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Mortality among patients with diffuse large B-cell lymphoma with mental disorders: a population-based study


Background — While mental disorders have been reported in patients with diffuse large B-cell lymphoma (DLBCL), studies examining their association with mortality are lacking.

Methods — We conducted a population-based study using linked administrative healthcare databases from Ontario, Canada. All patients with DLBCL aged ≥18 years treated with rituximab-based therapy between January 1st, 2005 and December 31st, 2017 were identified and followed until March 1, 2020. Mental disorders were defined as either pre-existing or post-diagnosis (after lymphoma treatment initiation). Cox proportional hazard models were used to estimate the adjusted hazard ratio (aHR) between mental disorders and outcomes 1-year and all-cause mortality, while controlling for covariates.

Results — We identified 10,299 patients with DLBCL; median age 67 years; 46% female; 28% with a pre-existing mental disorder. At 1-year follow-up, 892 (9%) had a post-diagnosis mental disorder, and a total of 2,008 (20%) patients died. Pre-existing mental disorders were not associated with 1-year mortality (aHR 1.06, 95% confidence interval [CI] 0.96-1.17, p = 0.25) while post-diagnosis disorders were (aHR 1.51, 95% CI 1.26-1.82, p = 0.0001). During a median follow-up of 5.2 years, 2,111 (22%) patients had a post-diagnosis mental disorder, and 4,084 (40%) patients died. Both pre-existing and post-diagnosis mental disorders were associated with worse all-cause mortality (pre-existing aHR 1.12, 95% CI 1.04-1.20, p = 0.0024; post-diagnosis aHR 1.63, 95% CI 1.49-1.79, p < 0.0001).

Conclusions — Patients with DLBCL and mental disorders had worse short-term and long-term mortality, particularly those with post-diagnosis mental disorders. Further studies are needed to examine mental health service utilization and factors mediating the relationship between mental disorders and inferior mortality.



Gong I, Cheung MC, Chan KKW, Arya S, Faught N, Calzavara A, Liu N, Odejide OO, Abel G, Kurdyak P, Raphael MJ, Kuczmarski T, Prica A, Mozessohn L. J Natl Cancer Inst. 2023; Aug 2 [Epub ahead of print].

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