Mental Health Disorders May Negatively Impact Survival in Patients With HL

The study found that patients with Hodgkin lymphoma (HL) were at an increased risk of any mental health disorder, which was associated with worse long-term outcomes.

Addressing the mental health of patients with Hodgkin lymphoma (HL) may have implications for survival, say new study findings, which indicated that these patients, particularly those undergoing hematopoietic stem cell transplantation (HSCT), are at an increased risk of mental health disorders.

The study found that patients with HL were at an increased risk of any mental health disorder (HR, 1.77; 95% CI, 1.57–2.00), which was associated with worse long-term outcomes. Among patients with HL, those who also had a mental health diagnosis had a 2.7-fold increased risk of death compared with patients without a mental health diagnosis.

Among patients who had a HL diagnosis for less than 2 years, those who also received a mental health diagnosis had inferior 5-year (77% vs 90%) and 10-year (70% vs 86%) OS compared with patients who did not also receive a mental health diagnosis.

According to the researchers, they were not surprised to find an increased risk of a mental health diagnosis among these patients due to the stress associated with cancer diagnosis and treatment.

“However, it is interesting to note our finding that patients with HL who had a mental health diagnosis in the acute time period (<2years after HL diagnosis) when they had the most appointments for treatment and follow-up had a sustained decrease in OS. This suggests that the higher incidence of mental health disorders in patients with HL may not only be caused by acute stresses from treatment or increased interaction with the health care system.”

The study included nearly 800 patients with HL and nearly 3600 individuals from the general population. Patients with HL were at a higher risk of anxiety (HR, 1.84; 95% CI, 1.54–2.20), depression(HR, 1.57; 95% CI, 1.33–1.87), substance-related disorders(HR, 1.63; 95% CI, 1.08–2.46), and suicide and intentional self- inflicted injuries(HR, 1.87; 95% CI, 1.07–3.28). The researchers also observed increased risks of all combinations of various mental health disorders among patients with HL compared with the general population.

The only treatment-related risk factor for being diagnosed with any mental health disorder was undergoing HSCT, with a hazard ratio of 2.06 (95% CI, 1.53–2.76). According to the researchers, this was the case for all mental health disorders after adjusting for age, body mass index, race, sex, and disease stage.

“Our findings are consistent with several survey-based studies on mental health in patients with lymphoma, and we also present some unique results,” wrote the researchers. “The majority of previous studies focused on anxiety and depression, finding that patient-reported rates of anxiety were in the range of from 15% to 40% and that therates of depression ranged from 10% to 35%. Our results fit in the range of these patient-reportedrates: 21% of our patients with HL were diagnosed with an anxiety disorder, and 23% were diagnosedwith a depressive disorder. The previous studies generally demonstrated no improvement in the prevalenceof anxiety or depression over time, whereas we foundthat the highest risk period for both anxiety and depression was <2years after diagnosis.”

Reference

Tao R, Chen Y, Kim S, et al. Mental health disorders are more common in patients with Hodgkin lymphoma and may negatively impact overall survival. Cancer. Published online August 2, 2022. doi: 10.1002/cncr.34359