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Patients with diffuse large B-cell lymphoma (DLBCL) who also had pre-existing depression, anxiety, or both had a worse prognosis than those without these pre-existing mental health conditions, according to results from a population-based study.

Among over 13,000 patients at a median follow-up of 2 years, the 5-year overall survival (OS) rate was 27% for patients with depression, anxiety, or both compared with 37.4% for those with none of these disorders (HR 1.37, 95% CI 1.29-1.44), reported Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues in .

When stratified by the different types of mental health disorders, patients with pre-existing depression alone had the worst OS compared with patients with no mental health disorder (HR 1.37, 95% CI 1.28-1.47), followed by those with depression and anxiety (HR 1.23, 95% CI 1.08-1.41), and anxiety alone (HR 1.17, 95% CI 1.06-1.29).

The 5-year lymphoma-specific survival rate in patients with depression, anxiety, or both was 42% versus 51.3% in those without any pre-existing mental health disorder. Patients with pre-existing depression alone had the worst lymphoma-specific survival compared with those with no mental health disorder (HR 1.37, 95% CI 1.26-1.49), followed by those with depression and anxiety (HR 1.25, 95% CI 1.07-1.47), and anxiety alone (HR 1.16, 95% CI 1.03-1.31).

Odejide and colleagues hypothesized that this relationship could be due to the fact that people with depression or anxiety may experience delays in getting lymphoma-related treatment, or could face barriers -- such as financial constraints and limited social support -- that reduce adherence to treatment plans.

Mental health disorders "are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival," they concluded. "As the field of lymphoma progresses with state-of-the-art diagnostics and targeted therapeutics, our analysis argues for increased attention to developing and disseminating high-quality psychological interventions for patients with DLBCL."

In , Elizabeth A. Davies, PhD, MBBS, and Yueh-Hsin Wang, a PhD student, at King's College London, noted that "this important and novel study increases our awareness of worse survival among older people with pre-existing mental health disorders after the diagnosis of diffuse large B-cell lymphoma."

However, they suggested that before embarking on large-scale, complex interventions to provide better care for cancer patients with pre-existing mental health conditions, providers should identify where psychosocial efforts should be focused.

For example, they pointed out that factors such as low income, poor diet and lifestyle factors, and lack of social support are not only associated with mental health disorders, but can act as barriers to early cancer diagnosis.

"Decreasing psychiatric comorbidity after diagnosis is important for well-being, but attempting this without tackling associated material and social factors might not necessarily be effective, or lead to better survival," they wrote.

In this study, Odejide and colleagues used the Surveillance, Epidemiology, and End Results-Medicare database to identify 13,244 patients ages 67 years and older who were diagnosed with DLBCL in the U.S. from January 2001 through December 2013. Nearly half of the patients (48.1%) had advanced disease (stages III or IV), and more than half (61.5%) had nodal disease.

Using billing claims, the authors identified 2,094 patients (15.8%) with existing depression, anxiety, or both before their DLBCL diagnosis; 52.8% were women and 94.1% were white.

Of these patients, 8.9% met diagnostic criteria for depression, 4.6% met criteria for anxiety, and 2.3% met criteria for both depression and anxiety. These patients were more likely to be women and not married, and more likely to have more comorbidities when compared with those without pre-existing mental health disorders.

Odejide and team acknowledged that a claims-based approach to measuring depression and anxiety likely underestimated the true rate of mental health disorders. Furthermore, because the cohort only included patients who were 67 years or older, their results may not be generalizable to younger populations.

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