Woersching Joanna, Van Cleave Janet H, Gonsky Jason P, Ma Chenjuan, Haber Judith, Chyun Deborah, Egleston Brian L
Rory Meyers College of Nursing, New York University, 433 1stAvenue, New York, NY, 10010, USA.
UTHealth Houston Cizik School of Nursing, 6901 Bertner Ave, Houston, TX, 77030, USA.
Cancer Causes Control. 2025 Mar;36(3):231-242. doi: 10.1007/s10552-024-01921-0. Epub 2024 Oct 28.
Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system.
This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use.
The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.
心理健康障碍、药物滥用和烟草使用在美国人群中普遍存在。然而，这些状况与头颈癌（HNC）分期之间的关联却鲜为人知。本研究旨在揭示在一个综合性公共安全网医疗系统接受治疗的患者中，既往存在的心理健康障碍、药物滥用和烟草使用与诊断时HNC分期之间的关系。
本研究是对关联的医院肿瘤登记数据和电子健康记录（EHR）数据进行的二次数据分析。该研究的主要自变量是心理健康障碍、药物滥用和烟草使用的合并症。因变量是诊断时的HNC分期，分为早期（即I、II和III期）和晚期（IV、IVA、IVB或IVC期）。分析包括对人口统计学变量、肿瘤解剖学协变量进行调整的多变量逻辑回归。
研究人群包括357名患者，中位年龄为59岁，主要为男性（77%），种族多样（黑人或非裔美国人占41%；西班牙裔占22%），且来自低收入社区（家庭年均收入中位数为39,785美元）。有心理健康障碍病史且有或无烟草使用史的患者在诊断时处于晚期HNC的几率显著较低（调整后的比值比[OR]=0.35，95%置信区间[CI]：0.17 - 0.72），而有药物滥用病史且有或无烟草使用史的患者在诊断时处于晚期HNC的几率显著高于无心理健康障碍、药物滥用或烟草使用史的患者（调整后的OR 1.41，95% CI：1.01 - 1.98）。
诊断时的HNC分期与心理健康障碍、药物滥用或烟草使用合并症之间的关系因这些合并症的类型和同时存在情况而异。这些发现表明需要创新的护理模式和教育举措，以满足有心理健康障碍、药物滥用和烟草使用问题的患者的需求，从而促进HNC的早期检测。
