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First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-3649-2639
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2017 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 28, no 8, 1964-1969 p.Article in journal (Refereed) Published
Abstract [en]

Background: The diagnosis of cancer is strongly associated with the risk of mental disorders even in patients with no previous history of mental disorders. Accumulating data suggest that mental distress may accelerate tumor progression. We hypothesized therefore that mental disorders after a cancer diagnosis may increase the risk of cancer-specific mortality.

Patients and methods: We conducted a nationwide cohort study including 244 261 cancer patients diagnosed in Sweden during 2004-2009 and followed them through 2010. Through the Swedish Patient Register, we obtained clinical diagnoses of all mental disorders and focused on mood-, anxiety-, and substance abuse disorders (ICD10: F10-F16, F18-F19, F32-F33, F40-F41, and F43-45) that are commonly diagnosed among patients with cancer. We further classified the studied mental disorders into first-onset or recurrent mental disorders. We used Cox regression to estimate multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) as a measure of the association between mental disorders after cancer diagnosis and cancer-specific mortality, adjusting for age, sex, calendar period, educational level, cancer stage, and cancer type at diagnosis.

Results: After cancer diagnosis, 11 457 patients were diagnosed with mood-, anxiety-, and substance abuse disorders; of which 7236 were first-onset mental disorders. Patients with a first-onset mental disorder were at increased risk of cancer-specific mortality (HR: 1.82, 95% CI: 1.71-1.92) while patients with a recurrent mental disorder had much lower risk elevation (HR: 1.14, 95% CI: 1.05-1.24). The increased cancer-specific mortality by first-onset mental disorders was observed for almost all cancer sites/groups and the association was stronger for localized cancers (HR: 2.00, 95% CI: 1.73-2.31) than for advanced cancers (HR: 1.49, 95% CI: 1.32-1.69).

Conclusions: Patients with a first-onset common mood-, anxiety-, or substance abuse disorder after cancer diagnosis may be at increased risk of cancer-specific death.

Place, publisher, year, edition, pages
Oxford University Press, 2017. Vol. 28, no 8, 1964-1969 p.
Keyword [en]
cancer, mental disorder, psychological stress, survival analysis, mortality
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-59423DOI: 10.1093/annonc/mdx265ISI: 000406790000048OAI: oai:DiVA.org:oru-59423DiVA: diva2:1137082
Funder
Swedish Cancer Society, CAN 2014/417Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0498Swedish Society for Medical Research (SSMF)
Note

Funding Agencies:

China Scholarship Council  201309370015

Karolinska Institutet Distinguished Professor Award  2368/10-221 

Karolinska Institutet 

Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2017-10-18Bibliographically approved

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CiteExportLink to record
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