Wadia Roxanne J, Yao Xiaopan, Deng Yanhong, Li Jia, Maron Steven, Connery Donna, Gunduz-Bruce Handan, Rose Michal G
Yale School of Medicine, Yale University, New Haven, Connecticut.
Veterans Affairs Healthcare System, West Haven, Connecticut.
Cancer Med. 2015 Sep;4(9):1365-73. doi: 10.1002/cam4.483. Epub 2015 Jun 9.
There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15-20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care.
关于心理健康合并症（MHC）对癌症诊断分期及癌症治疗及时性的影响，相关数据有限。第一轴MHC影响着约30%在退伍军人事务部（VA）系统接受治疗的退伍军人。本研究的目的是比较患有和未患有MHC的退伍军人实体瘤恶性肿瘤的诊断分期及治疗及时性。我们对2008年至2011年期间在康涅狄格州退伍军人医疗保健系统（VACHS）诊断并接受治疗的408例患有结直肠癌、尿路上皮癌和头颈癌的退伍军人病历进行了回顾性分析。我们收集了人口统计学数据、诊断分期、医疗和心理健康合并症、接受的治疗、关键时间间隔以及错过的预约次数。该研究旨在评估15% - 20%从I/II期到III/IV期的分期转移情况。在整个研究组以及每种单独的肿瘤类型中，患有和未患有MHC的患者的分期分布均无显著变化（p = 0.9442）。患有和未患有MHC的患者从症状出现到开始治疗的时间间隔也无显著差异（分别为p = 0.1135、0.2042和0.2352）。我们得出结论，在VACHS，患有和未患有MHC的结直肠癌、尿路上皮癌和头颈癌患者的诊断分期无显著差异。患有MHC的患者在治疗上没有出现显著延迟。我们的研究表明，在一个将心理健康纳入常规护理的医疗系统中，患有第一轴MHC的患者在癌症治疗方面不会出现延迟。
