How Do Mental Health Disorders Impact All-Cause Cancer Mortality?

The development of new-onset mental health disorders (MHDs) within the first year of a cancer diagnosis is associated with a significantly increased risk of all-cause mortality, according to a large-scale analysis of University of California (UC) Health system data published in Cancer. Investigators identified that 10.6% of patients with cancer developed an early MHD following their incident diagnosis. The presence of an early MHD was linked to a multivariable adjusted HR for all-cause mortality of 1.51 (95% CI, 1.47-1.56) during the initial 12 to 35 months following diagnosis. This risk was notably higher for patients who were also newly prescribed psychotropic medications, with an HR of 2.67 (95% CI, 2.52-2.83) in the same timeframe.

In terms of clinical efficacy and outcomes, the impact of these disorders demonstrated distinct temporal dynamics, with the strongest associations observed in the early survivorship phase. The HR for all-cause mortality among patients with early MHDs decreased to 1.17 (95% CI, 1.11-1.24) at 36 to 59 months and to 0.95 (95% CI, 0.89-1.01) by 60 to 120 months. The most frequently diagnosed early MHDs included generalized anxiety disorder at 43.0%, major depressive disorder at 35.5%, and reactive/adjustment disorder at 10.5%.

Julian Hong, MD, MS, associate professor of radiation oncology in the Baker Computational Health Sciences Institute at the University of California, San Francisco (UCSF), and head of Artificial Intelligence at UCSF Helen Diller Family Comprehensive Cancer Center, as well as an investigator on the trial, spoke with CancerNetwork® about these results. Hong noted that the punchline of the study is that a substantial number of patients diagnosed with cancer develop a mental health disorder, particularly in the short term. This aligns with what clinicians anecdotally observe, in that cancer diagnoses are stressful points in the lives of patients that have profound impacts on therapies. He emphasized that the major finding of the correlation with increased mortality is particularly salient in the first few years, and while it appears to decrease over time, it provides a way to look at the big picture across various disease sites.

The trial design involved a retrospective cohort analysis of 371,897 adult patients diagnosed with cancer between 2013 and 2023. Eligibility required at least 2 clinical encounters spaced 30 days apart and no documented MHD prior to the cancer diagnosis. Data were derived from the University of California Data Discovery Platform and UC Health Data Warehouse using the Observational Medical Outcome Partnership common data model. Study end points included the incidence of new-onset MHDs, defined as psychotic, mood, or anxiety disorders within 12 months, and all-cause mortality calculated from the date of initial cancer diagnosis.

Transcript:

CancerNetwork: What was the primary finding of this study?

Hong: The punchline of the study is that, in this big cohort, if there are people who are diagnosed with cancer, a substantial number end up developing a mental health disorder, certainly within the short term. That speaks for what we anecdotally observe, in that cancer diagnoses are very stressful points in people's lives. That has profound impacts on therapies.

The major finding in the study is that this is correlated with an increase in all-cause mortality, and it's particularly salient in the first few years. As we go through time, it looks like there's some temporal dynamics where some of that impact starts to decrease. This is consistent with some other data in specific disease sites. There are data around certain cancers where mental health disorders can impact how patients tolerate treatments, which certainly is an expected observation, but this is a way to look at the big picture, and how there are these relationships.

Reference

Ganjouei AA, Zack T, Friesner I, et al. Association of mental health disorders and all-cause mortality for patients with cancer: large-scale analysis of University of California Health System data. Cancer. 2026;132(5):e70254. doi:10.1002/cncr.70254