Mental health disorders in cancer: A survival risk factor

For many patients, the emotional toll of cancer can become a hidden risk factor, one that may influence survival as much as the disease itself.

Study: Association of mental health disorders and all-cause mortality for patients with cancer: Large-scale analysis of University of California Health System Data. Image credit: GBJSTOCK/Shutterstock.com

A recent study in Cancer evaluated the association between newly diagnosed MHDs within the first year after cancer diagnosis and all-cause mortality, while also characterizing patterns of early MHD emergence.

Prevalence and Impact of Mental Health Disorders in Cancer Patients

The overwhelming stress of receiving a cancer diagnosis can greatly complicate management. Many people who are diagnosed with cancer experience emotional distress, and prior research suggests that up to one-third experience mental health disorders at some point during their cancer journey. Previous research has shown that the onset of MHDs significantly increases morbidity and mortality in this population. When psychological reactions are particularly intense or prolonged, patients may develop further serious health issues, such as depression, anxiety, or, in severe cases, suicide.

While many studies have shown that MHDs are linked to higher death rates in cancer patients, most of this research is limited. These studies often use small samples and depend on self-reported symptoms, rather than confirmed medical diagnoses, which makes their findings less reliable.

There is a shortage of large-scale studies evaluating clinically verified mental health disorders, especially those that manifest following a cancer diagnosis, and their association with patient mortality. Furthermore, the impact of newly diagnosed psychiatric conditions and the potential role of psychotropic pharmacotherapy on survival outcomes in oncology populations remain inadequately characterized.

Assessing Mental Health Impact on Cancer Survival

The current study examined patterns and differences in the emergence of new MHDs within the first year after cancer diagnosis, using data from a diverse, multi-institutional cohort within a statewide academic health system. Additionally, the study aimed to investigate the association between these newly identified mental health disorders and overall mortality rates.

Individuals who were aged 18 years and older and were newly diagnosed with cancer at the University of California hospitals between January 2013 and January 2023 were identified using anonymized electronic health records. Eligible patients had at least two medical visits spaced 30 days apart. Cancer cases were identified using diagnosis codes.

Cancer and MHD diagnoses were determined using the International Classification of Diseases, 10th (ICD-10) codes, with cancer types grouped by location. Data on age, sex, race, ethnicity, comorbidity, and psychotropic medication prescriptions were obtained.

New MHDs, such as psychotic, mood, or anxiety disorders, diagnosed within 12 months of cancer diagnosis, and the need for new psychotropic medications in that period were evaluated. The primary outcome was all-cause mortality, measured from the date of cancer diagnosis using the California Death Certificate Registry. Multivariable Cox regression models adjusted for age, sex, race, Charlson comorbidity index, excluding malignancy, and cancer site, with time-partitioned analyses to account for nonproportional hazards.

New MHDs After Cancer Diagnosis Significantly Raise Early Mortality Risk

A total of 371,897 patients, with a mean age of 62.1 years and without prior MHDs, were included. Nearly half of the study cohort were female, and the majority were White. Median follow-up after cancer diagnosis was 28.2 months. During the study period, 23.1 % of patients died, with a 5-year overall survival rate of 72 %.

Breast, prostate, and hematologic cancers were most prevalent. Within a year of cancer diagnosis, 10.6 % of patients developed a new MHD, most commonly generalized anxiety or major depressive disorder. More than one-third of those with new MHDs received psychotropic medications. Nearly one in four cancer patients was prescribed benzodiazepines. It must be noted that the dataset did not capture indications or outcomes for these prescriptions.

Among patients with early MHDs, breast and hematologic cancers were the most frequent diagnoses. The incidence of new MHDs increased sharply beginning approximately three months before cancer diagnosis and peaking within the first six months after diagnosis. This pattern may reflect heightened symptom burden, diagnostic uncertainty, biological stress responses, or increased clinical attention and documentation during this period. Cancers with lower survival rates, such as pancreatic cancer, were strongly associated with new MHDs, while cancers with better outcomes, like nonmelanoma skin cancer, showed a lesser association.

Early MHDs were most likely to occur within the first six months after cancer diagnosis, although the study defined “early” as diagnoses occurring within 12 months. Patients who developed a new MHD during this period faced a substantially higher risk of death during the first mortality interval, 12 to 35 months after diagnosis, with an adjusted hazard ratio of approximately 1.5, although this risk decreased over time and was not statistically significant in the longest follow-up interval, 60 to 120 months.

The mortality risk was even greater for those who were prescribed new psychotropic medications during the early period, with an adjusted hazard ratio of approximately 2.7 in the 12–35 month interval, but this also lessened in later years. Overall, these findings highlight that early mental health challenges after cancer diagnosis are closely linked to poorer short-term survival.

Conclusions

Patients who develop a mental health condition after a cancer diagnosis and are prescribed psychotropic medication are at a heightened risk of all-cause mortality. However, the study design does not establish causation, and psychotropic medication use may reflect greater psychiatric severity, advanced cancer burden, or other underlying factors rather than a direct harmful effect of the medications themselves. Reliance on electronic health record diagnostic codes may also introduce documentation bias.

This association highlights a critical need for integrated care models that address both the physical and psychological needs of cancer patients. The current study findings suggest that multidisciplinary approaches, including routine mental health screening, timely intervention, and ongoing support, may help mitigate excess mortality risk. Prioritizing comprehensive mental health care alongside oncological treatment can lead to improved overall outcomes and quality of life for cancer patients.

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