Oral Papers: Palliative Care & Oncology I
Background/Significance: Patients with cancer and depression are at increased risk for emergency department (ED) visit, overnight hospitalization (HOSP), and incur higher annual healthcare costs than their non-depressed peers. However, anxiety and depressive disorders often co-occur and the increased risk for healthcare use and costs are unknown among patients with anxiety only, depression only, or co-morbid anxiety and depression. This paper examines these risks.
Methods: Healthcare use and charges were obtained for 13,447 patients with an ICD-9 diagnosis of cancer in 2014 from a large academic Healthcare System. 1,043 had a chart diagnosis of anxiety only, 1,008 had a depression diagnosis only, 1,055 had co-morbid anxiety and depression diagnoses, and 10,341 had neither diagnosis. Logistic regressions examined the association between diagnostic status and risk for at least one ED visit and one HOSP during the year after cancer diagnosis, controlling for age, sex, race/ethnicity, medical comorbidities, metastatic status, medical insurance, and receipt of radiation or chemotherapy. Annual healthcare charges were analyzed using a generalized linear model with a log‐link function and gamma distribution, controlling for the same covariates.
Results: Patients with anxiety only were more than twice as likely to visit an ED (OR = 2.34, 95% CI = 2.03-2.70; p < .001) and experience an overnight HOSP (OR = 2.02, 95% CI = 1.75-2.34; p < .001) relative to patients with neither anxiety nor depression. Patients with depression only were also more than twice as likely (OR = 2.26, 95% CI = 1.96-2.62; p < .001) to visit an ED and nearly twice as likely to experience an overnight HOSP (OR = 1.79, 95% CI = 1.54-2.08; p < .001). Patients with both anxiety and depression were nearly four times as likely to visit an ED (OR = 3.87, 95% CI = 3.36-4.46; p < .001) and nearly three times as likely to experience an overnight HOSP (OR = 2.69, OR = 2.33-3.11; p < .001). Estimated annual healthcare costs for patients with anxiety only ($133,046, 95% CI = $121,543-$145,648), depression only ($103,849, 95% CI = $94,749-113,822), and co-morbid anxiety and depression ($196,799, 95% CI = $179,746-$215,470) were significantly higher (p < .001) than patients with neither diagnosis ($75,373; 95% CI = $73,235-$77,574), and were also significantly higher (p < .001) than those with anxiety only and depression only.
Discussion: Risk for ED use, hospitalization, and annual healthcare costs increases substantially in cancer patients with depression or anxiety and is further exacerbated in those with co-morbid anxiety and depression.
Conclusion/Implications: Healthcare use and costs are significantly increased in cancer patients with depression and anxiety. Improved screening for anxiety and depression and increased referral to mental health services may be important for potentially reducing healthcare use and costs in cancer patients.