LIVING WITH DEPRESSION, post-traumatic stress disorder, substance use disorder and other mental health disorders can make cancer diagnosis, treatment and survivorship even more challenging. But findings published in the July 2020 issue of JAMA Oncology offer cause for hope.
“We’ve known for a long time that for patients diagnosed with cancer, among other chronic diseases, mental illness is associated with worse outcomes,” says Jacob E. Berchuck, a medical oncologist at Dana-Farber Cancer Institute in Boston and an author of the study. “We were interested in whether mental health treatment and addressing social needs would be associated with improved outcomes for patients with cancer.”
Berchuck and his colleagues analyzed electronic health records from the Veterans Affairs Central Cancer Registry, comprising data on 55,315 veterans who were newly diagnosed with non-small cell lung cancer between Sept. 30, 2000, and Dec. 31, 2011. Among the 18,229 patients who had a preexisting mental health diagnosis, those who were receiving treatment for that condition were more likely to be diagnosed at an earlier stage of cancer, more likely to receive more appropriate treatment for the stage of their cancer, and less likely to die from any cause within five years of their cancer diagnosis. Treatments included psychotherapy, post-traumatic stress disorder therapy and programs to address substance use.
At the time of the study, Berchuck was a trainee at the University of California, San Francisco Veterans Affairs Medical Center, part of the largest health care system in the United States. Unlike some health care systems in the U.S., the Veterans Health Administration integrates mental health programs as well as housing and employment support into its health care services.
The findings couldn’t come at a more important time, says Kimlin Tam Ashing, a psycho-oncologist who studies health disparities and strategies for overcoming them as the founding director of the Center of Community Alliance for Research & Education at City of Hope, a comprehensive cancer center in Duarte, California. Ashing was not involved in the study. Disparities in cancer outcomes have long been documented between white people and people of color, and between socioeconomically advantaged people and those who experience socioeconomic disadvantages, including unemployment and unstable housing. These factors show no signs of waning, says Ashing, pointing to the economic instability and social disruptions exacerbated by the pandemic, as well as ongoing calls for racial equity. “This finding provides evidence that supportive care and psycho-social care is an important part of cancer care,” says Ashing. “This is where the evidence starts building to inform insurance payers to provide coverage for these services, and for policy and legislative demand for whole-person services.”
She also urges people with cancer and those at increased risk of developing cancer to pursue emotional support and mental health treatment, free of embarrassment or shame. “It’s important to reach out,” she says. “It clearly has benefits for health and well-being, including lung cancer outcomes, if we address both mental and physical health needs.”
As a clinician, Berchuck says the data affirm his commitment to whole-person care. “My hope is that this educates the oncology community about the importance of screening patients and knowing how—within your health system—to get your patient the support services they need. I don’t want to be dramatic and say it’s a matter of life and death, but the study supports the idea that people are more likely to be diagnosed with early-stage, treatable disease when they’re in mental health treatment.”
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