Harriet Forbes, Helena Carreira, Garth Funston, Kirsty Andresen, Urvita Bhatia, Helen Strongman, Esha Abrol, Liza Bowen, Ceinwen Giles, Krishnan Bhaskaran
{"title":"癌症幸存者的早期、中期和长期精神健康状况与未患癌症的比较者的比较：使用链接的英国电子健康记录进行匹配队列研究。","authors":"Harriet Forbes, Helena Carreira, Garth Funston, Kirsty Andresen, Urvita Bhatia, Helen Strongman, Esha Abrol, Liza Bowen, Ceinwen Giles, Krishnan Bhaskaran","doi":"10.1016/j.eclinm.2024.102826","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We aimed to compare the risk of incident depression, anxiety, non-fatal self-harm and completed suicide in survivors from a wide range of cancers versus cancer-free individuals.</p><p><strong>Methods: </strong>We used electronic health records from the United Kingdom Clinical Practice Research Datalink linked to cancer registry data, hospital admissions data and death records between 1998 and 2021. Adult survivors of the 20 most common cancers were matched (age, sex, general practice) 1:10 to cancer-free individuals. Cox regression models, adjusted for shared risk factors, were used to estimate associations between cancer survivorship and mental health outcomes.</p><p><strong>Findings: </strong>853,177 adults with cancer diagnosed in 1998-2018 were matched to 8,106,643 cancer-free individuals. Survivors of all 20 cancer types under study had a higher risk of experiencing a new episode of anxiety and depression during follow-up compared with cancer-free individuals; there was also evidence of raised risks of non-fatal self-harm in 17/20 cancers and completed suicide in 8/20 cancers. Effect sizes were greatest in cancers with poorer 5-year survival: hazard ratios (HRs) for anxiety and depression of 1.1-1.2 were seen for malignant melanoma survivors, while HRs for both outcomes were >2.5 for lung and oesophageal cancer survivors. HRs were highest in the first year from cancer diagnosis, reducing over time since diagnosis. However, 5-year cancer survivors still experienced elevated risks of a subsequent new episode of anxiety or depression, in 18/20 cancers.</p><p><strong>Interpretation: </strong>Survivors of the 20 most common cancers were at increased risk of experiencing depression and anxiety, and these increased risks persisted in medium-to long-term cancer survivors. Substantially raised risks of non-fatal self-harm and completed suicide were also seen for several types of cancer. The risks of all mental health outcomes were generally higher in survivors of cancers with poorer prognosis. Our findings suggest a need for improved psychological support for all patients with cancer.</p><p><strong>Funding: </strong>Wellcome Trust.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"76 ","pages":"102826"},"PeriodicalIF":9.6000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421364/pdf/","citationCount":"0","resultStr":"{\"title\":\"Early, medium and long-term mental health in cancer survivors compared with cancer-free comparators: matched cohort study using linked UK electronic health records.\",\"authors\":\"Harriet Forbes, Helena Carreira, Garth Funston, Kirsty Andresen, Urvita Bhatia, Helen Strongman, Esha Abrol, Liza Bowen, Ceinwen Giles, Krishnan Bhaskaran\",\"doi\":\"10.1016/j.eclinm.2024.102826\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We aimed to compare the risk of incident depression, anxiety, non-fatal self-harm and completed suicide in survivors from a wide range of cancers versus cancer-free individuals.</p><p><strong>Methods: </strong>We used electronic health records from the United Kingdom Clinical Practice Research Datalink linked to cancer registry data, hospital admissions data and death records between 1998 and 2021. Adult survivors of the 20 most common cancers were matched (age, sex, general practice) 1:10 to cancer-free individuals. Cox regression models, adjusted for shared risk factors, were used to estimate associations between cancer survivorship and mental health outcomes.</p><p><strong>Findings: </strong>853,177 adults with cancer diagnosed in 1998-2018 were matched to 8,106,643 cancer-free individuals. Survivors of all 20 cancer types under study had a higher risk of experiencing a new episode of anxiety and depression during follow-up compared with cancer-free individuals; there was also evidence of raised risks of non-fatal self-harm in 17/20 cancers and completed suicide in 8/20 cancers. Effect sizes were greatest in cancers with poorer 5-year survival: hazard ratios (HRs) for anxiety and depression of 1.1-1.2 were seen for malignant melanoma survivors, while HRs for both outcomes were >2.5 for lung and oesophageal cancer survivors. HRs were highest in the first year from cancer diagnosis, reducing over time since diagnosis. However, 5-year cancer survivors still experienced elevated risks of a subsequent new episode of anxiety or depression, in 18/20 cancers.</p><p><strong>Interpretation: </strong>Survivors of the 20 most common cancers were at increased risk of experiencing depression and anxiety, and these increased risks persisted in medium-to long-term cancer survivors. Substantially raised risks of non-fatal self-harm and completed suicide were also seen for several types of cancer. The risks of all mental health outcomes were generally higher in survivors of cancers with poorer prognosis. Our findings suggest a need for improved psychological support for all patients with cancer.</p><p><strong>Funding: </strong>Wellcome Trust.</p>\",\"PeriodicalId\":11393,\"journal\":{\"name\":\"EClinicalMedicine\",\"volume\":\"76 \",\"pages\":\"102826\"},\"PeriodicalIF\":9.6000,\"publicationDate\":\"2024-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421364/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"EClinicalMedicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.eclinm.2024.102826\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"EClinicalMedicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.eclinm.2024.102826","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景我们旨在比较多种癌症幸存者与未患癌症者发生抑郁、焦虑、非致命性自残和自杀的风险：我们使用了英国临床实践研究数据链接（Clinical Practice Research Datalink）中的电子健康记录，这些记录与 1998 年至 2021 年间的癌症登记数据、入院数据和死亡记录相链接。20 种最常见癌症的成年幸存者与未患癌症者的匹配比例为 1:10（年龄、性别、全科）。在对共同风险因素进行调整后，采用 Cox 回归模型来估计癌症幸存者与心理健康结果之间的关系：1998年至2018年期间确诊的853,177名癌症患者与8,106,643名无癌症患者进行了配对。与未患癌症的人相比，研究中所有20种癌症的幸存者在随访期间经历新的焦虑和抑郁发作的风险更高；还有证据表明，17/20种癌症中的非致命性自残风险和8/20种癌症中的自杀风险也有所上升。5年存活率较低的癌症的影响程度最大：恶性黑色素瘤幸存者焦虑和抑郁的危险比（HRs）为1.1-1.2，而肺癌和食道癌幸存者这两种结果的危险比均大于2.5。HRs在癌症确诊后的第一年最高，随着确诊时间的推移而降低。然而，在18/20种癌症中，5年期癌症幸存者随后再次发生焦虑或抑郁的风险仍然较高：解释：20 种最常见癌症的幸存者患抑郁和焦虑症的风险增加，这些增加的风险在中长期癌症幸存者中持续存在。在几种癌症中，非致命性自残和自杀的风险也大大增加。预后较差的癌症幸存者出现所有心理健康后果的风险普遍较高。我们的研究结果表明，有必要为所有癌症患者提供更好的心理支持：资金来源：惠康基金会。
Early, medium and long-term mental health in cancer survivors compared with cancer-free comparators: matched cohort study using linked UK electronic health records.
Background: We aimed to compare the risk of incident depression, anxiety, non-fatal self-harm and completed suicide in survivors from a wide range of cancers versus cancer-free individuals.
Methods: We used electronic health records from the United Kingdom Clinical Practice Research Datalink linked to cancer registry data, hospital admissions data and death records between 1998 and 2021. Adult survivors of the 20 most common cancers were matched (age, sex, general practice) 1:10 to cancer-free individuals. Cox regression models, adjusted for shared risk factors, were used to estimate associations between cancer survivorship and mental health outcomes.
Findings: 853,177 adults with cancer diagnosed in 1998-2018 were matched to 8,106,643 cancer-free individuals. Survivors of all 20 cancer types under study had a higher risk of experiencing a new episode of anxiety and depression during follow-up compared with cancer-free individuals; there was also evidence of raised risks of non-fatal self-harm in 17/20 cancers and completed suicide in 8/20 cancers. Effect sizes were greatest in cancers with poorer 5-year survival: hazard ratios (HRs) for anxiety and depression of 1.1-1.2 were seen for malignant melanoma survivors, while HRs for both outcomes were >2.5 for lung and oesophageal cancer survivors. HRs were highest in the first year from cancer diagnosis, reducing over time since diagnosis. However, 5-year cancer survivors still experienced elevated risks of a subsequent new episode of anxiety or depression, in 18/20 cancers.
Interpretation: Survivors of the 20 most common cancers were at increased risk of experiencing depression and anxiety, and these increased risks persisted in medium-to long-term cancer survivors. Substantially raised risks of non-fatal self-harm and completed suicide were also seen for several types of cancer. The risks of all mental health outcomes were generally higher in survivors of cancers with poorer prognosis. Our findings suggest a need for improved psychological support for all patients with cancer.
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
