Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada, Spain.
Psychooncology. 2021 Jul;30(7):1160-1166. doi: 10.1002/pon.5632. Epub 2021 Feb 17.
Physical and psychiatric comorbidities are common in cancer patients and could impact their treatment and prognosis. However, the evidence base regarding the influence of comorbidities in the management and health service use of patients is still scant. In this research we investigated how physical comorbidities are related to the mental health and help-seeking of cancer patients.
Data were obtained from the representative National Health Survey of Spain (2017). Participants were respondents who reported a cancer diagnosis (n = 484). These were also matched with controls without cancer history (n = 484) based on age, gender, and region. Four alternative physical comorbidities indices were created based on information regarding 28 chronic conditions. Outcomes of interest were psychological distress and having consulted a mental healthcare professional in the year before the survey.
Thirty percent of cancer patients reported significant psychological distress but only 10% had consulted a professional. After adjusting for sociodemographic variables, among cancer patients each additional comorbidity was associated with 9% higher odds of reporting high psychological distress (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.01-1.16) and 21% higher odds of having consulted a mental healthcare professional (OR = 1.21, 95% CI: 1.09-1.34). The effects of comorbidities depended on the type of index and were different in controls without cancer history.
Physical comorbidities in cancer patients are associated with higher risk of psychological distress and higher demand for mental health services. We encourage further research on this issue as it could improve mental health screening and management in oncologic care.
癌症患者常同时患有躯体疾病和精神疾病，这可能会影响他们的治疗和预后。然而，关于躯体共病如何影响癌症患者的治疗管理和卫生服务利用，目前的证据仍然有限。在这项研究中，我们调查了躯体共病如何与癌症患者的心理健康和寻求帮助相关。
数据来自具有代表性的西班牙国家健康调查（2017 年）。参与者为报告癌症诊断的受访者（n=484）。根据年龄、性别和地区，这些人还与没有癌症病史的对照组（n=484）相匹配。根据 28 种慢性疾病的信息，创建了 4 种不同的躯体共病指数。感兴趣的结果是心理困扰和在调查前一年咨询过心理健康保健专业人员的情况。
30%的癌症患者报告有明显的心理困扰，但只有 10%的患者咨询过专业人员。在调整了社会人口学变量后，在癌症患者中，每增加一种共病，报告有较高心理困扰的几率会增加 9%（优势比 [OR] =1.09，95%置信区间 [CI]：1.01-1.16），咨询心理健康保健专业人员的几率会增加 21%（OR=1.21，95% CI：1.09-1.34）。共病的影响取决于指数的类型，在没有癌症病史的对照组中有所不同。
癌症患者的躯体共病与较高的心理困扰风险和对心理健康服务的较高需求相关。我们鼓励进一步研究这一问题，因为这可能会改善肿瘤护理中的心理健康筛查和管理。
