Defining the Psychiatric and Financial Landscape of Mental and Substance Use Disorders in Head and Neck Cancer Patients

Purpose/Objective(s)

To evaluate and describe mental and substance use disorders (MSUD) among head and neck cancer patients admitted to the emergency department (ED) in the United States.

Materials/Methods

We analyzed the Nationwide Emergency Database Sample (NEDS) which produces national estimates of ED visits across the United States. Inclusion criteria included patients with a head and neck cancer diagnosis identified through the Clinical Classifications Software. Mental and Substance use disorders were identified using ICD-9 and ICD-10 codes. Variables analyzed include patient demographics, hospital characteristics, expected payment source, and total visit charge. Survey weighted multivariable logistic regression was used to analyze predictors of MSUD.

Results

From 2009-2018, there were 1,398,671 discharges from the ED associated with head and neck cancer, of which 334,056 (23.9%) also presented with a concurrent MSUD. Patients presenting with a MSUD as the primary visit reason (2.3%) were more likely to be younger (58 vs 66 years, p<0.001), male (73.3% vs 70.6%, p<0.001), and less likely to be admitted to the hospital (51.6% vs 53.5%, p<0.001). Among all patients, the 5 most common MSUD disorders were depressive disorders (n=133,377; 9.5%), anxiety disorders (n=122,679; 8.8%), alcohol related disorders (n=80,994; 5.8%), opioid related disorders (n=23,801; 1.7%), and schizophrenia related disorders (n=22,540; 1.6%). Suicidal ideation or attempt was found in 10,228 discharges (3.1%). The total cost of ED admissions related to a primary MSUD was $103,828,679. The cost of ED admission was most expensive for patients with a primary admission diagnosis of alcohol related disorders (34.8%), opioid related disorders (12.5%), and suicidal ideation or attempt (10.9%). On multivariable logistic regression, younger age (OR: 0.98, p<0.001), female gender (OR:1.26, p<0.001), and non-Medicare insurance were associated with the odds of having any diagnosis of MSUD.

Conclusion

There is a high rate of concomitant MSUD in head and neck cancer patients who present to the ED. Our study identifies a subset of younger and female patients who may be at high risk of developing an MSUD. The financial burden of MSUD was high and the head and neck cancer population are particularly vulnerable to depressive, anxiety, and alcohol related disorders. Future studies should design therapeutic or behavioral interventions to mitigate and address mental health disorders in this population.