A RECENT study has found that older patients with a pre-existing diagnosis of depression and anxiety who are subsequently diagnosed with diffuse large B-cell lymphoma (DLBLC) have significantly lower overall survival and lymphoma-specific survival. These findings underline the importance of universal and systematic mental health screening in this patient population.
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the researchers identified patients over the age of 67 years who were diagnosed with DLBCL between 2001–2013. The study subsequently analysed billing claims to identify those who also had pre-existing depression, anxiety, or both within the 24 months leading to their DLBLC diagnosis.
In total, the researchers identified 13,244 patients with DLBCL, of whom 15.8% had depression, anxiety, or both. The patients had a median age of 79 years, and the median follow-up duration for the cohort was 2 years, while for the patients alive at the end of the study, it was 8 years. The study’s primary outcomes were 5-year overall survival and lymphoma-free survival, compared between individuals with or without a mental health diagnosis in the subsequent 24 months.
The researchers found that the 5-year overall survival was lower in patients with a mental health disorder compared to those with none (27.0% versus 37.4%; hazard ratio [HR]: 1.37; 95% CI: 1.29–1.44; p<0.0001). Furthermore, patients with depression alone had the worst 5-year survival (HR: 1.37; 95% CI: 1.28–1.47; p<0.0001), followed by those with depression and anxiety (HR: 1.23; 95% CI: 1.08–1.41; p=0.0023), and those with anxiety alone (HR: 1.17; 95% CI: 1.06–1.29; p=0.0025).
In addition to these outcomes, similar results were seen when the researchers analysed the 5-year lymphoma-specific survival. Patients with mental health disorders had significantly reduced lymphoma-specific survival compared to those with no mental health diagnosis (42.0% versus 51.3%; p<0.0001).
The authors of the study stressed that the data showed the importance of comprehensive psychosocial assessment as an essential component of DLBCL diagnosis, highlighting that depression and anxiety are both potentially modifiable factors, and interventions aimed at these disorders may improve mortality in these populations.
