An abstract presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting highlights the high incidence of mental health conditions in patients with low-grade non-Hodgkin lymphoma (LG-NHL) and underscores how mental health conditions can increase overall health care use and costs in patients with blood cancers.1
Although LG-NHL is often not imminently life-threatening, Asher A. Chanan-Khan, MD, of Mayo Clinic Comprehensive Cancer Center in Jacksonville, Florida, pointed out that these diseases can require multiple ongoing interventions, and patients may experience substantial stress from the chronic, incurable disease.
To explore the issue, Dr. Chanan-Khan and his colleagues retrospectively analyzed an insurance claims database, studying more than 36,000 patients who had received a new diagnosis of LG-NHL.
Between 29% and 32% of such patients had a documented mental health condition when they were diagnosed with LG-NHL. Additionally, between 19% and 26% of patients with LG-NHL received a new diagnosis of a mental health condition at some point after their LG-NHL diagnosis. Thus, roughly half of patients with newly diagnosed LG-NHL had at least one preexisting or newly diagnosed mental health condition, although this varied slightly by subtype of LG-NHL.
Among the patients in the study population, the types of mental health conditions most commonly present overall were anxiety (31-38%) and depression (28-32%), followed by insomnia (16-23%) and stress-related adjustment disorder (10-14%). The median time from LG-NHL diagnosis to mental health diagnosis in the claims data ranged from 248 to 351 days, varying by LG-NHL subtype. However, Dr. Chanan-Khan noted that many patients were likely suffering much earlier than this.
Additionally, patients with mental health diagnoses had comparatively increased health care use and consequent health care costs across all LG-NHL subtypes. For example, patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL) and a mental health diagnosis had 1.4 times the number of outpatient visits, three times the number of inpatient visits, and more than twice the estimated health care costs (p=0.0001 for all) as those without a mental health diagnosis. Work in other chronic diseases has demonstrated that comorbidity with mental health illnesses is associated with overall increased health care use and costs.3
An important limitation of the current retrospective study is that it can’t directly identify cause and effect, and the reliance on claims data risks indicates the potential for an overdiagnosis of mental health conditions in the study population, so further work is needed. However, Dr. Chanan-Khan noted that mental health issues may amplify patients’ perceptions of treatment side effects as well as impact treatment compliance, which may affect patient outcomes and overall health care uptake.
Dr. Chanan-Khan acknowledged the significant challenges of adding a mental health assessment to busy appointments that are already often time-constrained. But he encourages hematologists to consider the large potential impact on patients’ lives and make time to talk with them about such issues, referring to mental health providers when appropriate.
“A high proportion of patients with blood cancers have clinically detectable mental illness, such as depression or anxiety, and should be screened for it earlier in the course of their treatment,” he said.
Any conflicts of interest declared by the authors can be found in the original abstract.
References
- Yang K, Esselman K, Chuang P, et al. Clinical and financial burden of mental health (MH) conditions in patients (pts) with low-grade non-Hodgkin lymphoma (LG-NHL). Abstract 7072. Presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting; June 3, 2024; Chicago, Illinois.
- Lee B, Manns B, Tonelli M, et al. National, state-level, and county-level prevalence estimates of adults aged ≥ 18 years self-reporting a lifetime diagnosis of depression—United States, 2020. MMWR Morb Mortal Wkly Rep. 2023;72(24):644-650.
- Sporinova B, Manns B, Tonelli M, et al. Association of mental health disorders with health care utilization and costs among adults with chronic disease. JAMA Netw Open. 2019;2(8):e199910.