Pre-existing Mental Health Disorders are Associated with Disparities in Gastric Cancer Care: An American Combined Safety Net and Teaching Hospital Experience.

Abstract

Introduction: Delay in gastric cancer diagnosis is associated with inferior outcomes. The effects of pre-existing mental health disorders (MHDs) on delays in gastric cancer diagnosis and treatment disparities are not well-understood. In this study, we evaluated the impact of MHDs on time to gastric cancer diagnosis and receipt of guideline-concordant treatment.

Methods: We performed a retrospective review of patients diagnosed with gastric adenocarcinoma between 2015 and 2022. Patients with pre-existing diagnoses of mood, affective, and substance use disorders were classified as having an MHD. Univariable and multivariable regression were used to analyze the association between MHDs and delay in diagnosis. The association between MHD and receipt of guideline-concordant care was also evaluated.

Results: Overall, 460 patients diagnosed with gastric cancer were included in the analytic group. Seventy patients (15%) had an MHD prior to their cancer diagnosis, of whom 34 (49%) experienced a delay in diagnosis, compared with 109 (28%) without an MHD. On multivariable regression, patients with an MHD were more likely to experience a delay in diagnosis (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.58-5.11; p < 0.001) and have more than one visit to a provider prior to diagnosis (OR 2.71, 95% CI 1.37-5.37; p = 0.004). Patients with an MHD were also less likely to receive guideline-concordant care for their gastric cancer (OR 0.29, 95% CI 0.12-0.67; p = 0.004).

Conclusions: MHD is a patient-level factor that negatively impacts gastric cancer care. Addressing provider knowledge gaps and increasing efforts to counter the social stigma and implicit bias associated with MHD may improve the time to diagnosis and receipt of guideline-concordant care in this at-risk population.