Mental Health and Chronic Conditions in a Cohort of Non-Elderly Adult Cancer Patients Diana D. Jeffery, Ph.D., U.S. Department of Defense, Defense Health.

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Mental Health and Chronic Conditions in a Cohort of Non-Elderly Adult Cancer Patients Diana D. Jeffery, Ph.D., U.S. Department of Defense, Defense Health Agency Purpose To examine the prevalence and costs of mental health diagnoses in relation to other chronic comorbid conditions in a cohort of non-elderly adult cancer patients. Background Mental health conditions and chronic disease comorbidities among individuals diagnosed and treated for cancer potentially impact: Cancer stage at time of diagnosis (Xiao, et al., 2014) Treatment modality decisions (Østgård, et al., 2015; Daskivich, et al., 2014) Adherence to clinical guidelines for cancer care (Owen, et al., 2014) Management of post-treatment care (Jeong, et al., 2015; Snyder, et al., 2015) Quality of life outcomes (Mehnert, et al., 2008; Reeve, et al., 2014; Wang, et al., 2015) Level of productivity (Dowling, et al. 2013) Morbidity and mortality outcomes (Bøje, et al., 2014; Haque, et al., 2014; Hong, et al., 2015; Islam, et al., 2015; Kravchenko, et al., 2015; Stafford, et al., 2015) Healthcare utilization (Suppli, et al., 2014; Heins, et al., 2015) Healthcare costs (Islam, et al., 2014) The Department of Defense (DoD) Military Health System serves 9.5 million beneficiaries comprised of active duty personnel and their families, and retired military personnel and their families. Military family members and military retirees closely resemble the U.S. population with respect to health status, but, unlike the total U.S. population, all DoD beneficiaries have equal access to and reimbursement for health care. Methods Data source: The Military Data Repository (MDR) which contains diagnostic codes, costs paid by DoD, and healthcare encounters, and the Defense Enrollment Eligibility Reporting System (DEERS) which contains demographic data. Sample: All DoD beneficiaries, age 18 – 64, newly diagnosed with cancer in fiscal years 2006 – 2007, and with at least one claims record in FY2008, FY2009, and FY2010, excluding those diagnosed with non-melanoma skin cancer. Statistical analysis: Descriptive statistics, and logistic regression analysis, using FY09 as the index year to assess annual costs which included inpatient, ambulatory, laboratory, radiology, and pharmacy claims. Annual Cost of Care by Comorbid Condition Results Among the non-elderly adult cancer cohort… most comorbid conditions were diagnosed after the cancer diagnosis. 31.8% had been diagnosed with depression, anxiety, acute stress reaction, or adjustment disorder (DAAA), 12.1% prior to or at time of cancer diagnosis. annual cost of care cost was 58.9% - 87.9% higher when DAAA co-occurred with a chronic medical condition, except for diabetes. DAAA was an independent predictor of cost after controlling for demographic factors and select chronic diseases. Conclusion There is a clinical need and fiscal incentive to screen and manage DAAA for at least 2 years after cancer diagnosis, most notably for those with chronic medical conditions. Those diagnosed with DAAA and chronic medical conditions prior to cancer diagnosis may be at greatest risk for long-term psychological distress. Comorbid Condition Description N = 11014 % Mean Annual FY09 Cost Per Beneficiary No comorbid conditions 2739 24.9 $5018 ± 8864 Cancer AND … Asthma/Chronic Obstructive Pulmonary Disease (COPD) only 212 1.9 $6403 ± 10401 Asthma/COPD and hypertension 270 2.5 7713 ± 9955 Asthma/COPD and Depression/Anxiety/Acute stress reaction /Adjustment Disorder (DAAA) 159 1.4 $12031 ± 15693 Cerebrovascular disease only 51 0.5 $6093 ± 8074 Cerebrovascular disease and hypertension 48 0.4 7374 ± 8232 Cerebrovascular disease and DAAA 24 0.2 $11245 ± 12150 Heart disease only 306 2.8 $10820 ± 21100 Heart disease and hypertension 458 4.2 9366 ± 12870 Heart disease and DAAA 168 1.5 $17192 ± 60181 Hypertension only 1716 15.6 $5919 ± 10341 Hypertension and asthma/COPD Hypertension and DAAA 564 5.1 $9288 ± 15153 Diabetes only 147 1.3 $10033 ± 22421 Diabetes and hypertension 664 6.0 7886 ± 9597 Diabetes and DAAA 66 0.6 $7656 ± 8429 Prevalence of Comorbid Conditions Comorbid condition FY06 - FY09 Comorbid prior to, or concurrent with cancer diagnosis Comorbid Condition* N % n Top cancers in order of presentation (n ) Total No. Cancer Survivors 11014 100.0 Depression, anxiety, acute stress reaction, adjustment disorders 3504 31.8 1336 12.1 Pancreas (21), esophagus, (10), leukemia (54), brain & nervous system (68) Serious and persistent mental illness** 210 1.9 75 0.7 Pancreas (2), Thyroid (31) Asthma/Chronic Obstructive Pulmonary Disease 1799 16.2 839 7.6 Lung (167) Cerebrovascular Disease 662 6.0 170 1.5 Brain & nervous system (55) Heart Disease 2415 21.9 767 7.0 Esophagus (11), lung (110), stomach (15), multiple myelomas (24) Hypertension 5834 53.0 3486 31.7 Liver (19), kidney (258), lung (169), prostate (1346), bladder (129) Diabetes 2219 20.1 1217 11.0 Pancreas(17) , liver (8), bladder (59), kidney(97), leukemia (33) * Comorbid condition coded on the basis of one or more inpatient diagnoses or 2 or more outpatient diagnoses,FY06 - FY09 ** Includes schizophrenia and bipolar disorders Linear Regression for FY2009 Healthcare Costs References Bøje CR, et al. Radiother Oncol. 2014;110(1):91-7. Daskivich TJ, et al. Cancer. 2014;120(16):2432-9. Dowling EC, et al. Cancer. 2013;119(18):3393-401. Haque R, et al. Am J Manag Care. 2014;20(1):86-92. Heins MJ, et al. Cancer Epidemiol. 2015;39(1):109-14. Hong CC, et al. Adv Exp Med Biol. 2015;862:155-75. Islam KM, et al. Cancer Epidemiol Biomarkers Prev. 2015. [Epub] Islam MM, et al. BMC Public Health. 2014;14:1008. Jeong JR, et al. PLoS One. 2015;10(5):e0127346. Kravchenko J, et al. Lung Cancer. 2015;88(1):85-93. Mehnert A, et al. J Psychosom Res. 2008;64(4):383-91. Østgård LS, et al. Leukemia. 2015;29(3):548-55. Owen JB, et al. J Oncol Pract. 2014;10(3):e175-81. Reeve BB, et al. BJU Int. 2014;114(6b):E74-81. Snyder CF, et al. J Cancer Surviv. 2015 Feb 26. [Epub ] Stafford L, et al. Support Care Cancer. 2015.[Epub] Suppli NP, et al. J Clin Oncol. 2014;32(34):3831-9. Wang JW, et al. Support Care Cancer. 2015;23(5):1383-9. Xiao H, et al. Am J Mens Health. 2014 .[Epub] All cancer survivors N =11,014 Model R2 = 0.266 β SE p-value Gender (female) 1517.79 301.43 <0.01 Age 7.81 10.81 0.470 Sponsor Rank (officer) 1042.59 328.39 Marital Status* (married) 499.72 358.94 0.164 TRICARE Enrolled* 3673.99 291.87 Asthma/COPD 2729.04 430.83 Cerebrovascular Disease 3033.00 664.99 Heart Disease 5427.90 388.72 Hypertension 1412.10 320.44 Diabetes 2174.70 409.15 DAAA 4182.28 338.53 Serious, Persistent Mental Illness 1218.27 1145.09 0.287 Disclaimer: The opinions expressed herein are those of the authors, and are not necessarily representative of the opinions or policies of the Department of Defense (DOD); or the United State s Army, Navy, Marine Corps, Air Force, or Coast Guard.