Journal Article Annotations
2025, 1st Quarter

Psychooncology

Annotations by Marie Tobin, MD, Deepti Chopra, MD and Daniel McFarland, MD
March, 2025

Collaborative Approach to Cancer Care in Patients Who Have Co-Existing Severe Mental Illness with Psychotic Features.
Prediction model for delirium in advanced cancer patients receiving palliative care: development and validation.
Trends in depression and anxiety prevalence by cancer status among US adults: analyses of the 2019-2022 National Health Interview Survey.

PUBLICATION #1 — Psychooncology

Collaborative Approach to Cancer Care in Patients Who Have Co-Existing Severe Mental Illness with Psychotic Features.

Lindsay Lipinski, Desi Carozza, Alex Kemp, Sanjay Gupta

Abstract: Psychooncology. 2025 Feb;34(2):e70114. doi: 10.1002/pon.70114.

Severe and persistent mental illness with psychotic features as a comorbidity to a cancer diagnosis presents unique challenges to delivery of cancer care. Current literature suggests that there are poorer outcomes and higher mortality in patients with severe mental illness, partly explained by barriers to access of screening services and social vulnerability factors. However, cancer care is also delivered differently in patients with SMI, and often less aggressive care is offered. These healthcare disparities could be addressed in part by preparing for the ethical issues that can arise during the course of care. Cancer care staff may have limited experience and knowledge about treatment of psychiatric symptoms and may feel troubled in scenarios when patients lack capacity and become unwilling to participate in their care. Conversely, patients may benefit from early involvement of their mental health team for psychiatric optimization and contingency preparation. Specifically, preemptive planning between the cancer care team and the mental healthcare team can alleviate distress for the patient and healthcare teams alike. This is especially important when medical decision-making capacity can fluctuate during treatment. A person-centered, team-based approach to care delivery provides bidirectional empowerment. A process is proposed to enhance medical decision-making in patients with severe mental illness and cancer. It is imperative to acknowledge the disparities that exist in this patient population and create a process that will improve care and alleviate distress for the patient and the cancer care team.

Annotation

The finding:
Cancer patients with severe mental illness (SMI) present a unique set of challenges for cancer care. In this patient population, there is a higher case fatality, poorer cancer-specific prognosis, and lower survival time. In this article, the authors use a clinical case to highlight ethical dilemmas around medical decision-making capacity (MDC), treatment over objection, and treatment delivery in a fragmented healthcare framework. A pre-emptive process is proposed in which patients and the healthcare team are educated and plan for challenges in care. The authors propose supported decision-making in which patients with SMI receive assistance from trusted others to support decision-making. Another tool proposed is a version of the psychiatric advance directive. Patients are also encouraged to pre-emptively identify and engage a health care proxy. The second component of the proposed model is education of the healthcare team to facilitate cross-specialty problem-solving and reduce stigma associated with SMI. The proposed collaborative care approach would involve a mental health care manager to support the patient, identify triggers, and review safety and restraint protocols and the use of psychiatric medications.

Strengths and weaknesses:
The paper identifies a challenging and overlooked patient population in cancer care. The use of a case description effectively highlights challenges to care. However, the proposed model is time-intensive and requires commitment from the patient, the cancer care team, and the mental healthcare team. Additionally, it is unlikely that one single workflow will suffice for all patients.

Relevance:
CL psychiatrists play a crucial role in facilitating cancer care for patients with SMI. This paper highlights the ethical dilemmas involved in cancer care for patients with SMI. To optimize cancer care in patients with SMI, integration of mental healthcare and cancer healthcare is necessary to support the patient and the oncology team so that safe, timely care can be delivered while also honouring the patient’s preferences and values.

PUBLICATION #2 — Psychooncology

Prediction model for delirium in advanced cancer patients receiving palliative care: development and validation.

Duan Guo, Chuan Zhang, Chaohui Leng, Yu Fan, Yaoli Wang, Ling Chen, Han Zhang, Ning Ge, Jirong Yue.

Abstract: BMC Palliat Care. 2025 Feb 13;24(1):41. doi: 10.1186/s12904-025-01683-9.

Background:
Delirium is a common and distressing mental disorder in palliative care. To date, no delirium prediction model is available for the palliative care population. The research aimed to develop and validate a nomogram model for predicting the occurrence of delirium in advanced cancer patients admitted to palliative care units.

Methods:
This was a prospective, multicenter, observational study. Logistic regression was used to identify the independent risk factors for incident delirium among advanced cancer patients in palliative care units. Advanced cancer patients admitted to palliative care units between February 2021 and January 2023 were recruited from four hospitals in Chengdu, Sichuan Province, China. Model performance was evaluated via the area under the receiver operating characteristic curve, calibration plots and decision curve analysis.

Results:
There were 592 advanced cancer patients receiving palliative care in the development cohort, 196 in the temporal validation cohort and 65 in the external validation cohort. The final nomogram model included 8 variables (age, the Charlson comorbidity index, cognitive function, the Barthel index, bilirubin, sodium, the opioid morphine equivalent dose and the use of anticholinergic drugs). The model revealed good performance in terms of discrimination, calibration, and clinical practicability, with an area under the receiver operating characteristic curve of 0.846 in the training set, 0.838 after bootstrapping, 0.829 in the temporal validation and 0.803 in the external validation set.

Conclusions:
The model serves as a reliable tool to predict delirium onset for advanced cancer patients in palliative care units, which will facilitate early targeted preventive measures to reduce the burden of delirium.

Annotation

The finding:
Guo et al., evaluated a delirium prediction model and tested its validity in patients admitted to the palliative care unit in multiple hospitals in China. Their model performed well in the development phase and maintained good performance in the testing phase.

Strength and weaknesses:
Strengths of this study include its study design (prospective multicentre observational study) with development and testing phase. Limitations include lack of generalizability and unclear clinical application of the model.

Relevance:
Prediction models are becoming a part of medicine, so the development of a delirium prediction model specific to palliative care patients is innovative.

PUBLICATION #3 — Psychooncology

Trends in depression and anxiety prevalence by cancer status among US adults: analyses of the 2019-2022 National Health Interview Survey.

Ian Kim, Michelle Lee, Cynthia M Begay, Jonathan Lee, Jennifer Unger.

Abstract: BMJ Open. 2025 Feb 13;15(2):e090157. doi: 10.1136/bmjopen-2024-090157.

Objective:
To examine trends in the prevalence of depression and anxiety during the COVID-19 pandemic among US adult cancer patients and survivors (CPS) in comparison to those of non-CPS (NCPS).

Methods and analysis:
National Health Interview Survey 2019-2022 data were analysed using spline logistic regression.

Results:
A total of 115 664 participants completed the survey (mean age (SD), 52.8 (18.4) years; 54.3% female; 12.6% CPS). The age-adjusted prevalence of depression significantly increased from 26.53% in 2019 to 29.78% in 2022 among CPS, while that of anxiety increased from 24.02% in 2019 to 28.08% in 2022. Throughout the pandemic, there were consistently significant annual increases in the prevalence of both depression and anxiety with CPS experiencing significantly faster rates of increase compared with NCPS (average annual absolute increase 0.72% in NCPS vs 1.08% in CPS, p<0.01 for depression; 0.98% in NCPS vs 1.35% in CPS, p<0.01 for anxiety). Difficulty in social activity engagement emerged as the primary risk factor for both depression (adjusted OR (aOR), 7.38 (95% CI, 7.04 to 7.73), p<0.01) and anxiety disorders (aOR, 7.58 (95% CI, 7.23 to 7.95), p<0.01). Significant interactions were found between difficulty in social engagement and cancer status on the diagnoses of depression (aOR, 0.72 (95% CI, 0.63 to 0.83), p<0.01) and anxiety (aOR, 0.62 (95% CI, 0.55 to 0.70), p<0.01).

Conclusions:
The notably higher prevalence and more rapid increase in rates of depression and anxiety disorders among CPS compared with NCPS underscore the disproportionate impact of the COVID-19 pandemic on CPS and the necessity of prioritising mental health support and interventions for this population.

Annotation

The finding:
Data were drawn from the National Health Interview Survey (NHIS) (public use data files), which is an annual cross-sectional survey with measures of social activities and mental health in the U.S.A. These data included a total 15,011 cancer survivors and patients (CPS) and 105,244 non-CPS participants that were compared for rates of anxiety and depression during the COVID-19 pandemic from 2019-2022. While depression and anxiety increased for both CPS and non-CPS, rates of depression and anxiety were significantly more increased for CPS patients than non-CPS patients.

Strength and weaknesses:
The study leveraged data from the National Interview Survey so findings were generalizable across the U.S.. The reliance on self-report diagnoses may underestimate the prevalence due to recall bias, selective non-response, and the exclusion of institutionalized individuals. The study assumed that no other factors than COVID-19 influenced the prevalence of depression and anxiety during the study period.

Relevance:
This study highlights the ways in which CPS are vulnerable to environmental or possibly other large-scale crises larger than their individual situation. The study displayed a clear trend with large data that are generalizable. These data may be applicable broadly but it’s relevance for any given individual may be questionable.