The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center.

Roxanne J Wadia,Handan Gunduz‐Bruce,Jia Li,Donna Connery,Xiaopan Yao,Yanhong Deng,Michal G Rose,Steven Maron

doi:10.1002/cam4.483

Abstract

There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care.

Highlights

Axis I mental health disorders encompass major psychiatric illness, including mood disorders, anxiety disorders (e.g., post-traumatic stress disorder (PTSD)), psychotic disorders, and addiction disorders such as drug and alcohol abuse
The estimated prevalence of mental health comorbidities (MHC) among Veterans using the Veterans Affairs (VA) system is between 25% and 40% [2,3,4]
The purpose of this study is to examine the initial stage at diagnosis for patients with and without MHC, determine whether there is a difference in the timeliness of care between patients with and without MHC, and establish if MHC is associated with patient-mediated delays in care in Veterans with newly diagnosed solid tumor malignancies at the Veterans Affairs Connecticut Health Care System (VACHS)

Summary

Introduction

Axis I mental health disorders encompass major psychiatric illness, including mood disorders (e.g., depression, bipolar disorder), anxiety disorders (e.g., post-traumatic stress disorder (PTSD)), psychotic disorders (e.g., schizophrenia, schizoaffective disorder), and addiction disorders such as drug and alcohol abuse. They affect approximately 43 million adults in the United States which is 18.3% of the population [1]. There have been several large population-based studies looking at cancer incidence and mortality among patients with MHC [7,8,9,10,11,12,13]. Data from Australia has demonstrated an equal or decreased incidence of cancer in patients with

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