Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes.
All residents of Ontario diagnosed with one of the top 10 malignancies (1997–2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM).
A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04–1.06), PUG 2 h 1.36 (95% CI 1.30–1.42), and PUG 3 h 1.73 (95% CI 1.63–1.84). Increasing PUG score was also associated with worse ACM.
Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.
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Co-first authorship: Zachary Klaassen, Christopher J. D. Wallis.
Co-senior authorship: Paul Kurdyak, Girish S. Kulkarni.
The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. We acknowledge Service Ontario for providing data from ORGD. The authors would like to Simon Chen and Ruth Croxford for their assistance with data acquisition and study design, respectively. This study was funded by a Canadian Urological Association-Canadian Urologic Oncology Group-Astellas grant. Furthermore, this study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).
Z.K.: conceptualisation, methodology, investigation, writing original draft, writing-reviewing and editing, and visualisation. C.J.D.W.: methodology, investigation, writing-reviewing and editing. H.G.: conceptualisation, writing-review, visualisation and editing. T.C.: conceptualisation, writing-review, visualisation and editing. R.K.S.: writing-review, editing, methodology. S.B.W.: writing-review and editing, and supervision. K.A.M.: writing-review and editing, and supervision. M.K.T.: writing-review and editing, and supervision. R.K.N.: writing-review and editing, and supervision. D.U.: writing-review and editing, and supervision. P.C.A.: conceptualisation, methodology, writing-reviewing and editing, supervision, and visualisation. P.K.: conceptualisation, writing-reviewing and editing, and visualisation, and supervision. G.S.K.: conceptualisation, methodology, investigation, writing-reviewing and editing, supervision, project administration, and visualisation.