Addressing mental health in lung cancer patients improves outcomes

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Interview with Helio

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Mental health plays a significant role in overall health and, according to experts, addressing these concerns is no less important in lung cancer patients.

Deepti Chopra, MBBS, MPH, assistant professor of psychiatry at the University of Texas MD Anderson Cancer Center, told Healio that there are two broad categories among cancer patients who exhibit mental health symptoms: “those with pre-existing mental health problems and those who they may have just developed mental health problems because of being diagnosed with cancer ”.

Photo by Deepti Chopra

Deepti Chopraa

He explained that mental health can affect patient outcomes. For example, Chopra said: “Depression is a small but significant predictor of mortality and is also associated with quality of life. [and] respect for medical care “.

Mental health, lung cancer outcomes

In a study published in early 2022, researchers found that patients with non-small cell lung cancer whose symptoms of depression became more severe after diagnosis had shorter survival than those whose symptoms of depression improved or remained the same during treatment.

“New data show the post-diagnosis trajectories of psychological symptoms predicted the risk of premature mortality from advanced NSCLC, also controlling the survival benefits of immune and targeted therapies,” Barbara L. Andersen, PhD, distinguished university professor in Ohio State University’s psychology department, and colleagues wrote. “Substantial evidence underscores the need for psychological therapies to address the common comorbidities of stress, depression and anxiety with advanced NSCLC.”

Researchers enrolled patients with newly diagnosed stage IV NSCLC. Patients who had been treated with definitive chemo-radiotherapy, diagnosed more than 90 days after enrollment, had received treatment for over a month, or had a disabling visual, hearing or psychiatric condition were excluded from participation.

The researchers measured the patients’ depression and anxiety using the Patient Health Questionnaire-9 (PHQR9), which included a self-assessment scale that examines the frequency of symptoms of major depressive disorder over the past 2 weeks.

Patients completed the baseline and bimonthly questionnaires for 2 years, with an overall compliance of 80%.

Researchers used joint model analyzes to examine the interaction between a longitudinal survival model and the patients’ psychological symptoms from the time of NSCLC diagnosis up to 24 months.

They found that the 2-year trajectory of depressive symptoms was associated with cancer survival (increase in HR per unit of PHQR9 = 1.09; 95% CI, 1.03-1.15).

“Without interventions, concerns will remain about patients who have suboptimal understanding of their disease and its treatment, impaired decision making and involvement in treatment, impaired tolerance to symptoms and treatment side effects, and poor motivation to maintain functional status. “wrote Andersen and colleagues. “Attention and improvement in the psychological state of patients can provide an additional benefit that prolongs a quality and comfort life and potentially improves overall survival.

Pre-existing mental health conditions

In another study, researchers linked improved cancer outcomes in patients with pre-existing mental health conditions diagnosed with NSCLC to their participation in mental health treatment programs and housing and work support programs.

“Our results agree with those of several previous studies that [preexisting mental health disorders] are associated with increased mortality among patients diagnosed with NSCLC “, Jacob E. BerchuckMD, a medical oncologist at the Lank Center for Genitourinary Oncology at the Dana-Farber Brigham Cancer Center and colleagues wrote.

The population-based retrospective cohort study evaluated 55,315 veterans on the Veterans Affairs Cancer Center registry who were diagnosed with lung cancer from September 30, 2000 to December 31, 2011. Of these patients, 18,229 had lung cancer conditions. pre-existing mental health, such as bipolar disorder, depressive disorder, post-traumatic stress disorder, schizophrenia, and substance use disorder.

The researchers found that, among patients with a mental health disorder, those who participated in a mental health treatment program were less likely to be diagnosed with advanced disease (OR = 0.62; 95% CI , 0.58-0.66) and more likely to receive treatment appropriate to their stage of the disease (OR = 1.55; 95% CI, 1.26-1.89).

These patients also experienced lower lung cancer mortality (adjusted HR = 0.77; 95% CI, 0.74-0.8) and lower all cause mortality (adjusted HR = 0.74; 95 CI). %, 0.72-0.77) compared to those who did not participate in a mental health treatment program.

“Overall, we demonstrated in this large population-based study of veterans with pre-existing [mental health disorders] diagnosed with NSCLC that participation in [mental health treatment programs]housing support programs and employment support programs have been associated with better cancer-related outcomes, “wrote Berchuck and colleagues,” including a lower chance of being diagnosed with advanced disease, a higher chance of receiving stage appropriate treatment and lower all-cause mortality and lung cancer specific mortality compared to non-participants.

Addressing mental health in cancer treatment

Chopra told Healio that one thing doctors can do in their practice is to watch for “any kind of emotional distress” in patients diagnosed with lung cancer.

He explained that emotional distress is “something that needs further investigation, and this distress can result from anxiety, depression and even confusion, so it would be something that mental health [and] Healthcare professionals can, in general, resume and initiate the process [mental health] selection.”

He added: “Helping with emotional distress will help the patient feel listened to, appreciated and therefore able to process the information that is provided during assessments, treatment planning … all of that will sink there. If it’s something that doesn’t come through. dealt with, the anxiety will get worse; the depression will get worse “.

During survival, according to Chopra, addressing mental health problems in patients diagnosed with lung cancer “would help them with their quality of life. [and] making sure they don’t re-engage in risky behaviors such as cigarette smoking, which could worsen their results.

Chopra noted that more research is needed to evaluate the role of a more in-depth approach to mental health treatment among patients with poor prognosis or who are receiving invasive treatment.

“Understanding the impact of pre-existing mental health diagnoses on lung cancer outcomes and therefore also understanding the impact of the emotional distress that develops after cancer diagnosis on outcomes is important,” he said. “It’s an area of ​​research that can be broadened and there are opportunities there because it will help guide … when to screen, when to refer and how to develop a plan. [mental health care] – all this will take shape better.


Andersen BL, et al. Psycho With. 20225; doi: 10.1097 / PSY.00000000000001027.

Berchuck JE, et al. JAMA Oncology. 2020; doi: 10.1001 / jamaoncol.2020.1466.

Interview with Helio

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