Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Cancer. 2022 Mar 15;128(6):1312-1320. doi: 10.1002/cncr.34036. Epub 2021 Nov 19.
This study evaluated the association between preexisting stress-related diagnoses and mortality in a Danish population-based cancer cohort.
This study included Danish patients with cancer diagnosed in 1995-2011 who had a stress-related diagnosis before their cancer diagnosis. Cancer patients without a prior stress-related diagnosis were matched 5:1 to the stress disorder cohort by cancer site, age group, calendar period, and sex. The 5-year cumulative incidence of cancer-specific and all-cause mortality was computed by stress-related diagnosis category. Hazard ratios and 95% confidence intervals (CIs) associating stress-related diagnoses with mortality were computed by follow-up time, stress-related diagnosis category, stage, comorbidity status, and cancer type.
This study identified 4437 cancer patients with a preexisting stress-related diagnosis and 22,060 matched cancer cohort members. The 5-year cumulative risk of cancer-specific mortality was 33% (95% CI, 32%-35%) for those with a preexisting stress-related diagnosis and 29% (95% CI, 28%-29%) for those without a prior stress-related diagnosis. Cancer patients with a preexisting stress-related diagnosis had a 1.3 times higher cancer-specific mortality rate than the comparison cohort members (95% CI, 1.2-1.5). This increase persisted across categories of stress-related diagnosis. The association varied by stage and cancer type, with more pronounced associations found among those with a late stage at diagnosis and hematological malignancies.
Cancer patients with preexisting stress-related diagnoses had increased rates of cancer-specific and all-cause mortality. The results suggest that psychiatric comorbidities may be an important consideration for cancer prognosis, and cancer treatment informed by a patient's history may improve outcomes.
本研究评估了丹麦人群癌症队列中先前存在的与应激相关的诊断与死亡率之间的关联。
本研究纳入了 1995-2011 年诊断患有癌症的丹麦患者，这些患者在癌症诊断前存在与应激相关的诊断。没有先前与应激相关诊断的癌症患者按癌症部位、年龄组、日历时期和性别与应激障碍队列进行 5:1 匹配。通过应激相关诊断类别计算癌症特异性和全因死亡率的 5 年累积发生率。通过随访时间、应激相关诊断类别、分期、合并症状况和癌症类型计算与死亡率相关的应激相关诊断的风险比和 95%置信区间（CI）。
本研究确定了 4437 例有先前存在的与应激相关的诊断的癌症患者和 22060 例匹配的癌症队列成员。有先前存在的与应激相关的诊断的患者 5 年癌症特异性死亡率的风险为 33%（95%CI，32%-35%），而没有先前存在的与应激相关的诊断的患者为 29%（95%CI，28%-29%）。有先前存在的与应激相关的诊断的癌症患者的癌症特异性死亡率比对照队列成员高 1.3 倍（95%CI，1.2-1.5）。这种增加在与应激相关的诊断的各个类别中均存在。这种关联因分期和癌症类型而异，在诊断时处于晚期和血液恶性肿瘤的患者中更为明显。
先前存在与应激相关的诊断的癌症患者癌症特异性和全因死亡率的发生率较高。结果表明，精神合并症可能是癌症预后的一个重要考虑因素，根据患者的病史进行癌症治疗可能会改善预后。
