The Cumulative Burden of Mental Disorders and Self-Harm in 26 Adult Cancers

Chang, WH, Lai, AG26 Cumulative burden of mental disorders and self-harm in adult cancer. Nat Med (2022). https://doi.org/10.1038/s41591-022-01740-3

Commentary.

Although various studies have been conducted on the outcomes of the general adult population after a diagnosis of cancer, there is a lack of information on the effects of treatment exposure and long-term psychological burden. This study estimated the risk of self-harm after a diagnosis of mental disorder in cancer patients and the risk of unnatural death after self-harm in 459,542 patients.

Furthermore, depression is the most common mental disorder among cancer patients, and patients undergoing chemotherapy, radiation therapy, and surgery have been shown to have the highest cumulative burden of mental disorders.

Of these, patients treated with alkylating agent chemotherapy drugs had the highest burden of mental disorders, whereas patients treated with kinase inhibitors had the lowest burden. However, all of these mental disorders were also shown to be associated with an increased risk of later self-harm.

This was observed to be the highest risk within 12 months of diagnosis of a mental disorder, with patients who self-injured being 6.8 times more likely to die from unnatural causes of death compared to controls within 12 months of self-injury. (Hazard ratio (HR), 6.8; 95% confidence interval (CI), 4.3-10.7). (HR, 2.0; 95% CI, 1.5-2.7)

With these results, the researchers prioritized patients at highest risk, which they said provides an extensive knowledge base to help inform joint cancer and psychiatric care initiatives.