Mental Health and Survival in Medicare Beneficiaries With Lung and Head and Neck Cancer

Background: Mental health (MH) conditions can significantly influence cancer outcomes, yet associations with survival and potential impacts of MH care utilization remain underexplored. Aims: Examine associations between (1) MH diagnoses and (2) MH utilization and survival among Medicare beneficiaries with lung or head and neck (HN) cancers. Methods: Patients diagnosed with lung or HN cancers between 2004 and 2018 were stratified by MH diagnosis status in the two years prior to cancer diagnosis. We examined factors associated with MH diagnosis and MH services and evaluated overall and cancer specific survival analyses using Kaplan-Meier survival analyses and multivariable Cox regressions. Results: 19% of patients with a lung cancer diagnosis (n = 333,875) and 15% of HN patients (n = 39,253) received a MH diagnosis within two years before cancer diagnosis. Kaplan-Meier survival analysis indicated significantly worse survival among patients with a MH diagnosis and higher rates of survival among those receiving MH services. Among individuals with a MH diagnosis, the mortality hazard for individuals that received MH services was lower compared to those who did not receive MH services, in both HN and Lung cancer. Conclusions: MH conditions were common in people with lung and HN cancers and associated with worse overall and cancer-specific survival for head and neck cancer. Among those with MH diagnoses, receipt of MH services was associated with lower hazard of death, highlighting the need for early identification of this at-risk population and integration of MH care into oncology care.