The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies

Zachary W A Klaassen, Christopher J.D. Wallis, Hanan Goldberg, Thenappan Chandrasekar, Rashid K. Sayyid, Stephen B. Williams, Kelvin A. Moses, Martha Kennedy Terris, Robert K. Nam, David Urbach, Peter C. Austin, Paul Kurdyak, Girish S. Kulkarni

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: 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. Methods: 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). Results: 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. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

Original languageEnglish (US)
Pages (from-to)840-847
Number of pages8
JournalBritish Journal of Cancer
Volume120
Issue number8
DOIs
StatePublished - Apr 16 2019

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Tissue Survival
Psychiatry
Neoplasms
Mortality
Proportional Hazards Models
Mental Disorders
Survival
Mentally Ill Persons
Ontario
Hospital Emergency Service

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Klaassen, Z. W. A., Wallis, C. J. D., Goldberg, H., Chandrasekar, T., Sayyid, R. K., Williams, S. B., ... Kulkarni, G. S. (2019). The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies. British Journal of Cancer, 120(8), 840-847. https://doi.org/10.1038/s41416-019-0390-0

The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies. / Klaassen, Zachary W A; Wallis, Christopher J.D.; Goldberg, Hanan; Chandrasekar, Thenappan; Sayyid, Rashid K.; Williams, Stephen B.; Moses, Kelvin A.; Terris, Martha Kennedy; Nam, Robert K.; Urbach, David; Austin, Peter C.; Kurdyak, Paul; Kulkarni, Girish S.

In: British Journal of Cancer, Vol. 120, No. 8, 16.04.2019, p. 840-847.

Research output: Contribution to journalArticle

Klaassen, ZWA, Wallis, CJD, Goldberg, H, Chandrasekar, T, Sayyid, RK, Williams, SB, Moses, KA, Terris, MK, Nam, RK, Urbach, D, Austin, PC, Kurdyak, P & Kulkarni, GS 2019, 'The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies', British Journal of Cancer, vol. 120, no. 8, pp. 840-847. https://doi.org/10.1038/s41416-019-0390-0
Klaassen, Zachary W A ; Wallis, Christopher J.D. ; Goldberg, Hanan ; Chandrasekar, Thenappan ; Sayyid, Rashid K. ; Williams, Stephen B. ; Moses, Kelvin A. ; Terris, Martha Kennedy ; Nam, Robert K. ; Urbach, David ; Austin, Peter C. ; Kurdyak, Paul ; Kulkarni, Girish S. / The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies. In: British Journal of Cancer. 2019 ; Vol. 120, No. 8. pp. 840-847.
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abstract = "Background: 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. Methods: 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). Results: 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. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.",
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T1 - The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies

AU - Klaassen, Zachary W A

AU - Wallis, Christopher J.D.

AU - Goldberg, Hanan

AU - Chandrasekar, Thenappan

AU - Sayyid, Rashid K.

AU - Williams, Stephen B.

AU - Moses, Kelvin A.

AU - Terris, Martha Kennedy

AU - Nam, Robert K.

AU - Urbach, David

AU - Austin, Peter C.

AU - Kurdyak, Paul

AU - Kulkarni, Girish S.

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Y1 - 2019/4/16

N2 - Background: 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. Methods: 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). Results: 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. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

AB - Background: 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. Methods: 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). Results: 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. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

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