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Psychiatric care prior to cancer diagnosis linked to higher rates of death for Ontario patients


Patients who had psychiatric care prior to being diagnosed with cancer have reduced survival rates in comparison to those without mental health treatment, according to a new study by researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.

The study published today in the British Journal of Cancer examined the health records of more than 675,000 cancer patients aged 18 or over who had been diagnosed with one of the 10 most common cancers (prostate, breast, colorectal, melanoma, lung, bladder, endometrial, thyroid, kidney and oral) in Ontario from 1997 to 2014.

The cancer patients studied had used a mental health service or had a psychiatric consult, but had not necessarily been diagnosed with a mental health condition. Nearly half (45 per cent) of all the cancer patients had had a psychiatric assessment as an outpatient, often by a family doctor. Around 7,900 cancer patients had an emergency department visit for psychiatric care and more than 4,000 had been hospitalized for their mental health in the five years prior to their cancer diagnosis.

“Our study shows that as the level of psychiatric help increased, there was a greater risk of death and this effect persisted when cancer stage was available. We suspect that one of the possible reasons is that stress incurred from mental disorders may affect the body’s biological systems,” says Dr. Girish Kulkarni, senior author of the study, adjunct scientist at ICES and urologic surgeon in the Department of Surgical Oncology at the Princess Margaret Cancer Centre, University Health Network.

Compared to a cancer patient who had never had psychiatric help prior to their diagnosis, patients who had been seen in the emergency department were 1.44 times more likely to die and the chances increased to nearly two times higher for those who had been hospitalized for mental health issues.

In particular, bladder and bowel cancer patients who had received help for their mental health had a significantly higher chance of death compared to patients with the same cancers who hadn’t had any psychiatric problems. Bladder cancer patients with a history of hospital admission were more than twice as likely to die from their cancer, but researchers are unsure why this is.

“We think this means mental health may play a larger role in cancer outcomes than previously thought. Major depression and stress may affect our body’s immune surveillance systems, effectively hampering the ability to detect and fight cancer,” says Dr. Zachary Klaassen, lead author, student at ICES and assistant professor and urologic oncologist at the Georgia Cancer Center.

“A recent psychiatric history should be a red flag to all doctors and nurses treating cancer patients. It’s essential we keep a close eye on these patients to make sure they’re receiving the best possible care and are followed up if and when cancer appointments are missed.”

For patients who saw their family doctor or had an emergency appointment, the chance of death was higher if this encounter was less than 12 months before a cancer diagnosis compared to if this was between one and five years before.

While the study identified that there was an association between cancer patients having psychiatric help and an increased chance of dying from their disease, it did not prove a direct cause.

Dr. Richard Roope, Cancer Research UK’s senior clinical adviser, said: “More research needs to be done to work out why this is the case. It’s important that people seeing a doctor for mental health issues are reminded of their cancer screening invitations and that any potential cancer symptoms are addressed in a timely way.”​

Author block: Klaassen Z, Wallis CJD, Goldberg H, Chandrasekar T, Sayyid RK, Williams SB, Moses KA, Terris MK, Nam RK, Urbach D, Austin PC, Kurdyak P, Kulkarni GS.

The report “The impact of psychiatric utilization prior to cancer diagnosis on survival of solid organ malignancies,” is published in the March 5 issue of British Journal of Cancer.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

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