Newly Diagnosed Mental Health Disorders in Patients with Breast Cancer Receiving Radiation Therapy

Abstract

Patients with a mental health disorder (MHD) have higher age-adjusted mortality compared to the general population. There are few reports investigating the factors that contribute to newly diagnosed MHD following the diagnosis and treatment of breast cancer. Here, we report the incidence of acquired MHD after the diagnosis and treatment of breast cancer in patients who received radiation therapy. A database query of a single institution, prospectively maintained database identified patients diagnosed with breast cancer who received whole or partial breast irradiation (WB/PBI) or post-mastectomy radiotherapy (PMRT). A second query of the patients' electronic medical record cross-referenced those patients with ICD-10 mental health diagnosis codes (F1-F99) that were newly acquired following the diagnosis of breast cancer. Univariable and multivariable analyses were performed, analyzing the effect of multiple factors on new mental health diagnoses. Odds ratios (OR) were calculated with a linear regression model, examining demographic characteristics, cancer stage, surgery type, receipt of chemotherapy or hormone therapy, insurance type, and substance use. We identified 1129 patients, aged 26 - 92 years at the time of breast cancer diagnosis, who were treated at our institution between 2012 and 2017. 136 patients had a pre-existing MHD and were excluded from the analysis. 714 (74%) received WB/PBI, and 254 (26%) received PMRT with a median follow up of 63 months. 318 patients (33%) were diagnosed with MHD following breast cancer diagnosis. Median time to diagnosis of MHD was 30 months following the initial breast biopsy. On univariable (UVA) and multivariable analysis (MVA), N+ disease (UVA OR = 1.70, p<0.001), mastectomy (UVA OR = 1.55, p<0.01), receipt of chemotherapy (MVA OR = 1.77, p<0.0001), divorced relationship status (MVA OR = 2.38, p = 0.007), and retired employment status (MVA OR = 1.93, p<0.0001) conferred an increased risk of developing MHD. The primary new MHD identified following completion of radiation therapy included anxiety related disorders (44.4%), depression related disorders (19.4%), tobacco use disorder (12.9%), and dementia related disorders (6.2%). One in three patients treated with radiation therapy developed a new MHD following the diagnosis of breast cancer in this cohort. The majority of acquired MHD in this study were depression and anxiety related disorders. Patients who received chemotherapy, were divorced, or were retired were at a higher risk of developing MHD following breast cancer diagnosis. Further prospective studies are needed to identify potential interventions that would benefit this at-risk population.