‘Improves Outcomes and Cuts Costs for Cancer Patients’
Psychiatric comorbidities are associated with increased total cancer costs—especially in patients with very high cancer care costs.
Therefore, there is an opportunity to develop mitigation strategies, both to improve outcomes and reduce costs for these patients.
Care teams for patients approaching the ≥75th percentile of costs could implement more comprehensive assessment, closer monitoring, and proactive interventions in order to prevent patients from needing to access emergency and other expensive services—by providing better preventative mental and physical health care.
These are the findings of Shehzad Niazi, MD, FRCPC, FACLP, and colleagues, Department of Psychiatry and Psychology, Mayo Clinic, which are published in the March/April issue of Psychosomatics.
Health services in cancer centers are increasingly implementing psychosocial screening and treatment. “Our results suggest that, when allocating resources, it may be prudent to focus on patients with more complex conditions, including psychosocial comorbidities, and those who are higher utilizers of care.
“The development of predictive models may be helpful to stratify patients and highlight opportunities for targeted interventions.”
The research
The Mayo Clinic team evaluated from retrospective data the impact of pre-existing psychiatric comorbidities on the total cost of care during the six months after their cancer diagnosis.
All patients at the clinic diagnosed with cancer between the beginning of 2009 and the end of 2014 were included in the study and divided into those with or without psychiatric comorbidity. Roughly 10% (698) of 6,598 eligible patients had at least one psychiatric comorbidity. Total costs of care during the first six months of treatment were based on standardized costs adjusted to the value of the dollar in 2014.
The context
Approximately 14 million new cases of cancer were identified in 2012 and this number is expected to increase to 22 million cases per year over the next two decades. Survival among cancer patients is also increasing, resulting in an increased prevalence.
Psychiatric comorbidities, such as mood disorders, are common among patients with cancer. Roughly 29% of patients in palliative care and 38% of patients in oncology settings are reported to have mood disorders, and an estimated 15% have major depressive disorder.
“Psychiatric comorbidities can adversely impact cancer outcomes and the cost of care,” say the researchers. “Depression alone is associated with poor treatment adherence and earlier disease progression, likely contributing to increased mortality in cancer patients.
“In the general population and the medically ill, psychiatric comorbidities have been shown to increase morbidity and costs.
“The State of Massachusetts published a report identifying five categories of ‘persistently high-cost patients,’ three of which were those with behavioral health conditions. It concluded that psychiatric comorbidities were a standout factor in persistently high-cost patients and suggested that treatment to address these conditions should be considered a core component of addressing the needs of high-cost patients.”
The cost of cancer care is projected to reach USD $173 billion this year, a 39% increase from costs in 2010. “Considering the ways psychiatric comorbidities affect morbidity and mortality, care utilization, and health care costs for other conditions,” say the researchers, “it is plausible that psychiatric comorbidities are also impacting costs for cancer patients and evidence to support this is emerging.”
The presence of depression alone has been associated with increased health care utilization in patients with breast, colon, lung, and prostate cancers. A 2015 report showed that the presence of at least one psychiatric comorbidity in 300 leukemia patients was associated with an additional USD $55,000 per patient in just one year.
Other studies have demonstrated increased cancer costs and care utilization in distressed survivors of breast, prostate, colorectal, and other cancer types, compared to non-distressed survivors, and increased costs in multiple myeloma patients with psychiatric comorbidities compared to those without them.
“Although this evidence exists, there are holes in our knowledge about the effect of psychiatric comorbidities on the cost of care in cancer patients since existing studies have been limited to certain cancer types or psychiatric conditions, or to distress diagnosed after cancer diagnosis and treatment,” say the researchers, who call for more research into the effectiveness of C-L Psychiatry intervention.
“Alongside growing costs of cancer care overall, there is an increasing need to demonstrate the value of that cancer care, meaning better outcomes achieved at low cost. Thus, providers should consider any factor or comorbid condition that affects outcomes or increases cost in efforts to improve the value of the care they provide, and there is considerable evidence that psychiatric comorbidities can affect both outcomes and cost.
“This has implications for risk stratification among cancer patients and development of targeted management strategies to improve value.
“A better understanding of differences between groups of patients with and without psychiatric comorbidities and cost drivers has the potential to benefit all stakeholders.”
The full research paper, Impact of psychiatric comorbidities on healthcare costs among cancer patients, is here.