Preexisting psychological illness and its association with mortality in lung cancer patients with access to support resources

Abstract

Introduction: Diagnosis of lung cancer often results in tremendous stress for most patients, especially in patients with underlying psychological illness. Psychosocial support (consultation with psychologist, psychotherapist, or social worker) referral is considered standard for quality cancer care; however, which patients utilize these resources and how these resources affect patient outcomes remain unclear. Objectives: We aimed to identify which newly diagnosed lung cancer patients accessed available psychosocial resources and assessed how utilization of these resources correlated with treatment and survival outcomes. Methods: Data were collected from National Cancer Institute-designated cancer center at the University of New Mexico. We analyzed lung cancer registry and mortality data at the cancer center and bronchoscopy suite data to retrospectively identify patients diagnosed with lung cancer between 2012 and 2017. We used a logistic regression model to compare psychological support utilization at the cancer center between patients with and without history of psychiatric illness. We used a Cox proportional hazards model to identify individual risk factors for mortality. Results: Patients with a previous psychological diagnosis were 2.4 times more likely (odds ratio = 2.443; confidence interval [CI], 1.130–5.284) to utilize psychological resources than patients without a pre-cancer psychological diagnosis. Patients who received psychosocial intervention had a 120.4% higher hazard of dying than those who did not (hazard ratio = 2.204; 95% CI, 1.240–3.917). One-year survival probability among those who did not utilize resources was 62.65% (95% CI, 55.24%–71.06%) and 43.0% (95% CI, 31.61%–58.50%) among those who did. Patients with a previous psychiatric diagnosis were more likely to utilize psychosocial resources within 1 year of lung cancer diagnosis. Conclusions: Patients with previous psychiatric illness are more likely to utilize psychosocial resources at the cancer center after a new diagnosis of lung cancer. Patients who utilize psychosocial interventions have higher 1-year mortality than those who do not.