Predictors of mood-related psychiatric disorders after cancer diagnosis.
Authors: Villalona Seiichi , Chavez Perez Carlos , Wileyto E. Paul , Takvorian Samuel U. , Gabriel Peter Edward , Doucette Abigail , Blumenthal Daniel , Schnoll Robert 
Published: June 2024

e23043

Background: Mood-related psychiatric disorders (MRPDs) such as anxiety and depression are more common among cancer patients vs. the general population and are related to decreased quality of life and poor cancer survival. However, individual risk factors for MRPDs among cancer patients are poorly understood. This study characterized individual predictors of a new MRPD after cancer diagnosis, with a focus on individual behavioral risk factors (IBRFs) (ie., tobacco use and human papillomavirus [HPV]-association). Methods: Single-center retrospective cohort study of 11,712 patients with newly diagnosed breast, prostate, colon, lung, oropharyngeal, anorectal, gynecologic (cervical, vaginal, and vulvar), or penile cancers between 2009-2020. Patients with breast, prostate, and colon cancer were used as controls because of the lack of an association with IBRFs. The primary outcome was a new MRPD post-cancer diagnosis, ascertained via electronic health record data and using ICD10 codes for MRPDs. Covariates included age, sex, race/ethnicity, sexual orientation, disease stage at diagnosis, and IBRFs. We conducted a time-to-event analysis to assess risk factors for MRPDs using a Cox proportional hazards model. Results: The average age of participants was 63 years (SD = 12 years). Most of the study sample was female (59%), non-Hispanic White (72%), heterosexual (67%), and diagnosed with stage I or II disease (63%). Breast (40%), prostate (26%) and lung (21%) were the most common cancers. 328 cases (3%) in the sample consisted of HPV-associated cancers. Half of the sample were current or former smokers. Univariate analyses revealed lower hazard ratios (HRs) of a new MRPD among individuals that identified as Asian/Pacific Islander (API) and among older patients ( > 51 years). Higher HRs of MRPDs were found for females; sexual minorities; former and current smokers; those with HPV-associated cancers; and those with later cancer stages (III and IV). These associations were observed in the adjusted multivariate model: APIs (aHR 0.60, 95%CI 0.46-0.65); 51-64 years (aHR 0.83, 95%CI 0.76-0.92); > 65 years (aHR 0.70, 95%CI 0.63-0.78); females (aHR 1.78, 95%CI 1.64-1.94); sexual minority (aHR 1.78, 95%CI 1.40-2.27); former smoker (aHR 1.40, 95%CI 1.30-1.52); current smoker (aHR 1.79, 95%CI 1.60-2.00); HPV-associated tumors (aHR 1.23, 95%CI 1.02-1.49); stage III diagnosis (aHR 1.58, 95%CI 1.34-1.85); stage IV diagnosis (aHR 2.31, 95%CI 1.96-2.73). Conclusions: IBRFs increased the risk of a new MRPD after being diagnosed with cancer. Prior work has associated HPV-positivity with anxiety and depression in patients without a cancer diagnosis. Our findings build on this and show that individuals diagnosed with HPV-associated cancers have a higher risk of developing new MRPDs after their cancer diagnoses. These findings can help identify patients at risk of developing new MRPDs post-cancer diagnosis to engage them in treatment.