Prognosis Worse for Patients With DLBCL and Mental Health Disorders

According to data published in Lancet Haematology, patients who were diagnosed with depression and/or anxiety within 2 years of their diffuse large B-cell lymphoma (DLBCL) diagnosis experienced worsened prognosis.

“Mental health disorders can potentially decrease quality of life and survival in patients with cancer,” explained researchers. “Little is known about the survival implications of mental health disorders in patients with [DLBCL].”

Researchers aimed to investigate the influence of pre-existing mental health disorders on the survival outcomes of older patients diagnosed with DLBCL in the United States. Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, the investigators identified patients aged 67 years or older, who were diagnosed with DLBCL between January 1, 2001, and December 31, 2013. 

Billing claims were used to identify patients with pre-existing depression, anxiety, or both prior to their DLBCL diagnosis. Researchers compared the 5-year overall survival (OS) and lymphoma-specific survival rates between patients with pre-existing mental health disorders and those without, adjusting for various sociodemographic and clinical factors.

Among the 13,244 patients with DLBCL in the study, 15.8% (2094 patients) had pre-existing depression, anxiety, or both disorders. The majority were female (52.8%) and White (94.1%). The median follow-up period for the cohort was 2.0 years (with an interquartile range of 0.4 to 6.9 years). 

The 5-year overall survival rate for patients with mental health disorders was 27.0%, while patients without such disorders had a significantly higher survival rate of 37.4%, according to the findings. This result suggested that pre-existing mental health disorders negatively impacted the prognosis for patients with DLBCL (hazard ratio [HR] of 1.37).

Further analysis showed that patients with depression alone had the worst survival outcomes compared to those with no mental health disorder, with a hazard ratio of 1.37. Patients with both depression and anxiety had slightly better survival (HR of 1.23), and those with anxiety alone also experienced poorer survival (HR of 1.17) compared to patients without mental health disorders. 

The presence of pre-existing mental health disorders was also associated with lower 5-year lymphoma-specific survival. Of the mental health disorders studied, depression had the most significant negative impact (HR of 1.37), followed by depression and anxiety combined (HR of 1.25), and anxiety alone (HR of 1.16).

“Our data underscore the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival,” the authors concluded, adding that the provision of appropriate mental health support may enhance quality of life for patients with DLBCL.

Reference:
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. 2023;10(7):e530-e538. doi:10.1016/S2352-3026(23)00094-7