The impact of symptom screening on survival among patients with cancer across varying levels of pre-diagnosis psychiatric care

Background — Patients diagnosed with cancer often experience considerable challenges with mental health, and those who had more intense psychiatric care prior to their cancer diagnosis have a higher risk of mortality. As prior research demonstrated a survival benefit among patients screened for symptoms using the Edmonton symptom assessment system (ESAS), this study aims to examine the association between being ESAS-screened and the risk of mortality across varying intensity levels of pre-diagnosis psychiatric care utilization.

Methods — We conducted a retrospective matched cohort study using population-wide administrative databases. All patients diagnosed with cancer in Ontario, Canada, from January 2007 to December 2015 were identified. Propensity score matching was used to pair ESAS-screened individuals to those not screened. Pairs were also hard matched on a pre-diagnosis psychiatric care utilization gradient. A multivariable Cox proportional hazards regression model was implemented to estimate the association between ESAS and mortality, for each intensity level of pre-diagnosis psychiatric care.

Results — The matched cohort consisted of 119,806 patient pairs (ESAS-screened and not screened), of whom 54,468 (45.5%) pairs had prior outpatient psychiatric care and 2249 (1.8%) pairs had experienced emergency department visits or had been hospitalized for psychiatric care. Overall being exposed to ESAS was significantly associated with a 51% decrease in the hazard of mortality (HR 0.49, 95%CI 0.48–0.50, p-value <0.0001). This association was similar across all levels of prior psychiatric use, however, there was no evidence of a differential impact.

Conclusion — In addition to routinely monitoring symptom severity, including depression, among patients with cancer, it is also important to identify those with preexisting psychiatric comorbidities at the time of diagnosis. This information can be used to ensure that timely and appropriate psycho-oncology services and psycho-social supports are offered to help the patient and their family cope during the cancer disease trajectory.