The Role of Mental Health in Cancer Outcomes

A person’s pre-existing mental state may influence their cancer outcome, according to recent study findings.

A team of American and Canadian researchers examined mental health records of 191,068 patients from Ontario who either had bladder (29,884), kidney (23,485) or prostate cancer (137,699). Then they looked at which patients used psychiatric services within the previous five years. Nearly 60% did not use any of the services. However, 41.6% received outpatient treatment, 0.84% received emergency department treatment and 0.40% received hospital admission treatment. All patients were matched with 528,387 patients who never had cancer.

The researchers found a greater risk of people dying from their cancer if they were previously treated for mental health conditions. Compared with people who did not have cancer, these patients had a 1.78 times greater chance of cancer mortality.

“With the increased awareness of mental health in the general population and a decrease in the social stigma, it is of the utmost importance to assess the impact of mental health on outcomes in patients with cancer,” Zachary Klaassen, M.D., an assistant professor at Georgia Cancer Center in Augusta, Georgia, and lead author of the study, said in an interview with CURE®.

Suicide risk was also assessed by the researchers. The study showed patients with any of the three cancer types had higher rates of suicide following their cancer diagnosis. The overall risk of suicide increased by about 16%. That rate jumped to 39% in patients who had no previous history of mental health treatment.

“All patients with cancer should be routinely screened for distress, depression and suicidal ideation and appropriately referred for urgent psychologic/psychiatric evaluation, as necessary,” Klaassen said. “Particularly high-risk groups should be offered counseling or psychiatric referral regardless of suicidal ideation, in addition to smoking-cessation assistance when necessary. (And) patients with suicidal ideation should maintain a close alliance with their oncology team while also undergoing a complete psychiatric evaluation.”

Often, people with cancer can feel overwhelmed, anxious, angry, fearful, afraid, lonely and sad, explained William Goeren, M.S.W., OSW-C, LCSW-R, director of clinical programs at CancerCare. And these feelings could lead to larger mental health concerns, such as depression and anxiety, that could compromise quality of life and identity.

“Hearing the words ‘you have cancer’ sends people into state of shock,” Goeren said. “Then they don’t hear what the oncologist or oncology nurse tells them. When your future is clear and suddenly that is derailed by cancer, it really brings forth a huge wave of emotional responses.”

Klaassen noted four possible reasons as to why there is a greater risk of mortality in patients who have been treated for mental health conditions: First, the stress induced from a major psychiatric diagnosis may result in biologic changes that foretell a worse cancer diagnosis. Second, patients with psychiatric comorbidities may be less likely to adhere to follow-up schedules and more likely to engage in behaviors, such as alcoholism and smoking. Third, patients with psychiatric comorbidities may not be receiving adequate screening and timely or appropriate investigation of cardinal presentations. Last, patients with psychiatric comorbidities may be marginalized and receive substandard care that deviates from established guidelines.

“Patients and caregivers should be cognizant of signs of withdrawing/depression, such as lack of personal care, missing appointments/follow-up and substance abuse,” Klaassen said.

To help stay in the best mindset, patients and caregivers can seek professional support by reaching out to someone on their health care team, such as their oncologist, nurse or social worker. Organizations, like CancerCare or those that are specific to the patient’s disease type, can also be a useful place for support.

“Cancer doesn’t discriminate and it’s important (for patients) not to blame themselves,” Goeren said. “It’s human nature to ask ‘Why?’ and ‘What did I do to create this?’ But ultimately it is ‘What am I going to do about it?’ is where one can create goals and objectives.”

A method used by social workers at CancerCare is talking with people to hear how they have handled emergent issues, catastrophic events or disease in the past — showing them that they may already have the coping mechanisms to handle the diagnosis, Goeren explained.

“Working on your emotional and psychological well-being provides and gives someone a sense of feeling more in control of their lives,” he said. “That is empowering. And it helps them to feel the emotional strength they may have lost.”