Newly Diagnosed Mental Health Disorders in Patients with Breast Cancer Receiving Radiation Therapy

Bailey A Loving; Muayad F Almahariq; Shaveena Sivapalan; Ronald Levitin; Lihua Qu; Siddharth Ramanathan; Zainab Ijaz; Joshua T Dilworth

doi:10.1016/j.ijrobp.2024.03.028

Newly Diagnosed Mental Health Disorders in Patients with Breast Cancer Receiving Radiation Therapy

Int J Radiat Oncol Biol Phys. 2024 Apr 4:S0360-3016(24)00445-0. doi: 10.1016/j.ijrobp.2024.03.028. Online ahead of print.

Authors

Bailey A Loving¹, Muayad F Almahariq¹, Shaveena Sivapalan², Ronald Levitin¹, Lihua Qu³, Siddharth Ramanathan⁴, Zainab Ijaz⁵, Joshua T Dilworth⁶

Affiliations

¹ Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
² Oakland University William Beaumont School of Medicine, Rochester, MI.
³ Outcomes Research Center, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
⁴ Department of General Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
⁵ Department of Psychiatry, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
⁶ Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI. Electronic address: joshua.dilworth@corewellhealth.org.

PMID: 38582232
DOI: 10.1016/j.ijrobp.2024.03.028

Abstract

Objectives: Patients with a mental health disorder (MHD) have higher age-adjusted mortality compared to the general population. Few reports investigate factors contributing to MHD among breast cancer patients receiving radiotherapy. Here, we report the incidence of acquired MHD after the diagnosis of breast cancer and treatment with radiotherapy.

Methods: Utilizing a single-institution, prospectively maintained database, we analyzed patients with breast cancer treated with radiotherapy between 2012 and 2017. We cross-referenced these patients with newly acquired ICD-10 MHD codes within 3 years post-breast cancer diagnosis. The study included baseline NCCN distress tool scores and area deprivation index (ADI). Univariate (UVA) and multivariable (MVA) Cox regression analyses were conducted to evaluate factors impacting new MHD onset.

Results: Of the 967 included patients, 318 (33%) developed an MHD after their breast cancer diagnosis, which were predominately anxiety (45.1%) and depression (20.1%) related, with a median (IQR) time to diagnosis of 30 (24-33) months. UVA showed lymph node-positive disease, receipt of chemotherapy, receipt of a mastectomy, high comorbidity index, divorced status, retired status, and fourth-quartile ADI as significant predictors. On MVA, only receipt of chemotherapy (HR=1.70, p=0.014) and divorced status (HR=2.04, p=0.009) remained significant. Fourth-quartile ADI, retired status, and high comorbidity index showed trends towards significance (HR=1.78, p=0.065; HR=1.46, p=0.094; HR=1.41, p=0.059, respectively). On MVA examining the effects of the radiotherapy type on MHD, whole breast with regional nodal irradiation (WBI+RNI) (HR=2.31, p=0.015) and post-mastectomy radiotherapy (PMRT) (HR=1.88, p=0.024) were both strong predictors of MHD development. Additionally, an NCCN distress tool score of >3 was also predictive of MHD onset.

Conclusion: In this cohort, one in three patients with localized breast cancer developed a new MHD, predominantly related to anxiety and depression. MHD risk was higher among divorced patients, those receiving chemotherapy, and patients receiving PMRT or WBI+RNI. These findings highlight the importance of future studies and targeted interventions to support this vulnerable population.