Department of Radiation Oncology, University of California, San Francisco, San Francisco, California.
Department of Internal Medicine, Division of Palliative Medicine, and Department of Urology, University of California, San Francisco, San Francisco, California.
Cancer. 2022 Jan 15;128(2):344-352. doi: 10.1002/cncr.33903. Epub 2021 Sep 22.
Disparity in mental health care among cancer patients remains understudied.
A large, retrospective, single tertiary-care institution cohort study was conducted based on deidentified electronic health record data of 54,852 adult cancer patients without prior mental health diagnosis (MHD) diagnosed at the University of California, San Francisco between January 2012 and September 2019. The exposure of interest was early-onset MHD with or without psychotropic medication (PM) within 12 months of cancer diagnosis and primary outcome was all-cause mortality.
There were 8.2% of patients who received a new MHD at a median of 197 days (interquartile range, 61-553) after incident cancer diagnosis; 31.0% received a PM prescription; and 3.7% a mental health-related visit (MHRV). There were 62.6% of patients who were non-Hispanic White (NHW), 10.8% were Asian, 9.8% were Hispanic, and 3.8% were Black. Compared with NHWs, minority cancer patients had reduced adjusted odds of MHDs, PM prescriptions, and MHRVs, particularly for generalized anxiety (Asian odds ratio [OR], 0.66, 95% CI, 0.55-0.78; Black OR, 0.60, 95% CI, 0.45-0.79; Hispanic OR, 0.72, 95% CI, 0.61-0.85) and selective serotonin-reuptake inhibitors (Asian OR, 0.43, 95% CI, 0.37-0.50; Black OR, 0.51, 95% CI, 0.40-0.61; Hispanic OR, 0.79, 95% CI, 0.70-0.89). New early MHD with PM was associated with elevated all-cause mortality (12-24 months: hazard ratio [HR], 1.43, 95% CI, 1.25-1.64) that waned by 24 to 36 months (HR, 1.18, 95% CI, 0.95-1.45).
New mental health diagnosis with PM was a marker of early mortality among cancer patients. Minority cancer patients were less likely to receive documentation of MHDs or treatment, which may represent missed opportunities to identify and treat cancer-related mental health conditions.
癌症患者的心理健康护理差距仍然研究不足。
这是一项基于加利福尼亚大学旧金山分校 2012 年 1 月至 2019 年 9 月期间确诊的 54852 名无既往精神健康诊断（MHD）的成年癌症患者的电子健康记录数据进行的大型回顾性单中心队列研究。感兴趣的暴露因素是癌症诊断后 12 个月内新出现的 MHD，伴有或不伴有精神药物（PM）治疗，主要结局是全因死亡率。
有 8.2%的患者在癌症确诊后中位数 197 天（四分位距，61-553）内接受了新的 MHD；31.0%的患者接受了 PM 处方；3.7%的患者进行了心理健康相关就诊。62.6%的患者为非西班牙裔白人（NHW），10.8%为亚洲人，9.8%为西班牙裔，3.8%为黑人。与 NHW 相比，少数族裔癌症患者接受 MHD、PM 处方和心理健康相关就诊的调整后比值比降低，尤其是广泛性焦虑症（亚洲人比值比 [OR]，0.66，95%置信区间，0.55-0.78；黑人 OR，0.60，95%置信区间，0.45-0.79；西班牙裔 OR，0.72，95%置信区间，0.61-0.85）和选择性 5-羟色胺再摄取抑制剂（亚洲人 OR，0.43，95%置信区间，0.37-0.50；黑人 OR，0.51，95%置信区间，0.40-0.61；西班牙裔 OR，0.79，95%置信区间，0.70-0.89）。早期有 PM 的新 MHD 与全因死亡率升高相关（12-24 个月：风险比 [HR]，1.43，95%置信区间，1.25-1.64），但在 24 至 36 个月时降低（HR，1.18，95%置信区间，0.95-1.45）。
癌症患者出现新的精神健康诊断和 PM 治疗是早期死亡的标志。少数族裔癌症患者接受 MHD 或治疗的可能性较低，这可能代表着错过了识别和治疗癌症相关心理健康问题的机会。
