Preexisting stress-related diagnoses and mortality: A Danish cancer cohort study

• Type of Material: Article
• Authors: Lindsay J Collin, University of Utah; Katalin Veres, Aarhus University Hospital; Jaimie L Gradus, Boston University; Thomas P Ahern, University of Vermont; Timothy Lash, Emory University; Henrik Toft Sørensen, Aarhus University Hospital
• Language: English
• Date: 2021-11-19
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.34036
• Title of Journal or Parent Work: CANCER
• Volume: 128
• Issue: 6
• Start Page: 1312
• End Page: 1320
• Grant/Funding Information: This work was supported by the National Centre for Advancing Translational Sciences of the National Institutes of Health (TL1TR002540 to L.J.C), the National Institute of Mental Health (R01MH110453 to J.L.G.), and the National Institute of General Medical Sciences (P20GM103644 to T.P.A.).
• Keywords: RISK; Oncology; prognosis; Life Sciences & Biomedicine; neoplasms; trauma; ADJUSTMENT DISORDER DIAGNOSES; HEALTH; cancer survivorship; SYSTEM; Science & Technology; COMORBIDITY; stress-related disorders; TRAUMA; BREAST-CANCER

Abstract

Background: This study evaluated the association between preexisting stress-related diagnoses and mortality in a Danish population–based cancer cohort. Methods: This study included Danish patients with cancer diagnosed in 1995-2011 who had a stress-related diagnosis before their cancer diagnosis. Cancer patients without a prior stress-related diagnosis were matched 5:1 to the stress disorder cohort by cancer site, age group, calendar period, and sex. The 5-year cumulative incidence of cancer-specific and all-cause mortality was computed by stress-related diagnosis category. Hazard ratios and 95% confidence intervals (CIs) associating stress-related diagnoses with mortality were computed by follow-up time, stress-related diagnosis category, stage, comorbidity status, and cancer type. Results: This study identified 4437 cancer patients with a preexisting stress-related diagnosis and 22,060 matched cancer cohort members. The 5-year cumulative risk of cancer-specific mortality was 33% (95% CI, 32%-35%) for those with a preexisting stress-related diagnosis and 29% (95% CI, 28%-29%) for those without a prior stress-related diagnosis. Cancer patients with a preexisting stress-related diagnosis had a 1.3 times higher cancer-specific mortality rate than the comparison cohort members (95% CI, 1.2-1.5). This increase persisted across categories of stress-related diagnosis. The association varied by stage and cancer type, with more pronounced associations found among those with a late stage at diagnosis and hematological malignancies. Conclusions: Cancer patients with preexisting stress-related diagnoses had increased rates of cancer-specific and all-cause mortality. The results suggest that psychiatric comorbidities may be an important consideration for cancer prognosis, and cancer treatment informed by a patient's history may improve outcomes.