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Study: Behavioral health strongly impacts cancer surgery outcomes

Sasin Tipchai

A recent Ohio State University study sheds light on the relationship between behavioral health issues, such as substance abuse, eating or sleep disorders, and the prognoses of cancer patients following surgery.

The study found patients with behavioral health disorders were less likely to go through with cancer surgery, and those who did had generally worse outcomes than their peers.

Dr. Timothy Pawlik is surgeon-in-chief at The Ohio State University Wexner Medical Center and co-author of the study.

His team’s findings were recently published in the Journal of the American College of Surgeons.

Matthew: How much worse did cancer patients fare with the added complication of a behavioral health disorder?

Dr. Pawlik: We were a bit surprised that mental health and behavioral disorders actually had a pretty marked impact on surgical patients. You know, patients who have behavioral health disorders, which we defined as patients who had a challenge with substance abuse, eating disorders or sleep disorders, actually had roughly a 30-40% increased risk of a complication, prolonged length of stay or a readmission after a surgical procedure.

Matthew: A cancer diagnosis is an inherently stressful life event, one that might trigger a new behavioral health disorder or cause an old one to resurface or worsen. Can this be avoided?

Dr. Pawlik: The diagnosis of cancer is physically, mentally, emotionally, socially and economically a very stressful event. And I think patients who may have a predisposition, to mental health challenges or mental illnesses, a diagnosis of cancer could exacerbate that. And there are data that suggest that, among cancer patients, mental health is particularly a challenge, around depression, etc. And, in the current study, we did see that patients who had these challenges did have worse outcomes. The way that we defined it in the study is that we looked for patients who had a preexisting behavioral health disorder prior to their diagnosis of cancer.

Matthew: What else does your research suggest for improving cancer care, and what further research is needed?

Dr. Pawlik: I think one of the most important parts of this study is the recognition that behavioral health disorders are fairly prevalent among cancer patients. And perhaps equally importantly is that the data suggests that, in addition to tumor specific factors or other patient specific factors, like whether you have diabetes or heart disease, that mental health has a real, meaningful impact on your chance of having a kind of optimal outcome with surgery and mental health, and suboptimal outcomes, around the episode of care of surgery can drive health care costs and health care expenditures.

So, with that in mind, I think it's important that all of us, as healthcare providers and myself as a surgeon, screen for behavioral health disorders, mental health issues as part of our practice in a more routine manner and ensure that there's enhanced accessibility to behavioral health care resources and mental health care services within the context of other diseases, such as cancer.

Matthew Rand is the Morning Edition host for 89.7 NPR News. Rand served as an interim producer during the pandemic for WOSU’s All Sides daily talk show.