The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies

Zachary Klaassen, Christopher J.D. Wallis, Hanan Goldberg, Thenappan Chandrasekar, Rashid K. Sayyid, Stephen Williams, Kelvin A. Moses, Martha K. Terris, Robert K. Nam, David Urbach, Peter C. Austin, Paul Kurdyak, Girish S. Kulkarni

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    Background: Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes. Methods: All residents of Ontario diagnosed with one of the top 10 malignancies (1997–2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM). Results: A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04–1.06), PUG 2 h 1.36 (95% CI 1.30–1.42), and PUG 3 h 1.73 (95% CI 1.63–1.84). Increasing PUG score was also associated with worse ACM. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

    Original languageEnglish (US)
    JournalBritish Journal of Cancer
    DOIs
    StatePublished - Jan 1 2019

    Fingerprint

    Tissue Survival
    Psychiatry
    Neoplasms
    Mortality
    Proportional Hazards Models
    Mental Disorders
    Survival
    Mentally Ill Persons
    Ontario
    Hospital Emergency Service

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

    Cite this

    The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies. / Klaassen, Zachary; Wallis, Christopher J.D.; Goldberg, Hanan; Chandrasekar, Thenappan; Sayyid, Rashid K.; Williams, Stephen; Moses, Kelvin A.; Terris, Martha K.; Nam, Robert K.; Urbach, David; Austin, Peter C.; Kurdyak, Paul; Kulkarni, Girish S.

    In: British Journal of Cancer, 01.01.2019.

    Research output: Contribution to journalArticle

    Klaassen, Z, Wallis, CJD, Goldberg, H, Chandrasekar, T, Sayyid, RK, Williams, S, Moses, KA, Terris, MK, Nam, RK, Urbach, D, Austin, PC, Kurdyak, P & Kulkarni, GS 2019, 'The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies', British Journal of Cancer. https://doi.org/10.1038/s41416-019-0390-0
    Klaassen, Zachary ; Wallis, Christopher J.D. ; Goldberg, Hanan ; Chandrasekar, Thenappan ; Sayyid, Rashid K. ; Williams, Stephen ; Moses, Kelvin A. ; Terris, Martha K. ; Nam, Robert K. ; Urbach, David ; Austin, Peter C. ; Kurdyak, Paul ; Kulkarni, Girish S. / The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies. In: British Journal of Cancer. 2019.
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    title = "The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies",
    abstract = "Background: Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes. Methods: All residents of Ontario diagnosed with one of the top 10 malignancies (1997–2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM). Results: A toal of 676,125 patients were included: 359,465 (53.2{\%}) with PUG 0, 304,559 (45.0{\%}) PUG 1, 7901 (1.2{\%}) PUG 2, and 4200 (0.6{\%}) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95{\%} CI 1.04–1.06), PUG 2 h 1.36 (95{\%} CI 1.30–1.42), and PUG 3 h 1.73 (95{\%} CI 1.63–1.84). Increasing PUG score was also associated with worse ACM. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.",
    author = "Zachary Klaassen and Wallis, {Christopher J.D.} and Hanan Goldberg and Thenappan Chandrasekar and Sayyid, {Rashid K.} and Stephen Williams and Moses, {Kelvin A.} and Terris, {Martha K.} and Nam, {Robert K.} and David Urbach and Austin, {Peter C.} and Paul Kurdyak and Kulkarni, {Girish S.}",
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    T1 - The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies

    AU - Klaassen, Zachary

    AU - Wallis, Christopher J.D.

    AU - Goldberg, Hanan

    AU - Chandrasekar, Thenappan

    AU - Sayyid, Rashid K.

    AU - Williams, Stephen

    AU - Moses, Kelvin A.

    AU - Terris, Martha K.

    AU - Nam, Robert K.

    AU - Urbach, David

    AU - Austin, Peter C.

    AU - Kurdyak, Paul

    AU - Kulkarni, Girish S.

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes. Methods: All residents of Ontario diagnosed with one of the top 10 malignancies (1997–2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM). Results: A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04–1.06), PUG 2 h 1.36 (95% CI 1.30–1.42), and PUG 3 h 1.73 (95% CI 1.63–1.84). Increasing PUG score was also associated with worse ACM. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

    AB - Background: Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes. Methods: All residents of Ontario diagnosed with one of the top 10 malignancies (1997–2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM). Results: A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04–1.06), PUG 2 h 1.36 (95% CI 1.30–1.42), and PUG 3 h 1.73 (95% CI 1.63–1.84). Increasing PUG score was also associated with worse ACM. Conclusions: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.

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    U2 - 10.1038/s41416-019-0390-0

    DO - 10.1038/s41416-019-0390-0

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    JO - British Journal of Cancer

    JF - British Journal of Cancer

    SN - 0007-0920

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