Nearly 1 in 6 individuals have depression, anxiety, or both within 24 months before diffuse large B-cell lymphoma (DLBCL) diagnosis, and patients with these pre-existing mental health disorders have significantly lower overall survival and lymphoma-specific survival, according to research published in Lancet Haematology. The findings highlight the need for universal and systematic mental health screening in this patient population.
In the study, the researchers evaluated the effect of pre-existing depression, anxiety, or both on survival in a US cohort of older patients with DLBCL. They used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 67 years or older and diagnosed with DLBCL between Jan 1, 2001, and Dec 31, 2013. They then used billing claims to identify those with pre-existing depression, anxiety, or both within the 24 months prior to their DLBCL diagnosis.
The primary outcomes were 5-year overall survival and lymphoma-specific survival. The researchers compared the survival rates between patients with and without pre-existing depression, anxiety, or both using Cox proportional analyses adjusted for sociodemographic and clinical characteristics.
A total of 13 244 patients with DLBCL were identified (median age, 79.0 years; range, 73-84; 52.8% female; 94.1% White). Of those, 15.8% had depression, anxiety, or both. The median follow-up duration for the cohort was 2.0 years (interquartile range [IQR], 0.4-6.9), and the median follow-up duration for patients alive at the end of the study was 8.5 years (IQR, 6.5–11.5).
The 5-year overall survival was lower among patients with the mental health disorders compared with those with no mental health disorder (27.0% vs 37.4%; hazard ratio [HR], 1.37; 95% CI 1.29-1.44; P <.0001).
Compared with patients with no mental health disorder, patients with depression alone had the worst 5-year survival (HR, 1.37; 95% CI, 1.28-1.47; P <.0001), followed by those with depression and anxiety (HR, 1.23; 95% CI, 1.08-1.41; P =.0023) and those with anxiety alone (HR, 1.17; 95% CI, 1.06-1.29; P =.0025).
Similar results were seen for 5-year lymphoma-specific survival. Patients with the pre-existing mental health disorders had lower 5-year lymphoma-specific survival than those with no mental health disorder (42.0% vs 51.3%; P<.0001). Compared with those with no mental health disorder, patients with depression alone had the worst 5-year lymphoma-specific survival (HR, 1.37; 95% CI, 1.26-1.49), followed by those with depression and anxiety (HR, 1.25; 95% CI, 1.07-1.47) and those with anxiety alone (HR, 1.16; 95% CI, 1.03-1.31).
“These data suggest that comprehensive psychosocial assessment should be an essential component of evaluation at time of DLBCL diagnosis,” the study authors wrote in their report. “Given that underlying depression, anxiety, or both are potentially modifiable, interventions aimed at treating mental illness and improving mortality for this population are critically needed.”
Limitations of the study included potentially underestimating the true rates of mental health disorders given the claims-based approach to measuring depression and anxiety and the lack of generalizability to other populations as the cohort included only US patients who were aged 67 years or older and was predominantly White. Additionally, there was a general inability uncover the mechanism for decreased survival among patients with the specified pre-existing mental health disorders as well as a lack of more recent data to evaluate up-to-date trends between DLBCL and the mental health disorders, and inability to access data on other sources of residual confounding.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Kuczmarski TM, Tramontano AC, Mozessohn L, et al. Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study. Lancet Haematol. Published online June 1, 2023. doi:10.1016/S2352-3026(23)00094-7