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Mitchell RJ, Delaney GP, Arnolda G, Liauw W, Lystad RP, Braithwaite J. Three-year hospital service use trajectories of people diagnosed with cancer: A retrospective cohort study. Cancer Epidemiol 2024; 93:102676. [PMID: 39303658 DOI: 10.1016/j.canep.2024.102676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/27/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Information regarding hospital service use by people newly diagnosed with cancer can inform patterns of healthcare utilisation and resource demands. This study aims to identify characteristics of group-based trajectories of hospital service use three years after an individual was diagnosed with cancer; and determine factors predictive of trajectory group membership. METHOD A group-based trajectory analysis of hospital service use of people aged ≥30 years who had a new diagnosis of cancer during 2018 in New South Wales, Australia was conducted. Linked cancer registry, hospital and mortality data were examined for a three-year period after diagnosis. Group-based trajectory models were derived based on number of hospital admissions. Multinominal logistic regression examined predictors of trajectory group membership. RESULTS Of the 44,577 new cancer diagnosis patients, 29,085 (65.2 %) were hospitalised at least once since their cancer diagnosis. Four distinct trajectory groups of hospital users were identified: Low (68.4 %), Very-Low (25.1 %), Moderate-Chronic (2.2 %), and Early-High (4.2 %). Key predictors of trajectory group membership were age group, cancer type, degree of cancer spread, prior history of cancer, receiving chemotherapy, and presence of comorbidities, including renal disease, moderate/serious liver disease, or anxiety. CONCLUSIONS Comorbidities should be considered in cancer treatment and management decision making. Caring for people diagnosed with cancer with multimorbidity requires multidisciplinary shared care.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Geoffrey P Delaney
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), University of New South Wales, Sydney, Australia; Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, South-Western Sydney Clinical School, University of New South Wales, Sydney, Australia; University of New South Wales School of Clinical Medicine, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Winston Liauw
- University of New South Wales School of Clinical Medicine, Sydney, Australia; Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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2
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Triplett PT, Prince E, Bienvenu OJ, Gerstenblith A, Carroll CP. An Observational Study of Proactive and On-Request Psychiatry Consultation Services: Evidence for Differing Roles and Outcomes. J Acad Consult Liaison Psychiatry 2024; 65:338-346. [PMID: 38508493 DOI: 10.1016/j.jaclp.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Proactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce the length of stay and improve staff satisfaction. However, in some settings, it is impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future. Prior research has focused on changes in outcomes with the implementation of proactive services. OBJECTIVE AND METHODS This report describes differences between contemporary proactive and on-request services within the same academic medical center, comparing demographic and clinical data collected retrospectively from a 4-year period from the electronic medical record. RESULTS The proactive service saw patients over four times as many initial admissions (7592 vs. 1762), but transitions and handoffs between services were common, with 434 admissions involving both services, comprising nearly 20% of the on-request service's total contacts. The proactive service admissions had a shorter length of stay and a faster time to first psychiatric contact, and the patients seen were more likely to be female, of Black race, and to be publicly insured. There were over three times as many admissions to psychiatry from the proactive service. The on-request service's admissions had a longer length of stay, were much more likely to involve intensive care unit services, surgical services, and transfers among units, and the patients seen were more likely to die in the hospital or to be discharged to subacute rehabilitation. CONCLUSIONS Overall, the results suggest that the two services fulfill complementary roles, with the proactive service's rapid screening and contact providing care to a high volume of patients who might otherwise be unidentified and underserved. Simultaneously, the on-request service's ability to manage patients in response to consult requests over a much larger area of the hospital provided important support and continuity for patients with complex health needs. Institutions revising their consultation services will likely need to consider the best balance of these differing functions to address perceived demand for services.
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Affiliation(s)
- Patrick T Triplett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Elizabeth Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Avi Gerstenblith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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3
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Zhao J, Zeng X, Liu J, Liu X, Liu Z, Wang B, Chen Z, Dong Y, Guo S, Cui M, Xiao H, Liu X. Marasmius androsaceus mitigates depression-exacerbated intestinal radiation injuries through reprogramming hippocampal miRNA expression. Biomed Pharmacother 2023; 165:115157. [PMID: 37454593 DOI: 10.1016/j.biopha.2023.115157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Cancer patients commonly experience high levels of psychological stress, which poses significant risks to their well-being. Radiotherapy is a primary treatment modality for cancer; however, it often leads to intestinal injuries in these patients. Nevertheless, the impact of mental stress on radiotherapy-intertwined complications remains unclear. METHODS To induce intestinal injury, we employed total abdominal irradiation in our experimental model. We conducted high-throughput sequencing to analyze the expression profile of miRNAs in the hippocampus. RESULTS We observed that mice with depression exhibited more severe intestinal injuries following total abdominal irradiation. Remarkably, oral administration of Marasmius androsaceus not only alleviated the depressive phenotype but also mitigated radiation-induced intestinal toxicity. Notably, this radioprotective effect was not observed in mice without depression. Depression disrupted the hippocampal miRNA expression profile in mice subjected to local irradiation of the abdomen, leading to the accumulation of miR-139-5p and miR-184-3p in the hippocampus, serum, and small intestine tissues. However, treatment with Marasmius androsaceus reprogrammed the miRNA expression signature in mice with depression. Furthermore, intravenous injection of antagomirs targeting miR-139-5p and miR-184-3p ameliorated depression, up-regulated Spn expression, reduced radiation enteritis, and improved the integrity of the small intestine in irradiated mice. CONCLUSION Our findings demonstrate the efficacy of Marasmius androsaceus, a small mushroom, in alleviating depression-aggravated intestinal toxicity following radiotherapy by reprogramming hippocampal miRNA expression.
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Affiliation(s)
- Jiamin Zhao
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China
| | - Xiaozhou Zeng
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Jia Liu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China
| | - Xiaojing Liu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China
| | - Zhihong Liu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Dushuhu Campus, Soochow University, 199 Ren'ai Road, Suzhou 215123, China
| | - Bin Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Zhiyuan Chen
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Yanxi Dong
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China
| | - Suping Guo
- Shanxi Institute of Medicine and Life Science, 61 Pingyang Road, Taiyuan 030012, China; Shanxi Kangxin Pharmaceutical Co., Ltd, 1 West Ring Road, Luliang 030082, China
| | - Ming Cui
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 238 Baidi Road, Tianjin 300192, China.
| | - Huiwen Xiao
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China.
| | - Xingzhong Liu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of MolecularMicrobiology and Technology of the Ministry of Education, Department of Microbiology, College of Life Sciences, Nankai University, 94 Weijin Road, Tianjin 300071, China.
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Oldak SE, Maristany A, Ventura W, Alhajji L, Padilla VL. First-Onset Psychosis Leading to Multiple Myeloma Diagnosis: A Case Report and Literature Review. Cureus 2023; 15:e43842. [PMID: 37736447 PMCID: PMC10510305 DOI: 10.7759/cureus.43842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Although multiple myeloma (MM) can cause various neurological complications, direct central nervous system (CNS) involvement is exceedingly uncommon and poorly understood. There has been one other reported case in the literature of a patient presenting with psychosis prior to diagnosis of MM. We present a case of a 58-year-old female with no history of psychiatric illness who presented to a behavioral health inpatient unit with paranoid delusions, multisensory hallucinations, and disorganized behavior in the days preceding her MM diagnosis. Due to hypercalcemia and altered mental status, she was transferred to an inpatient medical unit for further medical workup. Imaging revealed a sternal mass and diffuse lytic lesions. MM was confirmed. Her psychotic symptoms improved after one cycle of chemotherapy and steroids, treatment with aripiprazole, and resolution of hypercalcemia. Unlike other case reports where mental status changes have been described as consequences of already diagnosed MM, this patient's psychotic symptoms manifested prior to her MM diagnosis. While the exact pathophysiological mechanisms remain unclear, this case highlights a potential link between the sudden onset of psychosis and underlying undiagnosed MM. Healthcare providers need to be aware of this rare clinical presentation of psychosis in conjunction with MM.
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Affiliation(s)
- Sean E Oldak
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
- Psychiatry and Behavioral Sciences, Jackson Memorial Hospital, Miami, USA
| | - Anthony Maristany
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - William Ventura
- Psychiatry and Behavioral Sciences, Universidad Tecnológica de Santiago, Santiago, DOM
| | - Lujain Alhajji
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Vanessa L Padilla
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
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Niazi SK, Iqbal M, Spaulding AC, Wood C, Manochakian R, Paulus A, Ailawadhi S, Brennan E, Kharfan Dabaja MA, Sher T. Impact of Benzodiazepine Use on Length of Stay and 30-Day ED Visits among Hospitalized Hematopoietic Stem Cell Transplant Recipients. South Med J 2022; 115:936-943. [DOI: 10.14423/smj.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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6
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Measuring hospital-related burden of treatment in multiple myeloma using Electronic Health Records’-reimbursement data. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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7
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Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med 2022; 20:234. [PMID: 35850686 PMCID: PMC9295506 DOI: 10.1186/s12916-022-02427-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity is a rising global phenomenon, placing strains on countries' population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What "cost ingredients" are most commonly included in these multimorbidity studies? METHODS We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$). RESULTS Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs. CONCLUSIONS Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Joseph Kazibwe
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mieke Rijken
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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8
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Depression and unplanned secondary healthcare use in patients with multimorbidity: A systematic review. PLoS One 2022; 17:e0266605. [PMID: 35390086 PMCID: PMC8989325 DOI: 10.1371/journal.pone.0266605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable.
Aim
To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity.
Methods
We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced.
Results
Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities.
Conclusion
Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients with depression. Findings indicate the need to improve planned care for patients with moderate-to-severe depression. We suggest regular reviews of care plans, depression severity monitoring and assessment of hospital admission risk in primary care settings.
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9
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Van Beek FE, Wijnhoven LMA, Holtmaat K, Custers JAE, Prins JB, Verdonck-de Leeuw IM, Jansen F. Psychological problems among cancer patients in relation to healthcare and societal costs: A systematic review. Psychooncology 2021; 30:1801-1835. [PMID: 34228838 PMCID: PMC9291760 DOI: 10.1002/pon.5753] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study systematically reviewed the association of psychological problems among cancer patients with healthcare and societal resource use and costs. METHODS PubMed, PsycINFO, and Embase were searched (until 31 January 2021) for studies on psychological symptoms (anxiety, depression, distress, fear of recurrence) or psychiatric disorders (anxiety, depression, adjustment) and healthcare use (e.g., mental, inpatient healthcare), economic losses by patients and family, economic losses in other sectors (e.g., absence from work), and costs. The search, data extraction, and quality assessment were performed by two authors. RESULTS Of the 4157 identified records, 49 articles were included (psychological symptoms (n = 34), psychiatric disorders (n = 14), both (n = 1)) which focused on healthcare use (n = 36), economic losses by patients and family (n = 5), economic losses in other sectors (n = 8) and/or costs (n = 13). In total, for 12 of the 94 associations strong evidence was found. Psychological symptoms and psychiatric disorders were positively associated with increased healthcare use (mental, primary, inpatient, outpatient healthcare), losses in other sectors (absence from work), and costs (inpatient, outpatient, total healthcare costs). Moderate evidence was found for a positive association between (any) psychiatric disorder and depression disorder with inpatient healthcare and medication use, respectively. CONCLUSIONS Psychological problems in cancer patients are associated with increased healthcare use, healthcare costs and economic losses. Further research is needed on psychological problems in relation to understudied healthcare use or costs categories, productivity losses, and informal care costs.
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Affiliation(s)
- Florie E Van Beek
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lonneke M A Wijnhoven
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Karen Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, VUmc Cancer Center Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, VUmc Cancer Center Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
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10
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Hart KL, Perlis RH, McCoy TH. Mapping of Transdiagnostic Neuropsychiatric Phenotypes Across Patients in Two General Hospitals. J Acad Consult Liaison Psychiatry 2021; 62:430-439. [PMID: 34210402 DOI: 10.1016/j.jaclp.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multidimensional transdiagnostic phenotyping systems are increasingly important to neuropsychiatric phenotyping, particularly in translational research settings. The relationship the National Institute of Mental Health's Research Domain Criteria multidimensional approach to psychopathology and nonpsychiatric diagnoses has not been studied at scale but is relevant to those caring for neuropsychiatric illness in medical and surgical settings. METHODS We applied the CQH Dimensional Phenotyper natural language processing tool to estimate National Institute of Mental Health's Research Domain Criteria domain-associated symptoms of individuals admitted to nonpsychiatric wards at each of 2 large academic general hospitals over an 8-year period. We compared patterns in individual domain symptom burden, as well as a new pooled unidimensional measure, by primary medical and surgical diagnosis. RESULTS Analysis included 227,243 patients from hospital 1 of whom 68,793 (30.3%) had a prior psychiatric history and 220,213 patients from hospital 2 of whom 50,818 (23.1%) had a prior psychiatric history. The distribution of Research Domain Criteria symptom burdens over primary diagnosis was similar across hospital sites and differed significantly across primary medical or surgical diagnosis. The effect of primary medical or surgical diagnosis was larger than that of prior psychiatric history on Research Domain Criteria symptom burden. CONCLUSION Research Domain Criteria-based neuropsychiatric symptom burden estimated from general hospital patients' clinical documentation is more strongly associated with the primary hospital medical or surgical diagnosis than it is with the presence of a previous psychiatric history. The bidirectional role of psychiatric and somatic illness warrants further study through the lens of transdiagnostic phenotyping.
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Affiliation(s)
- Kamber L Hart
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA
| | - Roy H Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA
| | - Thomas H McCoy
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA.
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Niazi SK, Spaulding A, Brennan E, Meier SK, Crook JE, Cornell LF, Ailawadhi S, Clark MM, Rummans TA. Mental Health and Chemical Dependency Services at US Cancer Centers. J Natl Compr Canc Netw 2021; 19:829-838. [PMID: 33662936 DOI: 10.6004/jnccn.2020.7657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is standard of care and an accreditation requirement to screen for and address distress and psychosocial needs in patients with cancer. This study assessed the availability of mental health (MH) and chemical dependency (CD) services at US cancer centers. METHODS The 2017-2018 American Hospital Association (AHA) survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases were used to assess availability of services and associations with hospital-level and health services area (HSA)-level characteristics. RESULTS Of 1,144 cancer centers surveyed, 85.4% offered MH services and 45.5% offered CD services; only 44.1% provided both. Factors associated with increased adjusted odds of offering MH services were teaching status (odds ratio [OR], 1.76; 95% CI, 1.18-2.62), being a member of a hospital system (OR, 2.00; 95% CI, 1.31-3.07), and having more beds (OR, 1.04 per 10-bed increase; 95% CI, 1.02-1.05). Higher population estimate (OR, 0.98; 95% CI, 0.97-0.99), higher percentage uninsured (OR, 0.90; 95% CI, 0.86-0.95), and higher Mental Health Professional Shortage Area level in the HSA (OR, 0.99; 95% CI, 0.98-1.00) were associated with decreased odds of offering MH services. Government-run (OR, 2.85; 95% CI, 1.30-6.22) and nonprofit centers (OR, 3.48; 95% CI, 1.78-6.79) showed increased odds of offering CD services compared with for-profit centers. Those that were members of hospital systems (OR, 1.61; 95% CI, 1.14-2.29) and had more beds (OR, 1.02; 95% CI, 1.01-1.03) also showed increased odds of offering these services. A higher percentage of uninsured patients in the HSA (OR, 0.92; 95% CI, 0.88-0.97) was associated with decreased odds of offering CD services. CONCLUSIONS Patients' ability to pay, membership in a hospital system, and organization size may be drivers of decisions to co-locate services within cancer centers. Larger organizations may be better able to financially support offering these services despite poor reimbursement rates. Innovations in specialty payment models highlight opportunities to drive transformation in delivering MH and CD services for high-need patients with cancer.
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Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry & Psychology.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and.,Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Emily Brennan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and.,Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Sarah K Meier
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Julia E Crook
- Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | | | | | - Matthew M Clark
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Teresa A Rummans
- Department of Psychiatry & Psychology.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
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12
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Kim SJ, Kang D, Park Y, Mun YC, Kim K, Kim JS, Min CK, Cho J. Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma. Support Care Cancer 2021; 29:4969-4977. [PMID: 33575840 DOI: 10.1007/s00520-021-06017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM. METHODS This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4 cycles, 4-11 cycles, and more than 12 cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively. RESULTS Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment. CONCLUSIONS Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.
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Affiliation(s)
- Seok Jin Kim
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Park
- Divison of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Yeung-Chul Mun
- Department of Hematology, Ewha Womans University, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea. .,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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13
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Ribeiro-Carvalho F, Gonçalves-Pinho M, Bergantim R, Freitas A, Fernandes L. Trend of depression and its association with sociodemographic and clinical factors among multiple myeloma hospitalizations: A Portuguese nationwide study from 2000 to 2015. Psychooncology 2020; 29:1587-1594. [PMID: 32658348 DOI: 10.1002/pon.5469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients hospitalized with multiple myeloma (MM) are particularly vulnerable to depression. The present study aims to determine the frequency of depression among MM hospitalized patients, in order to assess the possible differences between those with and without depression in relation to sociodemographic and clinical variables and to measure the impact of depression on hospitalization outcomes. METHODS An observational retrospective study was performed using an administrative data set of all hospitalizations with a primary diagnosis of MM between 2000 and 2015 in Portuguese mainland public hospitals. Codes related to depressive disorders were grouped to generate the dichotomous variable of depression (yes/no). A multivariate analysis was conducted and adjusted odd ratios (aOR) calculated between different variables and depression. RESULTS Of a total of 14.575 MM hospitalizations studied, a concurrent code of depression was registered in 666 patients (4.6%). A greater odds of depression was observed in female patients (aOR = 2.26; 95%CI = 1.91-2.66), transplanted patients (aOR = 1.78; 95%CI = 1.44-2.20), patients with plasma cell leukemia (aOR = 1.79; 95%CI = 1.22-2.64) and patients with a higher Charlson Comorbidity Index (CCI) (aOR = 1.10; 95%CI = 1.05-1.15). Length of stay was longer in patients with a registered diagnosis of depression (aOR = 1.01; 95%CI = 1.01-1.02) while the odds of in-hospital mortality were lower in these patients (aOR = 0.53; 95%CI = 0.41-0.68). CONCLUSIONS These results may help identify MM inpatients at higher risk of presenting depression (female gender, younger age, high CCI, plasma cell leukemia, transplant procedure). This will enable timely psychological assessment and treatment to prevent worse outcomes and higher healthcare costs associated with depression.
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Affiliation(s)
| | - Manuel Gonçalves-Pinho
- Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.,Center for Health Technology and Services Research (CINTESIS), FMUP, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), FMUP, Porto, Portugal
| | - Rui Bergantim
- Hematology Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Cancer Drug Resistance Group, IPATIMUP-Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research (CINTESIS), FMUP, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), FMUP, Porto, Portugal
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), FMUP, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, FMUP, Porto, Portugal.,Psychiatry Service, CHUSJ, Porto, Portugal
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14
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Niazi SK, Naessens JM, White L, Borah B, Vargas ER, Richards J, Cabral S, Clark MM, Rummans T. Impact of Psychiatric Comorbidities on Health Care Costs Among Patients With Cancer. PSYCHOSOMATICS 2019; 61:145-153. [PMID: 31864662 DOI: 10.1016/j.psym.2019.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Psychiatric disorders are common in cancer patients and impact outcomes. Impact on cancer care cost needs study to develop business case for psychosocial interventions. OBJECTIVE To evaluate the impact of preexisting psychiatric comorbidities on total cost of care during 6 months after cancer diagnosis. METHODS This retrospective cohort study examined patients diagnosed with cancer between January 1, 2009, and December 31, 2014, at one National Cancer Institute-designated cancer center. Patients who received all cancer treatment at the study site (6598 of 11,035 patients) were included. Patients were divided into 2 groups, with or without psychiatric comorbidity, based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Total costs of care during the first 6 months of treatment were based on standardized costs adjusted to 2014 dollars, determined by assigning Medicare reimbursement rates to professional billed services and applying appropriate cost-to-charge ratios. Quantile regression models with covariate adjustments were developed to assess the effect of psychiatric comorbidity across the distribution of costs. RESULTS Six hundred ninety-eight (10.6%) of 6598 eligible patients had at least one psychiatric comorbidity. These patients had more nonpsychiatric Elixhauser comorbidities (mean 4 vs. 3). Unadjusted total cancer care costs were higher for patients with psychiatric comorbidity (mean [standard deviation]: $51,798 [$74,549] vs. $32,186 [$45,240]; median [quartiles]: $23,871 [$10,705-$57,338] vs. $19,073 [$8120-$38,230]). Quantile regression models demonstrated that psychiatric comorbidity had significant incremental effects at higher levels of cost: 75th percentile $8629 (95% confidence interval: $3617-13,642) and 90th percentile $42,586 (95% confidence interval: $25,843-59,330). CONCLUSIONS Psychiatric comorbidities are associated with increased total cancer costs, especially in patients with very high cancer care costs, representing an opportunity to develop mitigation strategies.
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Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL; Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL.
| | - James M Naessens
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL; Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Launia White
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Bijan Borah
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Emily R Vargas
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | | | | | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Teresa Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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15
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Magnuson A, Sattar S, Nightingale G, Saracino R, Skonecki E, Trevino KM. A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression. Am Soc Clin Oncol Educ Book 2019; 39:e96-e109. [PMID: 31099668 DOI: 10.1200/edbk_237641] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.
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Affiliation(s)
- Allison Magnuson
- 1 Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
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16
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Abu-Ghname A, Clementi M, Marton S, Schwarzwald H, Giwa E, Hollier L, Chapman S. Behavioral health service utilization: Trends in utilization within a patient-centered medical home for low-income children and women. J Family Med Prim Care 2019; 8:3983-3989. [PMID: 31879647 PMCID: PMC6924215 DOI: 10.4103/jfmpc.jfmpc_412_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 11/04/2022] Open
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