Impact of Behavioral Health Disorders on Cancer Surgery Outcomes

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Investigators may have uncovered new insights into the relationship between behavioral health disorders and cancer surgery outcomes, according to a recent study published by Katayama et al in the Journal of the American College of Surgeons. The findings clarified the need for behavioral health disorder screenings and therapies in oncology patient care.


Behavioral health disorders—including substance abuse, eating disorders, and sleep disorders— can increase the risk of cancer. For instance, substance abuse can activate inflammatory pathways and increase exposure to environmental risk factors that may lead to the development of cancer, eating disorders may increase the risk of gastrointestinal cancers through poor nutrition and lower levels of physical activity, and sleep quality and duration have been linked to many different types of cancers.

“The diagnosis of cancer is a physically, mentally, emotionally, socially, and economically stressful event,” the study authors detailed. This stress can lead to the emergence of new behavioral health disorders, relapse of previous disorders, or the intensification of current disorders.

Study Methods and Results

In the recent study, the investigators used data from the Medicare Standard Analytic Files to identify 694,836 patients with cancer, 6.7% (n = 46,719) of whom had behavioral health disorders. They noted that the patients involved in the study had a higher prevalence of behavioral health disorders compared with those in the general population.

The investigators revealed that patients with behavioral health disorders were less likely to undergo surgical resection of their cancerous tissues. Those who did have surgery faced a higher probability of complications, extended hospital stays, and readmission within 90 days of the procedure. Further, this trend was linked to a 7.76% increase in health-care costs, which was particularly concerning since many patients with behavioral health disorders are from socially vulnerable communities and rely on publicly financed health care.

“Patients who had behavioral health disorders had a significantly lower likelihood [of] achieving an optimal outcome after surgery,” emphasized senior study author Tim Pawlik, MD, FACS, PhD, MPH, MTS, MBA, Surgeon-in-Chief of The Ohio State University Wexner Medical Center. “This was associated with higher expenditures for their care and a worse prognosis, even after controlling for other clinical factors,” he added.


The investigators suggested that implementing interventions such as psychiatry compensation programs could encourage practice in vulnerable areas. These proposed programs would offer incentives such as loan repayment to incentivize psychiatrists to work in certain lower income and rural areas. Additionally, a collaborative care model and continued use of telehealth systems could help counter workforce shortages and expand access.

The Investigators stated that with the use of Medicare data, their findings may not fully capture the experiences of younger patients or the complete range of behavioral health disorders, potentially affected by factors like underreporting and high copays for mental health treatments.

“Knowing the important role that behavioral health disorders can play in the continuum of care of patients with cancer, health-care providers can screen for these medical issues. They can ask patients not only whether they have diabetes or hypertension, but more specifically screen for substance abuse, eating disorders, and sleep disorders," Dr. Pawlik concluded.

Disclosure: For full disclosures of the study authors, visit

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®.