Psychiatric Comorbidities and Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer

Abstract

Background

The association between psychiatric comorbidities (PCs) and long-term survival after lobectomy for early-stage non-small cell lung cancer is unknown. We sought to investigate this relationship using the Surveillance, Epidemiology, & End-Results (SEER)-Medicare registry.

Methods

Data for all patients in the SEER-Medicare registry who underwent lobectomy for stage I non-small cell lung cancer from 2007 to 2014 were included. Those older than 80 years at time of diagnosis, with multiple cancers, or histology other than adenocarcinoma or squamous cell carcinoma were excluded. Patients diagnosed with depression, anxiety, bipolar disorder, schizophrenia, other (non-schizophrenic) psychotic disorders, unspecified mood disorder, attention-deficit/hyperactivity disorder, alcohol use disorder, or substance use disorder prior to lung cancer diagnosis were considered to have a PC. Survival of patients with PC was compared to controls using univariable and multivariable analysis adjusting for age, sex, race, stage (IA/IB), histology, surgical approach, and Charlson Comorbidity Index.

Results

Of 5516 patients, 1369 (24.8%) had PCs. Patients with PCs were more likely to be younger (P < .001), female (P < .001), white (P < .001), and have stage IA cancer (P < .001). PC was associated with shorter survival (median, 2478 vs 2820 days; P = .002). Multivariable analysis retained PC in the final model, with a hazard ratio of 1.10 (P < .001). Subgroup analysis revealed that this survival difference was driven by differences in survival of patients with schizophrenia (P < .001) and alcohol use disorder (P = .006).

Conclusions

Select psychiatric comorbidities are associated with reduced survival after lobectomy for early-stage non-small cell lung cancer.