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BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Mental disorders around cancer diagnosis and increased hospital admission rate - a nationwide cohort study of Swedish cancer patients

Authors: Jianwei Zhu, Arvid Sjölander, Katja Fall, Unnur Valdimarsdottir, Fang Fang

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

Whether the emotional distress around cancer diagnosis is associated with the long-term outcomes and care utilization is unknown. We aimed to examine the association of mental disorders around cancer diagnosis with the hospital admission rates of cancer patients thereafter.

Methods

We conducted a nationwide cohort study including 218,508 cancer patients diagnosed in Sweden during 2004–2009 and followed them from 90 days after cancer through 2010. We used a clinical diagnosis of stress-related mental disorders from 90 days before to 90 days after cancer diagnosis as the exposure. We studied first all hospital admissions and then separately three common admissions, including external injuries, infections, and cardiovascular diseases. The Cox model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

Four thousand one hundred five patients received a diagnosis of stress-related mental disorders around the cancer diagnosis, and experienced a 35% increased rate of any hospital admission during follow-up (HR: 1.35, 95%CI: 1.28–1.41) as well as hospital admissions for external injuries (HR: 1.89, 95%CI: 1.67–2.14), infections (HR: 1.28, 95%CI: 1.08–1.52), and cardiovascular diseases (HR: 1.16, 95%CI: 1.03–1.30). Similar association was noted for most common cancer types.

Conclusions

These data suggest that cancer patients diagnosed with a stress-related mental disorder immediately before or after cancer diagnosis are subsequently at increased risk of hospital admissions for major comorbidities of cancer.
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Literature
1.
Lu D, Andersson TM, Fall K, Hultman CM, Czene K, Valdimarsdottir U, Fang F. Clinical Diagnosis of Mental Disorders Immediately Before and After Cancer Diagnosis: A Nationwide Matched Cohort Study in Sweden. JAMA Oncol. 2016;2(9):1188–96.
2.
Awsare NS, Green JS, Aldwinckle B, Hanbury DC, Boustead GB, McNicholas TA. The measurement of psychological distress in men being investigated for the presence of prostate cancer. Prostate Cancer Prostatic Dis. 2008;11(4):384–9.CrossRefPubMed
3.
Ellman R, Angeli N, Christians A, Moss S, Chamberlain J, Maguire P. Psychiatric morbidity associated with screening for breast-Cancer. Brit J Cancer. 1989;60(5):781–4.CrossRefPubMedPubMedCentral
4.
Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. The Lancet Oncology. 2011;12(2):160–74.CrossRefPubMed
5.
Randall JR, Walld R, Finlayson G, Sareen J, Martens PJ, Bolton JM. Acute risk of suicide and suicide attempts associated with recent diagnosis of mental disorders: a population-based, propensity score-matched analysis. Can J Psychiatr. 2014;59(10):531–8.
6.
Goldstein BI, Carnethon MR, Matthews KA, McIntyre RS, Miller GE, Raghuveer G, Stoney CM, Wasiak H, McCrindle BW, Young CCD. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease a scientific statement from the American Heart Association. Circulation. 2015;132(10):965–86.CrossRefPubMed
7.
Kiecoltglaser JK, Marucha PT, Malarkey WB, Mercado AM, Glaser R. Slowing of wound-healing by psychological stress. Lancet. 1995;346(8984):1194–6.CrossRef
8.
Cawthorpe D, Wilkes TCR, Guyn L, Li B, Lu MS. Association of Mental Health with Health Care use and Cost: a population study. Can J Psychiatr. 2011;56(8):490–4.CrossRef
9.
Shen Q, Lu D, Schelin ME, Joud A, Cao Y, Adami HO, Cnattingius S, Fall K, Valdimarsdottir U, Fang F. Injuries before and after diagnosis of cancer: nationwide register based study. BMJ. 2016;354:i4218.CrossRefPubMed
10.
Fang F, Fall K, Mittleman MA, Sparen P, Ye WM, Adami HO, Valdimarsdottir U. Suicide and cardiovascular death after a Cancer diagnosis. New Engl J Med. 2012;366(14):1310–8.CrossRefPubMed
11.
Zhu J, Fang F, Sjolander A, Fall K, Adami HO, Valdimarsdottir U. First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study. Ann Oncol. 2017;28(8):1964–9.CrossRefPubMed
12.
Barlow L, Westergren K, Holmberg L, Talback M. The completeness of the Swedish Cancer register: a sample survey for year 1998. Acta Oncol. 2009;48(1):27–33.CrossRefPubMed
13.
Boele FW, Klein M, Reijneveld JC, Verdonck-de Leeuw IM, Heimans JJ. Symptom management and quality of life in glioma patients. CNS Oncol. 2014;3(1):37–47.CrossRefPubMed
14.
Noll KR, Ziu M, Weinberg JS, Wefel JS. Neurocognitive functioning in patients with glioma of the left and right temporal lobes. J Neuro-Oncol. 2016;128(2):323–31.CrossRef
15.
Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol. 2009;24(11):659–67.CrossRefPubMedPubMedCentral
16.
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRefPubMedPubMedCentral
17.
Mehnert A, Brahler E, Faller H, Harter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Hund B, et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2014;32(31):3540–6.CrossRef
18.
Klengel T, Binder EB. Epigenetics of stress-related psychiatric disorders and gene x environment interactions. Neuron. 2015;86(6):1343–57.CrossRefPubMed
19.
Ehlert U, Gaab J, Heinrichs M. Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder, and stress-related bodily disorders: the role of the hypothalamus-pituitary-adrenal axis. Biol Psychol. 2001;57(1–3):141–52.CrossRefPubMed
20.
Brown GW, Bifulco A, Harris TO. Life events, vulnerability and onset of depression: some refinements. Br J Psychiatry. 1987;150:30–42.CrossRefPubMed
21.
Toussaint L, Shields GS, Dorn G, Slavich GM. Effects of lifetime stress exposure on mental and physical health in young adulthood: how stress degrades and forgiveness protects health. J Health Psychol. 2016;21(6):1004–14.CrossRefPubMed
22.
23.
Kendal WS, Kendal WM. Comparative risk factors for accidental and suicidal death in cancer patients. Crisis. 2012;33(6):325–34.CrossRefPubMed
24.
Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annu Rev Psychol. 2002;53:83–107.CrossRefPubMed
25.
Glaser R, Robles TF, Sheridan J, Malarkey WB, Kiecolt-Glaser JK. Mild depressive symptoms are associated with amplified and prolonged inflammatory responses after influenza virus vaccination in older adults. Arch Gen Psychiatry. 2003;60(10):1009–14.CrossRefPubMed
26.
Glaser R, Rabin B, Chesney M, Cohen S, Natelson B. Stress-induced immunomodulation: implications for infectious diseases? JAMA. 1999;281(24):2268–70.CrossRefPubMed
27.
Sheridan JF, Feng NG, Bonneau RH, Allen CM, Huneycutt BS, Glaser R. Restraint stress differentially affects anti-viral cellular and humoral immune responses in mice. J Neuroimmunol. 1991;31(3):245–55.CrossRefPubMed
28.
Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado AM, Glaser R. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–6.CrossRefPubMed
29.
Rojas IG, Padgett DA, Sheridan JF, Marucha PT. Stress-induced susceptibility to bacterial infection during cutaneous wound healing. Brain Behav Immun. 2002;16(1):74–84.CrossRefPubMed
30.
Rutledge T, Reis SE, Olson MB, Owens J, Kelsey SF, Pepine CJ, Mankad S, Rogers WJ, Merz CN, Sopko G, et al. Depression symptom severity and reported treatment history in the prediction of cardiac risk in women with suspected myocardial ischemia: the NHLBI-sponsored WISE study. Arch Gen Psychiatry. 2006;63(8):874–80.CrossRefPubMed
31.
Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA. 2011;306(11):1241–9.CrossRefPubMedPubMedCentral
32.
Haines AP, Imeson JD, Meade TW. Phobic anxiety and ischaemic heart disease. Br Med J (Clin Res Ed). 1987;295(6593):297–9.CrossRef
33.
Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Symptoms of anxiety and risk of coronary heart disease. The normative aging study. Circulation. 1994;90(5):2225–9.CrossRefPubMed
34.
Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, Jemal A, Cho H, Anderson RN, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120(9):1290–314.CrossRefPubMed
35.
van Nimwegen FA, Schaapveld M, Janus CP, Krol AD, Petersen EJ, Raemaekers JM, Kok WE, Aleman BM, van Leeuwen FE. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. 2015;175(6):1007–17.CrossRefPubMed
36.
Jones SMW, LaCroix AZ, Li WJ, Zaslavsky O, Wassertheil-Smoller S, Weitlauf J, Brenes GA, Nassir R, Ockene JK, Caire-Juvera G, et al. Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative. J Cancer Surviv. 2015;9(4):620–9.CrossRefPubMedPubMedCentral
37.
Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. Br Med J. 2005;330(7493):702–5.CrossRef
38.
Krebber AMH, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, Becker A, Brug J, van Straten A, Cuijpers P, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psycho-Oncology. 2014;23(2):121–30.CrossRefPubMed
39.
Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Curr Psychiatry Rep. 2013;15(11):404.CrossRefPubMed
Metadata
Title
Mental disorders around cancer diagnosis and increased hospital admission rate - a nationwide cohort study of Swedish cancer patients
Authors
Jianwei Zhu
Arvid Sjölander
Katja Fall
Unnur Valdimarsdottir
Fang Fang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4270-4

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