PO.CL11.02 · 临床研究
某多中心学术医疗系统中成年癌症患者生存期后精神疾病诊断的差异
Disparities in post-survivorship psychiatric diagnoses among adult cancer patients in a multi-center academic health system
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：癌症患者承受着巨大的心理负担，然而其精神健康问题往往未被识别和治疗。不同人口统计学群体之间的精神科诊疗可能存在差异，但针对这些模式进行的多癌种综合分析仍然有限。
方法：我们对2015年1月至2025年9月期间在加州大学健康系统内确诊为十种常见癌症的1,161,370名成年患者开展了一项回顾性队列研究。既往（诊断前12个月）已有精神科诊断或接受姑息性治疗的患者被排除。主要结局为癌症诊断后新发的抑郁和焦虑诊断。采用多变量logistic回归识别精神科诊断的预测因素，并对年龄、性别、种族、族裔、保险类型、癌症类型和诊断年份进行校正。
结果：在1,161,370名患者中（平均年龄66.1岁，52.9%为女性），258,076名（22.2%）获得了新发精神科诊断：8.4%仅有焦虑，5.7%仅有抑郁，8.2%两种情况兼有。虽然同时患有两种情况的患者中有22.5%在癌症诊断后一个月内即被确诊，但32%–43%的患者是在12个月之后才获得诊断，表明识别存在延迟。研究显示出显著的人口统计学差异。女性患者获得抑郁（aOR=1.35，95%CI：1.32–1.38）和焦虑（aOR=1.57，95%CI：1.54–1.61）诊断的比值高于男性。与白人患者相比，亚裔患者获得抑郁（aOR=0.58，95%CI：0.56–0.59）和焦虑（aOR=0.56，95%CI：0.55–0.58）诊断的比值显著更低。西班牙裔/拉丁裔患者获得抑郁诊断的比值低51%（aOR=0.49，95%CI：0.37–0.56）。与私人保险患者相比，Medicaid患者获得抑郁（aOR=1.40，95%CI：1.37–1.44）和焦虑（aOR=1.12，95%CI：1.09–1.14）诊断的比值均升高。在各癌症类型中，乳腺癌患者的精神科诊断率最高，而前列腺癌患者的比值显著更低（抑郁aOR=0.79，焦虑aOR=0.63）。
结论：近四分之一的癌症患者获得了新发精神科诊断，然而在性别、种族、族裔、保险状况和癌症类型方面存在显著差异。大多数诊断发生在癌症后12个月之后的延迟识别凸显了错失的早期干预机会。这些发现表明肿瘤学中精神健康的识别与诊疗提供存在不公平。系统性地实施文化适宜的筛查、加强医务人员培训、在整个癌症诊疗过程中改善行为健康整合，以及确保公平获得精神健康服务的政策改革，对于解决这些差异至关重要。
查看英文原文 English abstract
Background: Cancer patients experience substantial psychological burden, yet mental health conditions often remain unrecognized and untreated. Disparities in psychiatric care may exist across demographic groups, though comprehensive multi-cancer analyses examining these patterns are limited.
Methods: We conducted a retrospective cohort study of 1,161,370 adult patients diagnosed with ten common cancers between January 2015 and September 2025 within the University of California Health system. Patients with pre-existing psychiatric diagnoses (12 months prior) or palliative-intent treatment were excluded. Primary outcomes were new-onset depression and anxiety diagnoses following cancer diagnosis. Multivariable logistic regression identified predictors of psychiatric diagnosis, adjusting for age, sex, race, ethnicity, insurance type, cancer type, and diagnosis year.
Results: Of 1,161,370 patients (mean age 66.1 years, 52.9% female), 258,076 (22.2%) received new psychiatric diagnoses: 8.4% anxiety only, 5.7% depression only, and 8.2% both conditions. While 22.5% of patients with both conditions were diagnosed within one month of cancer diagnosis, 32-43% received diagnoses beyond 12 months, indicating delayed recognition. Significant demographic disparities emerged. Female patients had higher odds of depression (aOR=1.35, 95%CI:1.32-1.38) and anxiety (aOR=1.57, 95%CI:1.54-1.61) diagnoses than males. Asian patients had substantially lower odds of depression (aOR=0.58, 95%CI:0.56-0.59) and anxiety (aOR=0.56, 95%CI:0.55-0.58) compared to White patients. Hispanic/Latino patients had 51% lower odds of depression diagnosis (aOR=0.49, 95%CI:0.37-0.56). Patients with Medicaid had elevated odds of both depression (aOR=1.40, 95%CI:1.37-1.44) and anxiety (aOR=1.12, 95%CI:1.09-1.14) compared to privately insured patients. Breast cancer patients had the highest psychiatric diagnosis rates across cancer types, while prostate cancer patients had substantially lower odds (depression aOR=0.79, anxiety aOR=0.63).
Conclusions: Nearly one-quarter of cancer patients receive new psychiatric diagnoses, yet substantial disparities exist by sex, race, ethnicity, insurance status, and cancer type. Delayed recognition with most diagnoses occurring beyond 12 months post-cancer highlights missed opportunities for early intervention. These findings suggest inequitable mental health recognition and care delivery in oncology. Systematic implementation of culturally appropriate screening, enhanced provider training, improved behavioral health integration throughout the cancer continuum, and policy reforms ensuring equitable mental health access are essential to address these disparities.
利益披露 Disclosure
S. M. Rajan, None..
V. Tran, None..
J. Demb, None..
M. Schiaffino, None..
J. Murphy, None.