ASCO Quality Care 2017: Mental Health Conditions Contribute to Care-Related Costs, Hospital Visits in Breast and Prostate Cancers

Key Points

  • On average for each year, patients with breast and prostate cancers and a comorbidity of mood and adjustment disorders had 9.4% (breast) and 6.7% (prostate) more ambulatory visits, 2.3% (breast) and 2.9% (prostate) more hospital admissions, and 5.4% (breast) and 8.4% (prostate) more hospital bed days compared to their counterparts without such disorders.
  • When mood and adjustment disorders were present, an additional 4,800 admissions per year occurred for patients with breast cancer, and 2,600 admissions occurred for men with prostate cancer, as well as an additional 72,000 days in the hospital each year for patients with breast cancer and 65,000 days for patients with prostate cancer.
  • Mood and adjustment disorders resulted in an additional 312,000 outpatient visits per year for the breast cancer population and 169,000 visits for the prostate cancer population.

A new analysis of data from the U.S. Military Health System found that mood and adjustment disorders such as anxiety and depression were strong predictors of the annual number of outpatient visits, hospital admissions, and number of days in the hospital for patients with breast and prostate cancers. The study also found that between 2007 and 2014, mood and adjustment disorders increased 7% (21% to 28%) among breast cancer patients and 4% (9% to 13%) among prostate cancer patients. However, during this period, the rate at which depression increased was identical for both groups. Burke et al will present their findings at the upcoming ASCO Quality Care Symposium, taking place March 3 to 4, in Orlando, Florida (Abstract 18).

“Just as we’re helping patients who are undergoing treatment and experiencing physical side effects, we should be doing the same thing when it comes to a patient’s mental health,” said lead author Diana Jeffery, PhD, Director of the Center for Healthcare Management Studies at the U.S. Department of Defense. “Early and frequent mental health assessments are essential not only to improving quality of life, but also to avoiding unnecessary hospital admissions.”

Study Findings

Researchers from the U.S. Department of Defense analyzed claims data from 9.5 million beneficiaries of the Military Health System. The Military Health System is the health-care system of the Department of Defense that provides care to active duty and retired U.S. military personnel and their families.

Dr. Jeffery and colleagues found that for patients with breast and prostate cancers, mood and adjustment disorders were strong predictors of hospital admissions, following the number of other chronic illnesses and having received chemotherapy within the year.

On average for each year, patients with breast cancer and a comorbidity of mood and adjustment disorders had 9.4% more ambulatory visits, 2.3% more hospital admissions, and 5.4% more hospital bed days compared to their counterparts without such disorders. Men with prostate cancer and mood or adjustment disorders had 6.7% more ambulatory visits, 2.9% more hospital admissions, and 8.4% more hospital bed days compared to their counterparts without mood and adjustment disorders.

When mood and adjustment disorders were present, an additional 4,800 admissions per year occurred for patients with breast cancer, and 2,600 admissions occurred for men with prostate cancer. Further, the presence of mood and adjustment disorders added an additional 72,000 days in the hospital each year for patients with breast cancer and 65,000 days for patients with prostate cancer.

Mood and adjustment disorders resulted in an additional 312,000 outpatient visits per year for the breast cancer population and 169,000 visits for the prostate cancer population.

Researchers also identified mood and adjustment disorders as a strong predictor of cost for both breast cancer and prostate cancer populations. Data show that a mood or adjustment disorder increases costs by $9,000 per year for a breast cancer patient and $8,000 per year for a prostate cancer patient.

The authors conclude the data provide compelling evidence that integrated mental health services and care is an important element of routine oncology care, because it contributes to better patient care and could reduce system-wide costs.

The average annual number of cancer cases were 24,612 and 13,258 for breast or prostate cancer patients, respectively, in the Military Health System. Researchers conducted a cross-sectional analysis using administrative data from patients ages 18 to 64. The study population had a primary diagnosis of either invasive breast or prostate cancer from 2007 to 2014.

Researchers identified several limitations to the study including disease stage, which required them to postulate that for many patients, advanced disease was associated with more ambulatory visits, hospital admissions, and bed days, as well as increased risk of depression, anxiety, and adjustment disorders. The researchers also note that each year's patient population had individuals at all stages of cancer, from newly diagnosed to late-stage, and in all phases of the cancer continuum.

“Mental health issues are common but often under-recognized,” said Joshua Adam Jones, MD, MA, ASCO Expert. “They affect the well-being of a significant number of people living with cancer, as well as drive up health-care costs and hospital admissions. This study shows that routine mental health screening and treatment should be a standard part of quality cancer care.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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