Mental health conditions contribute to PCa-related costs

Mood and adjustment disorders like anxiety and depression were strong predictors of the annual number of outpatient visits, hospital admissions, and number of days in the hospital for patients with prostate and breast cancer, according to the results of a study presented at the American Society of Clinical Oncology’s Quality Care Symposium in Orlando, FL.

The data, presented by Diana Jeffery, PhD, of the Center for Healthcare Management Studies at the U.S. Department of Defense, were taken from the U.S. Military Health System.

“Just as we’re helping patients who are undergoing treatment and experiencing physical side effects, we should be doing the same thing when it comes to a patient’s mental health. Early and frequent mental health assessments are essential not only to improving quality of life, but also to avoiding unnecessary hospital admissions,” Dr. Jeffery said in an ASCO press release.

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Badar M. Mian, MD, of Albany Medical College, Albany, NY, commented on the findings to Urology Times.

“Mental health challenges are prevalent in our patients with invasive cancers, but these are often undiagnosed and under-appreciated as a significant source of morbidity for the patients and cost to the health care system. While the subjects of this study were men and women in the Military Health System, the results can be applied to the general population,” said Dr. Mian, who was not involved with the study.

The study was designed to compare rate of mental health comorbidities between Department of Defense beneficiaries with prostate or breast cancer. Dr. Jeffery and colleagues looked at outcomes related to depression, anxiety, adjustment disorders, alcohol or drug use disorders, and serious, persistent mental illness. The study included data on 9.5 million beneficiaries and was composed of military retirees and family members aged 18 to 64 years.

Patients with breast cancer had significantly higher rates of depression/anxiety/adjustment disorders, substance abuse disorders, and serious persistent mental illness compared with patients with prostate cancer.

Next: What the authors found

The strongest predictors for annual prostate cancer costs were chemotherapy, radiation therapy, surgery, and mood or adjustment disorder (p<.0001), according to the ASCO press release. Men with prostate cancer and a mood or adjustment disorder had 6.7% more ambulatory visits, 2.9% more hospital admissions, and 8.4% more hospital bed days compared to their counterparts without these disorders.

Mood and adjustment disorder comorbidities accounted for an additional 2,600 admissions per year for men with prostate cancer. Additionally, presence of these disorders added 65,000 days in the hospital and 169,000 outpatients visits for patients with prostate cancer.

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“Those of us who care for patients with various cancers know that there is a wide range of psychological responses to the initial diagnosis, during treatment, and the remission period,” Dr. Mian said. “If anything, this study likely underestimates the burden of mental health challenges faced by our patients with cancer.”

Finally, a cost analysis showed that mood and adjustment disorders were strong predictors of cost for both disease types. These disorders increased costs by $8,000 a year for a patient with prostate cancer.

“Mental health evaluations should begin immediately after the initial diagnosis and should be pursued with a similar vigor as the CT scan for staging of the cancer,” Dr. Mian said. “Mental health evaluation should probably be a quality measure for those providers who are managing patients with invasive or advanced malignancies.”

More on Prostate Cancer:

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PCa: Emotional distress influences treatment decision

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