Meeting News

Anxiety, depression predict increased medical use in patients with breast, prostate cancer

Mood and adjustment disorders, such as anxiety and depression, predicted the number of outpatient visits, hospital admissions and days spent in the hospital for patients with breast or prostate cancer, according to analysis of data from the United States Military Health System scheduled for presentation at the Quality Care Symposium.

Further, between 2007 and 2014, the incidence of mood and adjustment disorders increased from 21% to 28% among women with breast cancer and from 9% to 13% among men with prostate cancer.

Diana Jeffery

“Mental health comorbidities are strong predictors of health care costs and utilization for patients with breast cancer and prostate cancer, even after controlling for other variables,” Diana Jeffery, PhD, director of the Center for Healthcare Management Studies at the U.S. Department of Defense, told HemOnc Today. “Early and frequent mental health assessments are essential, not only to improve quality of life, but also to decrease the number of hospital admissions.”

The Military Health System provides care to 9.5 million active duty and retired military personnel and their families. Researchers analyzed claims data from beneficiaries aged 18 to 64 years who had direct care following a diagnosis of breast cancer (average annual cases, n = 24,612) or prostate cancer (average annual cases, n = 13,258).

Jeffery and colleagues used regression models to identify predictors of health care cost and utilization, including sociodemographic variables, system of care, treatment modalities, and chronic disease and mental health comorbidities.

A greater proportion of women with breast cancer experienced comorbid depression (16.8%) or anxiety (14.2%) compared with men with prostate cancer (depression, 6.9%; anxiety, 6.7%).

Further, the annual cost per patient was significantly higher among women with breast cancer ($16,287 vs. $11,069; P < .001).

Having a mood or adjustment disorder increased costs by about $9,000 per year for a woman with breast cancer and about $8,000 per year for a man with prostate cancer. In total, these disorders led to 312,000 more outpatient visits per year among women with breast cancer and 169,000 visits for men with prostate cancer.

Multiple factors likely contribute to the increase in mood and adjustment disorders, including enhanced guidelines on anxiety and depression management by ASCO, the American College of Surgeons and the National Comprehensive Cancer Network, Jeffery speculated.