Mental health disorders increase mortality from cervical cancer

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The presence of a mental health disorder lowers the odds of survival in patients with cervical cancer, according to a recent study published in JAMA Network Open.

Cervical cancer is the fourth most common cancer worldwide. Prevention methods include papanicolaou test screening, high vaccination coverage, and cervical screening uptake. However, health inequities have been identified as one of the most significant challenges when reducing cervical cancer incidence.

Mental illness is highly prevalent among female individuals, estimated in 12,760 per 100,000. It has been associated with significant morbidity and mortality, with significant health disparity identified in individuals with mental disorders.

Rates of human papillomavirus vaccination and cervical screening have been measured as lower in female individuals with mental illnesses. However, there is little data on mental illnesses and cervical cancer outcomes, according to the study authors.

Investigators conducted a cohort study to determine the association between mental illnesses and cervical cancer outcomes. Participants included individuals diagnosed with cervical cancer from 1978 to 2018.

Cervical cancer diagnosis was determined using the Swedish Cancer Register. Patients were followed from cervical cancer diagnosis until death, emigration, or end of the study period. Two study groups were created, the first including patients diagnosed with cervical cancer from 2002 to 2016 and the second including patients diagnosed from 1978 to 2018.

The Swedish Patient Register was evaluated to identify mental health disorders diagnosed before cervical cancer. Psychiatric disorders in the analysis included substance abuse, anxiety, depression, psychotic disorders, and stress-related disorders. 

Neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder were also included. Study outcomes included death from any cause and death from cervical cancer, described as overall mortality and cervical cancer-specific mortality respectively.

Data on FIGO tumor stage, tumor histologic type, and mode of detection was collected. Covariates included region of residence at birth and cervical cancer diagnosis, highest educational attainment level, and marital status.

There were 20,177 female patients diagnosed with cervical cancer from 1978 to 2018 and 6725 in a subgroup diagnosed from 2002 to 2016. A preexisting mental health disorder diagnosis was reported in 13.28% of the subgroup. These patients were often younger at cancer diagnosis, had a lower educational attainment level, lived alone, and had squamous cell cancer.

Overall mortality was reported in 2466 patients diagnosed with cervical cancer between 2002 and 2016. Patients with a mental disorder had an increased risk of death compared to those without a mental disorder, with fully adjusted hazard ratios (HRs) of 1.19 and 1.06 to 1.34 respectively.

Fully adjusted HRs of overall mortality were 1.27 for substance abuse, 1.48 for psychotic disorders, and 1.25 for depressive disorders. Intellectual disabilities and anxiety and stress-related disorders were not associated with an increased risk of overall mortality.

Similar results were observed among deaths from cervical cancer. These deaths were more common among patients with preexisting mental health disorders, with the risk increased among patients with substance abuse and psychotic disorders. However, these associations were only observed in partially adjusted models rather than fully adjusted models.

These results indicated lower overall and cervical cancer-specific survival among cervical cancer patients diagnosed with a preexisting mental health condition. Investigators concluded patients with severe mental health disorders should be considered high-risk.

Reference

Herweijer E, Wang J, Hu K, et al. Overall and cervical cancer survival in patients with and without mental disorders. JAMA Netw Open. 2023;6(9):e2336213. doi:10.1001/jamanetworkopen.2023.36213