Development of mental health disorders in endometrial cancer survivors and the impact on overall survival—a population-based cohort study
1Department of Radiation Oncology, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
2Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
3Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
4Intermountain Healthcare, Salt Lake City, UT 84107, USA
5University of Utah Health Care CMIO Office, Salt Lake City, UT 84112, USA
6Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
7Utah Cancer Registry, University of Utah, Salt Lake City, UT 84112, USA
8Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
DOI: 10.22514/ejgo.2023.006 Vol.44,Issue 1,February 2023 pp.51-61
Submitted: 14 October 2022 Accepted: 08 December 2022
Published: 15 February 2023
*Corresponding Author(s): Lindsay M Burt E-mail: Lindsay.Burt@hci.utah.edu
To better understand the risk of developing a mental health disorder and the association on outcomes in endometrial cancer patients. Endometrial cancer patients ≥18 years old diagnosed between 1997–2012 were identified from the Utah Population Database and matched with up to 5 cancer free women from the general population. Mental health disorders were identified by International Classification of Diseases ICD-9 diagnostic codes. Endometrial cancer survivors with pre-existing mental health issues were excluded. Diagnosis of a mental health disorder in endometrial cancer patients was compared with the endemic rate. The impact of a mental health disorders on overall survival (OS) and cause specific survival (CSS) was evaluated. There were 2941 endometrial cancer patients and 12,192 general population matched subjects that met criteria with a median follow up time of 7.1 years (range 0–19.2) and 7.7 years (0.4–19.2) respectively. Within the first 1.5 years from diagnosis, there was an association of endometrial cancer patients being diagnosed with a mental health disorder (Hazard radio (HR) 3.09, 95% confidence interval (CI) 2.66–3.59). However, no association was found in endometrial cancer patients being diagnosed with a mental health disorder between 1.5–3 years (HR 1.07, 95% CI 0.83–1.38) and ≥3 years (HR 1.09, 95% CI 0.95–1.26). Treatment with tri-modality (surgery, radiation and chemotherapy) and advanced disease was associated with mental health disorders. OS was worse in endometrial cancer survivors who developed an anxiety disorder (p = 0.0265). CSS was worse in endometrial cancer patients diagnosed with all mental health disorders and anxiety disorders (p < 0.0001, p = 0.002). Endometrial cancer patients have an increased diagnosis of mental health disorders within the first 1.5 years of cancer diagnosis compared to the general population. Endometrial cancer survivors with anxiety disorder have worse OS. Anxiety disorders and all mental health disorders have a worse CSS.
Mental health disorders; Endometrial cancer; Cancer survivors
Lindsay M Burt,Yuji Chen,Alison Fraser,John Snyder,Vikrant Deshmukh,Michael Newman,Paul Thielking,David Gaffney,Mia Hashibe. Development of mental health disorders in endometrial cancer survivors and the impact on overall survival—a population-based cohort study. European Journal of Gynaecological Oncology. 2023. 44(1);51-61.
 American Cancer Society. Cancer Facts & Figures 2018. 2018. Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html (Accessed: 01 March 2019).
 Pirl WF. Evidence report on the occurrence, assessment, and treatment of depression in cancer patients. Journal of the National Cancer Institute. Monographs. 2004; 2004: 32–39.
 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. BMJ. 2005; 330: 702.
 Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, et al. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983; 249: 751–757.
 National Association of Health Data Organizations. Next Steps for the InterState Exchange of Nonresident Data Between State Health Data Organizations. 2009. Available at: https://www.nahdo.org/node/ 167 (Accessed: 01 March 2019).
 Bureau UC. State-to-State Migration Flows. 2017. Available at: https://www.census.gov/data/tables/time-series/demo/geographic-mobility/state-to-state-migration.html (Accessed: 01 March 2019).
 American Academy of Family Physicians. Coding for Tobacco Screening and Cessation. 2018. Available at: https://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/tobacco-cessation-telehealth-guide.pdf (Accessed: 01 March 2019).
 Agency for Healthcare Research and Quality. HCUP-US Tools & Software Page. 2018. Available at: https://www.hcup-us.ahrq. gov/tools_software.jsp (Accessed: 01 March 2019).
 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases. 1987; 40: 373–383.
 Dewar R, Khan I. A new SAS macro for flexible parametric survival modeling: applications to clinical trials and surveillance data. Clinical Investigation. 2015; 5: 855–866.
 Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology. 1992; 45: 613–619.
 Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care. 2005; 43: 1130–1139.
 Honda K, Goodwin RD. Cancer and mental disorders in a national community sample: findings from the national comorbidity survey. Psychotherapy and Psychosomatics. 2004; 73: 235–242.
 Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psycho-Oncology. 2001; 10: 19–28.
 Smith HR. Depression in cancer patients: pathogenesis, implications and treatment (Review). Oncology Letters. 2015; 9: 1509–1514.
 Watson M, Haviland J, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. The Lancet. 1999; 354: 1331–1336.
 Pasquini M, Biondi M. Depression in cancer patients: a critical review. Clinical Practice and Epidemiology in Mental Health. 2007; 3: 2.
 Kiecolt-Glaser JK, Glaser R. Psychoneuroimmunology and cancer: fact or fiction? European Journal of Cancer. 1999; 35: 1603–1607.
 Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and disease progression. Biological Psychiatry. 2003; 54: 269–282.
 Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994; 74: 2570–2578.
 Jones LE, Doebbeling CC. Suboptimal depression screening following cancer diagnosis. General Hospital Psychiatry. 2007; 29: 547–554.
 Nakash O, Levav I, Aguilar-Gaxiola S, Alonso J, Andrade LH, Angermeyer MC, et al. Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys. Psycho-Oncology. 2014; 23: 40–51.
 Telepak LC, Jensen SE, Dodd SM, Morgan LS, Pereira DB. Psychosocial factors and mortality in women with early stage endometrial cancer. British Journal of Health Psychology. 2014; 19: 737–750.
 Kisely S, Sadek J, MacKenzie A, Lawrence D, Campbell LA. Excess cancer mortality in psychiatric patients. The Canadian Journal of Psychiatry. 2008; 53: 753–761.
 Ell K, Sanchez K, Vourlekis B, Lee P, Dwight-Johnson M, Lagomasino I, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. Journal of Clinical Oncology. 2005; 23: 3052–3060.
 Lawrence D, Kisely S. Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology. 2010; 24: 61–68.
 Suppli NP, Johansen C, Kessing LV, Toender A, Kroman N, Ewertz M, et al. Survival after early-stage breast cancer of women previously treated for depression: a nationwide Danish cohort study. Journal of Clinical Oncology. 2017; 35: 334–342.
 Pirl WF, Roth AJ. Diagnosis and treatment of depression in cancer patients. Oncology. 1999; 13:1293–1301
 Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of compliance with treatment on survival among patients with hematologic malignancies. Journal of Clinical Oncology. 1990; 8: 356–364.
 Spiegel D, Kato PM. Psychosocial influences on cancer incidence and progression. Harvard Review of Psychiatry. 1996; 4: 10–26.
 Wong RL, El-Jawahri A, D’Arpino SM, Fuh C, Johnson PC, Lage DE, et al. Use of antidepressant medications moderates the relationship between depressive symptoms and hospital length of stay in patients with advanced cancer. The Oncologist. 2019; 24: 117–124.
 Vartolomei L, Ferro M, Mirone V, Shariat SF, Vartolomei MD. Systematic review: depression and anxiety prevalence in bladder cancer patients. Bladder Cancer. 2018; 4: 319–326.
 Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications. JAMA Psychiatry. 2015; 72: 334–341.
 Wong-Kim EC, Bloom JR. Depression experienced by young women newly diagnosed with breast cancer. Psycho-Oncology. 2005; 14: 564–573.
 Riba MB, Donovan KA, Andersen B, Braun I, Breitbart WS, Brewer BW, et al. Distress management, version 3.2019, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2019; 17: 1229–1249.
Vol., Issue , Invalid dateTable of contents
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.