Longitudinal Analysis of Mental Disorder Burden Among Elderly Patients With Gastrointestinal Malignancies

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Jeremy P. Harris Department of Radiation Oncology, University of California, Irvine, Orange;

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Mehr Kashyap Department of Radiation Oncology, Stanford University, Stanford; and

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Jessi N. Humphreys Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.

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Daniel T. Chang Department of Radiation Oncology, Stanford University, Stanford; and

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Erqi L. Pollom Department of Radiation Oncology, Stanford University, Stanford; and

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Background: Patients with cancer are at high risk for having mental disorders, resulting in widespread psychosocial screening efforts. However, there is a need for population-based and longitudinal studies of mental disorders among patients who have gastrointestinal cancer and particular among elderly patients. Patients and Methods: We used the SEER-Medicare database to identify patients aged ≥65 years with colorectal, pancreatic, gastric, hepatic/biliary, esophageal, or anal cancer. Earlier (12 months before or up to 6 months after cancer diagnosis) and subsequent mental disorder diagnoses were identified. Results: Of 112,283 patients, prevalence of an earlier mental disorder was 21%, 23%, 20%, 20%, 19%, and 26% for colorectal, pancreatic, gastric, hepatic/biliary, esophageal, and anal cancer, respectively. An increased odds of an earlier mental disorder was associated with pancreatic cancer (odds ratio [OR], 1.17; 95% CI, 1.11–1.23), esophageal cancer (OR, 1.10; 95% CI, 1.02–1.18), and anal cancer (OR, 1.17; 95% CI, 1.05–1.30) compared with colorectal cancer and with having regional versus local disease (OR, 1.09; 95% CI, 1.06–1.13). The cumulative incidence of a subsequent mental disorder at 5 years was 19%, 16%, 14%, 13%, 12%, and 10% for patients with anal, colorectal, esophageal, gastric, hepatic/biliary, and pancreatic cancer, respectively. There was an association with having regional disease (hazard ratio [HR], 1.08; 95% CI, 1.04–1.12) or distant disease (HR, 1.36; 95% CI, 1.28–1.45) compared with local disease and the development of a mental disorder. Although the development of a subsequent mental disorder was more common among patients with advanced cancers, there continued to be a significant number of patients with earlier-stage disease at risk. Conclusions: This study suggests a larger role for incorporating psychiatric symptom screening and management throughout oncologic care.

Submitted November 18, 2019; accepted for publication July 14, 2020. Published online January 5, 2021.

Author contributions: Study concept and design: Harris, Chang, Pollom. Data acquisition: Harris, Chang, Pollom. Data analysis and interpretation: All authors. Statistical analysis: Harris. Manuscript preparation: All authors. Critical revision of the manuscript for important intellectual content: All authors. Study supervision: Harris, Chang, Pollom.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Jeremy P. Harris, MD, MPhil, Department of Radiation Oncology, University of California, Chao Family Comprehensive Cancer Center, 101 The City Drive, Building 23, Orange, CA 92868. Email: jeremy.harris@uci.edu

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