Cancer patients face increased risk of long-term mental health problems

People diagnosed with cancer are at a greater risk of mental health problems even five years after their diagnosis, according to a large-scale study of data from UK GP patient records.

Patterns varied by cancer type, with substantially raised risks of suicide and non-fatal self-harm among certain cancers with poor survival, such as lung and pancreatic cancer.

The research was led by the London School of Hygiene & Tropical Medicine (LSHTM) and published in eClinical Medicine.

The team analyzed data from 853,177 adults who were diagnosed with cancer between 1998 and 2018, which was matched with 8,106,643 cancer-free individuals to enable comparison.

The analysis focused on the 20 most common cancers: oral cavity, oesophageal, stomach, colorectal, liver, pancreatic, lung, malignant melanoma, breast (female), cervical, uterine, ovarian, prostate, kidney, bladder, central nervous system, thyroid, non-Hodgkin lymphoma, multiple myeloma and leukemia.

They found that those who had been diagnosed with cancer remained at increased risk of experiencing new episodes of anxiety and depression, both in the short term and more than five years after diagnosis, compared to people who had not had cancer. The risks of adverse mental health outcomes were generally higher for people with cancer types with poorer prognosis: those with malignant melanoma had around 10-20% increased risk of anxiety and depression, whereas lung cancer patients were almost 3 times more likely to develop anxiety and depression, compared to people without cancer. Use of antianxiety and antidepressants medications were consistently higher in people diagnosed with cancer (compared to cancer-free comparators) throughout the 10 years following diagnosis for most cancers.

Of the 20 cancer types studied, the researchers found 17 cancer types were more likely to self-harm, and 8 were more likely to die by suicide, compared to similar individuals without cancer. Using anonymised GP electronic health records enabled the team to investigate the issue on a large scale, revealing detailed patterns of risk based on the point at which most people report mental health issues to give a fuller picture of the situation affecting people who have had cancer. However, the researchers acknowledged limitations in the study, including the fact the health data used rarely records social and socioeconomic factors that can be important determinants of both mental health and cancer. For example, there is little or no data on finance, employment, and education.

It's tough enough to face cancer without also having to deal with mental health problems such as depression or anxiety which may last longer than the cancer itself. The physical and psychological ramifications of cancer must be looked at and supported as a whole.

People who have been diagnosed with cancer may find these results useful if they are struggling with the long-term effects of cancer on their mental health; they are certainly not alone in experiencing mental health issues many years after diagnosis.

Our findings suggest a need for improved psychological support for all patients with cancer, not only when they have just been diagnosed, but in subsequent years.

We also need more targeted prevention strategies. Cancer itself and its treatments can have varied side effects, including chronic pain, lymphedema, sexual dysfunction, poor mobility, financial instability or lack or employment, all of which could profoundly affect people's lives, potentially leading to mental health issues.

By gaining a better understanding of what happens to people during their cancer journey and when they may be at highest risk of experiencing mental health issues, decisionmakers, doctors and carers are better placed to step in or provide support at the right time and in the right way."

Dr. Harriet Forbes, Study Lead Author, Assistant Professor at LSHTM

The study was funded by Wellcome.