancer-associated anxiety were also more likely to have presented with pre-diagnostic depression (18.9%) compared with patients who did not have cancer-associated anxiety (10.4%).

“Given our finding that the biggest risk factor for developing cancer-associated depression or anxiety was actually a preexisting mental health disorder, we believe that additional psychosocial support for individuals with baseline mental health illness is crucial,” said Kuczmarski.

However, he acknowledged that there were some limitations with the data.

“We use billing claims as merely a proxy for depression and anxiety diagnoses, and therefore, they may underestimate the true rate of these mental health disorders,” he concluded. “Secondly, we were unable to obtain the strategies that oncologists used to diagnose and manage cancer-associated depression and anxiety. And lastly, our cohort was all age 67 years or older. So therefore, the generalizability of our findings to younger patients may be limited.”