1. 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% % 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):
Dowling EC, et al. Cancer. 2013;119(18):
Haque R, et al. Am J Manag Care. 2014;20(1):86-92.
Heins MJ, et al. Cancer Epidemiol. 2015;39(1):
Hong CC, et al. Adv Exp Med Biol. 2015;862:
Islam KM, et al. Cancer Epidemiol Biomarkers Prev [Epub]
Islam MM, et al. BMC Public Health. 2014;14:1008.
Jeong JR, et al. PLoS One. 2015;10(5):e
Kravchenko J, et al. Lung Cancer. 2015;88(1):85-93.
Mehnert A, et al. J Psychosom Res. 2008;64(4):
Østgård LS, et al. Leukemia. 2015;29(3):
Owen JB, et al. J Oncol Pract. 2014;10(3):e
Reeve BB, et al. BJU Int. 2014;114(6b):E74-81.
Snyder CF, et al. J Cancer Surviv Feb 26. [Epub ]
Stafford L, et al. Support Care Cancer [Epub]
Suppli NP, et al. J Clin Oncol. 2014;32(34):
Wang JW, et al. Support Care Cancer. 2015;23(5):
Xiao H, et al. Am J Mens Health [Epub]
All cancer survivors N =11,014 
Model R2 = 0.266  β SE
p-value
Gender (female)
301.43
<0.01
Age
7.81
10.81
0.470
Sponsor Rank (officer)
328.39
Marital Status* (married)
499.72
358.94
0.164
TRICARE Enrolled*
291.87
Asthma/COPD
430.83
Cerebrovascular Disease
664.99
Heart Disease
388.72
Hypertension
320.44
Diabetes
409.15
DAAA
338.53
Serious, Persistent Mental Illness
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.