Investigators have found that patients who had depression and/or anxiety prior to their diagnosis of diffuse large B-cell lymphoma (DLBCL) may have had shorter survival times than patients who didn’t have a mental health condition prior to their DLBCL diagnosis, according to a new study published by Kuczmarski et al in The Lancet Haematology. The findings point to an urgent need for systematic mental health assessments and interventions for patients with DLBCL.
Background
DLBCL, an aggressive hematologic malignancy, is the most common form of lymphoma. Most factors that affect survival times for patients with DLBCL—such as age and the stage of the disease—are not modifiable, but depression and anxiety can be.
“Anxiety and depression are conditions that are treatable, and treatment could potentially impact survival for our patients,” explained senior study author Oreofe O.Odejide, MD, MPH, Assistant Professor of Medicine at Harvard Medical School and a physician in the Divisions of Adult Lymphoma and Population Sciences at the Dana-Farber Cancer Institute.
Although previous studies have linked mental health to survival outcomes in breast cancer, there have been few studies focused on lymphoma and no published studies on mental health in DLBCL. Treatment for patients with lymphoma has recently improved with the advent of immunotherapy and targeted therapies. With some patients living longer, mental health is becoming an even more important consideration.
“We need to not only help our patients live longer, but also we want to ensure that they are living well by addressing mental health issues,” Dr. Odejide stressed.
Study Methods and Results
In the new retrospective study, the investigators used the Surveillance, Epidemiology, and End Results database to identify 13,244 patients who had been diagnosed with DLBCL aged 67 years or older from 2001 and 2013. The investigators then noted preexisting depression or anxiety prior to DLBCL diagnosis, calculated survival times from the date of diagnosis, and tracked the cause of death for each patient in order to better understand the association between mental health conditions and mortality. This is the largest retrospective cohort analysis assessing the association between mental health conditions and mortality.
After comparing survival outcomes for patients with and without preexisting depression or anxiety, the investigators discovered that patients with depression had the lowest rate of survival—with a 37% higher risk of dying from DLBCL or other causes compared with patients without a mental health diagnosis. Additionally, patients with anxiety also had decreased rates of survival.
Nearly 17% of patients involved in the study had depression and/or anxiety within 2 years prior to their diagnoses, suggesting that preexisting mental health conditions in patients with DLBCL could be associated with lower survival times. However, the investigators emphasized that the percentage of patients with these preexisting conditions could be an underrepresentation, since the numbers were based on retrospective medical claims data that might have been missing information such as diagnoses of mild symptoms.
Conclusions
The investigators pointed out that a cancer diagnosis can be destabilizing and contribute to the development of depression and anxiety, supporting their recommendation that mental health interventions could benefit a substantial number of patients. Physicians treating patients with DLBCL were advised to ask about their mental health and refer them to specialists or support services if they are experiencing depression or anxiety.
“You need to know who is experiencing these disorders to be able to act on them; and these aren’t topics [patients] will typically volunteer on their own if they aren’t screened or asked,” Dr. Odejide underscored.
The investigators noted that they were not able to determine what factors potentially linked these mental health conditions to decreased survival times—but proposed that patients coping with depression or anxiety may get diagnosed later, or that these patients might have barriers like limited financial or social support that make it harder for them to adhere to a treatment plan. The investigators also acknowledged that it was possible the relationship was not causal.
“This [study] is a first step that lays the groundwork for future investigation to figure out which factors, if any, explain this association between anxiety and depression and survival,” Dr. Odejide reiterated.
The investigators concluded more studies will be needed to better understand the association and that in other countries or regions, the prevalence and impact of mental health disorders on patients with lymphoma could be different.
Disclosure: The research in this study was funded by the American Society of Hematology, the Alan J. Hirschfield Lymphoma Research Award, and the National Cancer Institute. For full disclosures of the study authors, visit thelancet.com.
