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Healio Interview
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Chopra does not report relevant financial information.
Mental health plays a significant role in overall health, and addressing these concerns is no less important in lung cancer patients, experts say.
Deepti Chopra, MBBS, MPH, Assistant professor of psychiatry at the University of Texas MD Anderson Cancer Center, Healio said there are two broad categories among cancer patients who have mental health symptoms: “Those with pre-existing mental health problems and those who may have developed mental health problems precisely because of the cancer diagnosis.” .”
Deepti Chopra
She explained that mental health can affect patient outcomes. For example, Chopra said, “Depression is a small but significant predictor of mortality, and it is also associated with quality of life [and] Compliance with medical treatment.”
Mental health, consequences of lung cancer
In a study published in early 2022, researchers found that patients with non-small cell lung cancer whose symptoms of depression became more severe after diagnosis had a shorter survival time than those whose symptoms of depression improved or remained the same during treatment.
“New data reveal the course of psychological symptoms after diagnosis, the predicted risk of premature mortality from advanced NSCLC, even accounting for the survival benefits of immune and targeted therapies,” Barbara L. Andersen, PhD, Distinguished University Professor in the Department of Psychology at Ohio State University, and colleagues wrote. “Substantial evidence underscores the need for psychological therapies to address the common comorbidities of stress, depression, and anxiety in advanced NSCLC.”
Researchers enrolled patients with newly diagnosed stage IV NSCLC. Patients were excluded from participation if they had been treated with definitive chemo-radiation therapy, had been diagnosed more than 90 days after enrollment, had been treated for more than one month, or had a vision, hearing, or psychiatric condition that she impaired.
Researchers measured patients’ depression and anxiety using the Patient Health Questionnaire-9 (PHQR9), which included a self-report scale that assessed the frequency of symptoms of major depressive disorder over the past two weeks.
Patients completed the questionnaires at baseline and every two months for 2 years, with an overall compliance of 80%.
Researchers used joint modeling analyzes to examine the interaction between a longitudinal model of survival and patients’ psychological symptoms from the time of NSCLC diagnosis to 24 months.
They found that the 2-year course of depressive symptoms was associated with cancer survival (increase in HR per unit in PHQR9 = 1.09; 95% CI, 1.03-1.15).
“Without interventions, concerns remain about patients with suboptimal understanding of their disease and treatment, impaired decision making and commitment to treatment, reduced tolerance for symptoms and treatment side effects, and low motivation to maintain functional status,” wrote Andersen and colleagues. “Attention and improvement in patients’ psychological status may provide additional benefits, extending quality and comfort living and potentially improving overall survival.”
Pre-existing mental illness
In another study, researchers linked improved cancer outcomes in patients with pre-existing mental illnesses who were diagnosed with NSCLC to their participation in mental illness treatment programs and residential and employment programs.
“Our results are consistent with those of several previous studies [preexisting mental health disorders] are associated with increased mortality in patients diagnosed with NSCLC,” Jacob E BerchuckMD, a medical oncologist at the Lank Center for Genitourinary Oncology at the Dana-Farber Brigham Cancer Center and colleagues wrote.
The retrospective, population-based cohort study evaluated 55,315 veterans on the Veterans Affairs Cancer Center registry who were diagnosed with lung cancer from September 30, 2000 to December 31, 2011. Of these patients, 18,229 had pre-existing mental illnesses, such as bipolar disorder, depressive disorder, PTSD, schizophrenia, and substance use disorder.
The researchers found that among patients with a mental disorder, those participating in a mental health treatment program were less likely to be diagnosed with late-stage disease (OR = 0.62; 95% CI, 0.58-0.66) and were more likely to receive treatment appropriate to their disease stage (OR = 1.55; 95% CI, 1.26-1.89).
These patients also had lower lung cancer mortality (adjusted HR = 0.77; 95% CI, 0.74-0.8) and lower all-cause mortality (adjusted HR = 0.74; 95% CI, 0.72-0.77 ) than those who did not participate in a mental health treatment program.
“Overall, we demonstrated in this large population-based study of veterans with pre-existing conditions [mental health disorders] diagnosed with NSCLC that attend [mental health treatment programs]Housing assistance programs and employment assistance programs have been associated with improved cancer-related outcomes,” Berchuck and colleagues wrote, “including a lower likelihood of being diagnosed with late-stage disease, a higher likelihood of receiving stage-appropriate treatment, and lower all-cause and lung cancer-specific mortality compared to non-participants.”
Addressing mental health in cancer treatment
Chopra told Healio that in their practice, doctors can watch for “any kind of emotional distress” in patients with lung cancer.
She explained that emotional stress is “something that needs to be studied further and that stress can derive from anxiety, depression and even confusion, so that would be something that is mental health.” [and] Healthcare providers can generally pick up and initiate the process [mental health] screening.”
She added, “Emotional distress support will help the patient feel heard, feel valued, and then be able to process the information provided as you conduct assessments and treatment planning…all of that.” will sink in there. If it’s something that isn’t addressed, the anxiety gets worse; the depression will get worse.”
During survival, Chopra said, treating mental health issues in patients diagnosed with lung cancer would “help them have a better quality of life [and] Make sure they don’t re-engage in risky behaviors like cigarette smoking, which can worsen their results.
Chopra noted that additional research is needed to assess the role of a more in-depth mental health treatment approach in patients with poor prognosis or patients receiving invasive treatment.
“It’s important to understand the impact of pre-existing mental health diagnoses on lung cancer outcomes, and then just to understand the impact of emotional distress that develops after cancer diagnosis on outcomes,” she said. “It’s an area of research that can be expanded and there are opportunities because it will help guide … when to do screening, when to refer and how to develop a plan for it [mental health care] – all of this will be designed better.”
References:
Andersen BL, et al. psychosome medication. 20225;doi:10.1097/PSY.0000000000001027.
Berchuck JE, et al. JAMA oncology. 2020;doi:10.1001/jamaoncol.2020.1466.
Healio Interview
Central lung cancer
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