Psychiatric comorbidities, such as depression, anxiety, and substance use disorder, are common among patients with cancer. While numerous studies have examined the short- and long-term impact of a cancer diagnosis on mental health, less is known of the mental health impact of diagnostic testing leading to a cancer diagnosis.
To investigate risk changes in several mental health disorders from cancer diagnostic workup to postdiagnosis, Donghao Lu, M.D., of the Karolinska Institutet and colleagues conducted a matched cohort study of people in Sweden from January 2001 through December 2010, totaling 304,118 patients with cancer and more than 3 million cancer-free individuals randomly selected for comparison.
On the basis of information contained in several Swedish health registers, the authors estimated the time-varying hazard ratios (HRs) of the first clinical diagnosis (made during inpatient or outpatient hospital visit) of depression, anxiety, substance abuse, somatoform/conversion disorder, and stress reaction/adjustment disorder from two years before cancer diagnosis, through the time of diagnosis, and until 10 years after diagnosis. The use of psychiatric medications for patients with cancer was also examined to assess milder mental health conditions and symptoms.
The relative rate for all studied mental disorders started to increase from 10 months before cancer diagnosis (HR=1.1) and peaked during the first week after diagnosis (HR=6.7). Although the rate increase dropped rapidly after this period, the rate remained elevated 10 years later. The rate increase immediately before and after cancer diagnosis was greater among women than men. Among patients with cancer, depression had the highest cumulative incidence during the study, followed by anxiety and stress reaction/adjustment disorder.
Additionally, the authors found that there was increased use of psychiatric medications from one month before cancer diagnosis that peaked about three months after cancer diagnosis and remained elevated two years after diagnosis.
“Although our findings highlight the importance of timely psychological intervention throughout the cancer diagnosis, it remains to be explored whether or not such intervention should be specifically tailored for patients with cancer compared with individuals without such life-threatening conditions,” the authors wrote.
For related information, see the Psychiatric News column "Integrated Psychosocial Care for Cancer Patients” by Jesse Fann, M.D., M.P.H., of the University of Washington.