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Olive JK, Zhou N, Mitchell KG, Corsini EM, Hofstetter WL, Mehran RJ, Rice DC, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB. Impact of Psychiatric Comorbidities on Surgical Outcomes for Non-Small Cell Lung Cancer. Ann Thorac Surg 2021; 113:1008-1014. [PMID: 33774003 DOI: 10.1016/j.athoracsur.2021.03.034] [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: 08/08/2020] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psychiatric comorbidities (PC) have been associated with poor surgical outcomes in several malignancies. However, the impact of PC on surgical outcomes for non-small cell lung cancer (NSCLC) remains largely unknown. METHODS NSCLC patients who underwent pulmonary resection at a single institution between 2006-2017 were included. Presence of preoperative PC was identified by documented diagnostic codes. Demographic, histopathologic, perioperative, and survival data were analyzed. Categorical variables were compared using chi-squared or Fisher's exact test. Overall and disease-free survival were analyzed using Kaplan-Meier method. Univariable and multivariable logistic regression analyses were performed for 30-day readmission. RESULTS Among 2907 patients, PC were present preoperatively in 180 (6%), including 130 (72%) anxiety, 52 (29%) depression, 28 (16%) adjustment disorder, 16 (9%) alcohol abuse, 8 (4%) sleep disorder, and 3 (2%) schizophrenia. Patients with PC were younger, with fewer cardiovascular complications. There were no differences in length of stay. However, PC led to increased 30-day readmission (12% vs 6%, p=0.004). Reasons for readmission did not differ between groups (p=0.679). Upon multivariable analysis, PC independently predicted 30-day readmission (OR: 2.00, p=0.005). Importantly, there were no differences in 30- or 90-day mortality (p=0.495 and 0.748, respectively), overall survival (p=0.439), or disease-free survival (p=0.924). CONCLUSIONS NSCLC patients with and without PC experienced similar perioperative and long-term outcomes, suggesting that individuals should not be denied surgical care on the basis of such comorbidities. However, further research should seek to identify reasons for increased risk of readmission for patients with PC and validate these findings in other settings.
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Affiliation(s)
- Jacqueline K Olive
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Nicolas Zhou
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
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Kashyap M, Harris JP, Chang DT, Pollom EL. Impact of mental illness on end-of-life emergency department use in elderly patients with gastrointestinal malignancies. Cancer Med 2021; 10:2035-2044. [PMID: 33621438 PMCID: PMC7957203 DOI: 10.1002/cam4.3792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/25/2022] Open
Abstract
Background Elderly patients with gastrointestinal cancer and mental illness have significant comorbidities that can impact the quality of their care. We investigated the relationship between mental illness and frequent emergency department (ED) use in the last month of life, an indicator for poor end‐of‐life care quality, among elderly patients with gastrointestinal cancers. Methods We used SEER‐Medicare data to identify decedents with gastrointestinal cancers who were diagnosed between 2004 and 2013 and were at least 66 years old at time of diagnosis (median age: 80 years, range: 66–117 years). We evaluated the association between having a diagnosis of depression, bipolar disorders, psychotic disorders, anxiety, dementia, and/or substance use disorders and ED use in the last 30 days of life using logistic regression models. Results Of 160,367 patients included, 54,661 (34.1%) had a mental illness diagnosis between one year prior to cancer diagnosis and death. Patients with mental illness were more likely to have > 1 ED visit in the last 30 days of life (15.6% vs. 13.3%, p < 0.01). ED use was highest among patients with substance use (17.7%), bipolar (16.5%), and anxiety disorders (16.4%). Patients with mental illness who were male, younger, non‐white, residing in lower income areas, and with higher comorbidity were more likely to have multiple end‐of‐life ED visits. Patients who received outpatient treatment from a mental health professional were less likely to have multiple end‐of‐life ED visits (adjusted odds ratio 0.82, 95% confidence interval 0.78–0.87). Conclusions In elderly patients with gastrointestinal cancers, mental illness is associated with having multiple end‐of‐life ED visits. Increasing access to mental health services may improve quality of end‐of‐life care in this vulnerable population.
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Affiliation(s)
- Mehr Kashyap
- Department of Radiation Oncology, Stanford University, Stanford, California, USA.,Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California, Irvine, Orange, California, USA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Harris JP, Kashyap M, Humphreys JN, Chang DT, Pollom EL. Longitudinal Analysis of Mental Disorder Burden Among Elderly Patients With Gastrointestinal Malignancies. J Natl Compr Canc Netw 2021; 19:163-171. [PMID: 33401234 DOI: 10.6004/jnccn.2020.7620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with cancer are at high risk for having mental disorders, resulting in widespread psychosocial screening efforts. However, there is a need for population-based and longitudinal studies of mental disorders among patients who have gastrointestinal cancer and particular among elderly patients. PATIENTS AND METHODS We used the SEER-Medicare database to identify patients aged ≥65 years with colorectal, pancreatic, gastric, hepatic/biliary, esophageal, or anal cancer. Earlier (12 months before or up to 6 months after cancer diagnosis) and subsequent mental disorder diagnoses were identified. RESULTS Of 112,283 patients, prevalence of an earlier mental disorder was 21%, 23%, 20%, 20%, 19%, and 26% for colorectal, pancreatic, gastric, hepatic/biliary, esophageal, and anal cancer, respectively. An increased odds of an earlier mental disorder was associated with pancreatic cancer (odds ratio [OR], 1.17; 95% CI, 1.11-1.23), esophageal cancer (OR, 1.10; 95% CI, 1.02-1.18), and anal cancer (OR, 1.17; 95% CI, 1.05-1.30) compared with colorectal cancer and with having regional versus local disease (OR, 1.09; 95% CI, 1.06-1.13). The cumulative incidence of a subsequent mental disorder at 5 years was 19%, 16%, 14%, 13%, 12%, and 10% for patients with anal, colorectal, esophageal, gastric, hepatic/biliary, and pancreatic cancer, respectively. There was an association with having regional disease (hazard ratio [HR], 1.08; 95% CI, 1.04-1.12) or distant disease (HR, 1.36; 95% CI, 1.28-1.45) compared with local disease and the development of a mental disorder. Although the development of a subsequent mental disorder was more common among patients with advanced cancers, there continued to be a significant number of patients with earlier-stage disease at risk. CONCLUSIONS This study suggests a larger role for incorporating psychiatric symptom screening and management throughout oncologic care.
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Affiliation(s)
- Jeremy P Harris
- 1Department of Radiation Oncology, University of California, Irvine, Orange
| | - Mehr Kashyap
- 2Department of Radiation Oncology, Stanford University, Stanford; and
| | - Jessi N Humphreys
- 3Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Daniel T Chang
- 2Department of Radiation Oncology, Stanford University, Stanford; and
| | - Erqi L Pollom
- 2Department of Radiation Oncology, Stanford University, Stanford; and
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Harris JP, Kashyap M, Humphreys JN, Pollom EL, Chang DT. The clinical and financial cost of mental disorders among elderly patients with gastrointestinal malignancies. Cancer Med 2020; 9:8912-8922. [PMID: 33022135 PMCID: PMC7724481 DOI: 10.1002/cam4.3509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022] Open
Abstract
The clinical and financial effects of mental disorders are largely unknown among gastrointestinal (GI) cancer patients. Using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database, we identified patients whose first cancer was a primary colorectal, pancreatic, gastric, hepatic/biliary, esophageal, or anal cancer as well as those with coexisting depression, anxiety, psychotic, or bipolar disorder. Survival, chemotherapy use, total healthcare expenditures, and patient out‐of‐pocket expenditures were estimated and compared based on the presence of a mental disorder. We identified 112,283 patients, 23,726 (21%) of whom had a coexisting mental disorder. Median survival for patients without a mental disorder was 52 months (95% CI 50–53 months) and for patients with a mental disorder was 43 months (95% CI 42–44 months) (p < 0.001). Subgroup analysis identified patients with colorectal, gastric, or anal cancer to have a significant association between survival and presence of a mental disorder. Chemotherapy use was lower among patients with a mental disorder within regional colorectal cancer (43% vs. 41%, p = 0.01) or distant colorectal cancer subgroups (71% vs. 63%, p < 0.0001). The mean total healthcare expenditures were higher for patients with a mental disorder in first year following the cancer diagnosis (increase of $16,823, 95% CI $15,777‐$18,173), and mean patient out‐of‐pocket expenses were also higher (increase of $1,926, 95% CI $1753–$2091). There are a substantial number of GI cancer patients who have a coexisting mental disorder, which is associated with inferior survival, higher healthcare expenditures, and greater personal financial burden.
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Affiliation(s)
- Jeremy P. Harris
- Department of Radiation Oncology University of California Irvine, Orange CA USA
| | - Mehr Kashyap
- Department of Radiation Oncology Stanford University Stanford CA USA
| | - Jessica N. Humphreys
- Division of Palliative Medicine Department of Medicine University of California San Francisco CA USA
| | - Erqi L. Pollom
- Department of Radiation Oncology Stanford University Stanford CA USA
| | - Daniel T. Chang
- Department of Radiation Oncology Stanford University Stanford CA USA
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Kashlan O, Swong K, Alvi MA, Bisson EF, Mummaneni PV, Knightly J, Chan A, Yolcu YU, Glassman S, Foley K, Slotkin JR, Potts E, Shaffrey M, Shaffrey CI, Haid RW, Fu KM, Wang MY, Asher AL, Bydon M, Park P. Patients with a depressive and/or anxiety disorder can achieve optimum Long term outcomes after surgery for grade 1 spondylolisthesis: Analysis from the quality outcomes database (QOD). Clin Neurol Neurosurg 2020; 197:106098. [PMID: 32717562 DOI: 10.1016/j.clineuro.2020.106098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the current study, we sought to compare baseline demographic, clinical, and operative characteristics, as well as baseline and follow-up patient reported outcomes (PROs) of patients with any depressive and/or anxiety disorder undergoing surgery for low-grade spondylolisthesis using a national spine registry. PATIENTS AND METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing surgery for Meyerding grade 1 lumbar spondylolisthesis undergoing 1-2 level decompression or 1 level fusion at 12 sites with the highest number of patients enrolled in QOD with 2-year follow-up data. RESULTS Of the 608 patients identified, 25.6 % (n = 156) had any depressive and/or anxiety disorder. Patients with a depressive/anxiety disorder were less likely to be discharged home (p < 0.001). At 3=months, patients with a depressive/anxiety disorder had higher back pain (p < 0.001), lower quality of life (p < 0.001) and higher disability (p = 0.013); at 2 year patients with depression and/or anxiety had lower quality of life compared to those without (p < 0.001). On multivariable regression, depression was associated with significantly lower odds of achieving 20 % or less ODI (OR 0.44, 95 % CI 0.21-0.94,p = 0.03). Presence of an anxiety disorder was not associated with decreased odds of achieving that milestone at 3 months. The presence of depressive-disorder, anxiety-disorder or both did not have an impact on ODI at 2 years. Finally, patient satisfaction at 2-years did not differ between the two groups (79.8 % vs 82.7 %,p = 0.503). CONCLUSION We found that presence of a depressive-disorder may impact short-term outcomes among patients undergoing surgery for low grade spondylolisthesis but longer term outcomes are not affected by either a depressive or anxiety disorder.
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Affiliation(s)
- Osama Kashlan
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Kevin Swong
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - John Knightly
- Atlantic Neurosurgical Specialists, Morristown, New Jersey, United States
| | - Andrew Chan
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Yagiz U Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Steven Glassman
- Norton Leatherman Spine Center, Louisville, Kentucky, United States
| | - Kevin Foley
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | | | - Eric Potts
- Goodman Campbell Brain and Spine, Indianapolis, Indiana, United States
| | - Mark Shaffrey
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Christopher I Shaffrey
- Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina, United States
| | | | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical College, New York City, NY, United States
| | - Michael Y Wang
- Department of Neurologic Surgery, University of Miami, Miami, Florida, United States
| | - Anthony L Asher
- Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina, United States
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
| | - Paul Park
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, United States
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Jeremiasen M, Linder G, Hedberg J, Lundell L, Björ O, Lindblad M, Johansson J. Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007-2016 from a national quality register. Dis Esophagus 2019; 33:5585604. [PMID: 31608927 PMCID: PMC7672200 DOI: 10.1093/dote/doz070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/23/2019] [Accepted: 06/29/2019] [Indexed: 12/11/2022]
Abstract
The Swedish National Register for Esophageal and Gastric cancer was launched in 2006 and contains data with adequate national coverage and of high internal validity on patients diagnosed with these tumors. The aim of this study was to describe the evolution of esophageal and gastric cancer care as reflected in a population-based clinical registry. The study population was 12,242 patients (6,926 with esophageal and gastroesophageal junction (GEJ) cancers and 5,316 with gastric cancers) diagnosed between 2007 and 2016. Treatment strategies, short- and long-term mortality, gender aspects, and centralization were investigated. Neoadjuvant oncological treatment became increasingly prevalent during the study period. Resection rates for both esophageal/GEJ and gastric cancers decreased from 29.4% to 26.0% (P = 0.022) and from 38.8% to 33.3% (P = 0.002), respectively. A marked reduction in the number of hospitals performing esophageal and gastric cancer surgery was noted. In gastric cancer patients, an improvement in 30-day mortality from 4.2% to 1.6% (P = 0.005) was evident. Overall 5-year survival after esophageal resection was 38.9%, being higher among women compared to men (47.5 vs. 36.6%; P < 0.001), whereas no gender difference was seen in gastric cancer. During the recent decade, the analyses based on the Swedish National Register for Esophageal and Gastric cancer database demonstrated significant improvements in several important quality indicators of care for patients with esophagogastric cancers. The Swedish National Register for Esophageal and Gastric cancer offers an instrument not only for the control and endorsement of quality of care but also a unique tool for population-based clinical research.
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Affiliation(s)
- M Jeremiasen
- Department of Clinical Sciences, Surgery, Lund University, Skane University Hospital, Lund, Sweden,Address correspondence to: Martin Jeremiasen, MD, Department of Surgery, Lund University, Skåne University Hospital, S-221 85 Lund, Sweden.
| | - G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet (CLINTEC), Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Surgery, Odense University Hospital, Odense, Denmark
| | - O Björ
- Department of Radiation Science, Oncology, Umea University, Umea, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet (CLINTEC), Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J Johansson
- Department of Clinical Sciences, Surgery, Lund University, Skane University Hospital, Lund, Sweden
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Klingelhöfer D, Zhu Y, Braun M, Brüggmann D, Schöffel N, Groneberg DA. A world map of esophagus cancer research: a critical accounting. J Transl Med 2019; 17:150. [PMID: 31077194 PMCID: PMC6511204 DOI: 10.1186/s12967-019-1902-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background Esophageal cancer (EC) is one of the deadliest cancers worldwide. The contemporary strong increase of the adenocarcinomas in Western countries and the high mortality rates require the intensification of prospective multinational studies. Methods Therefore, this global health issue has been chosen for the bibliometric review of the global publication output. As source for meta and citation data, the Web of Science has been used and Density Equalizing Maps were applied for visualization. Results 17,387 articles on EC could be identified. The years with publication and citation maxima correspond to the appearance of the most prolific articles. China is the most publishing country, followed by Japan and the USA. Germany and the UK ranked 4th and 5th. The analysis of the ratios articles and socio-economic parameters emphasizes the leading position of the Scandinavian countries and Japan. Here, the high-income countries come out on top. The high incidence regions are mainly represented by Chinese and Japanese research. The association of the publication output and the overall research funding could be shown. Conclusions A strengthened international network increasingly consisting of the scientifically best positioned countries as well as more of the high incidence countries worldwide is mandatory for future research. The findings deliver scientists, clinicians and decision makers backgrounds for future decisions all over the world.
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Affiliation(s)
- Doris Klingelhöfer
- Institute of Occupational, Social and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Yun Zhu
- Integrative Medicine Centre, 302 Military Hospital, Beijing, China
| | - Markus Braun
- Institute of Occupational, Social and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Dörthe Brüggmann
- Institute of Occupational, Social and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Norman Schöffel
- Institute of Occupational, Social and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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