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Many patients with multiple myeloma ( MM ) have a high risk for developing psychiatric comorbidities and , according to a study published in Blood Advances , managing these additional psychiatric conditions are associated with an increased use of health-care resources and higher health-care expense .

“ An important component of survivorship is psychosocial well-being ,” the study authors , led by Shehzad Niazi , MD , of the Mayo Clinic in Jacksonville , Florida , wrote . “ Although novel therapeutic agents are considered the major cause of the increasing cost of cancer care , … caring for cancer patients with depression and other psychiatric conditions [ has been ] associated with significantly higher costs .”

The researchers reviewed the National Cancer Institute ’ s Surveillance , Epidemiology , and End Results ( SEER ) database to collect information about two groups of patients who were diagnosed with MM between 1991 and 2010 :

• an “ MM-only ” group enrolled in and receiving Medicare benefits for one year before MM diagnosis ( n = 20,839 )

• an “ MM + psychiatric ” group with MM and a psychiatric diagnosis ( n = 15,168 )

Because depression was the most common psychiatric condition in this dataset , the investigators also identified a separate group of 8,421 patients with MM and specifically depression (“ MM + depression ” group ).

The median age for both the MMonly and MM + psychiatric groups was 76 years ( range = 70-82 years ). “ There was a significant difference in sex distribution between the two groups ,” the authors noted . “ The majority ( 54.5 %) of MM-only patients were males , whereas 51.1 percent of MM + psychiatric patients were females ( p < 0.001 ).”

Clinical myeloma-defining events ( MDEs ; defined as hypercalcemia , renal dysfunction , anemia , bone fractures , and dialysis > 30 days post-diagnosis ) were more frequent in the MM + psychiatric group ( p < 0.01 for all types ). Compared with MM-only patients , the MM + psychiatric group had a significantly higher Charlson Comorbidity Index score at diagnosis ( 0 vs . 1 , respectively ; p < 0.001 ).

In a comparison of the MM-only and MM + depression groups , the authors observed that women represented the majority ( 57.3 %) of MM + depression patients ( p < 0.001 ).

Over a median follow-up period of 1.8 years ( range not reported ), health-care resource use ( defined as the number of patients with MM receiving ambulatory , emergency department , or inpatient care ) was higher in the MM + psychiatric and MM + depression groups , compared with the MM-only group . For example , 74 % of patients in the MM-only group used inpatient care , while 81.6 % of patients in the MM + psychiatric group reported used inpatient services ( odds ratio = 1.48 ; 95 % CI 1.39-1.57 ; p < 0.001 ). See more results in TABLE 1 .

Increased health-care resource use was coupled with increased health-care costs ( defined as inpatient , outpatient , and drug charges from Medicare insurance claims

TABLE 1 . Health-Care Resource Use by Setting

within the first six months after MM diagnosis ). The median costs of care were significantly higher among patients in the MM + psychiatric group , compared with MM-only individuals ($ 18,700 vs . $ 12,300 ; multivariate odds ratio [ OR ] = 1.25 ; 95 % CI 1.20-1.31 , p < 0.001 ). Patients with MM and depression had an even higher cost of care compared with MM-only patients ($ 19,500 vs . $ 12,300 ; multivariate OR = 1.23 ; 95 % CI 1.16-1.30 ; p < 0.001 ).

“ Similar trends were noted when the cost of care for inpatient and outpatient care was evaluated separately , with the cost being highest for [ the ] MM + depression [ group ],” the authors reported ( TABLE 2 ).

According to the researchers , long-term systemic steroids may be a contributing factor to the higher risk of neuropsychiatric conditions for patients with MM , noting that “ as many as three-fourths of those taking corticosteroids develop neuropsychiatric complications , likely increasing morbidity and cost of care .”

“ Although national entities and accreditation bodies emphasize screening and identifying and addressing the psychological needs of cancer patients , more needs to be done ,” the researchers concluded . They added that creating targeted treatment strategies for these patients must rely on the improved understanding “ of the true prevalence of psychiatric comorbidities in cancer patients , as well as their impact on health-care [ use ] and cost of cancer care .”

The retrospective analysis of billing data for identifying psychiatric comorbidities in patients is a limitation of this study . ●

The researchers reported no financial conflicts .

REFERENCE

Niazi S , Frank RD , Sharma M , et al . Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma . Blood Advances . 2018 ; 2:1120-8 .

TABLE 2 . Health-Care Costs by Setting

Median health-care costs $ 8,000 ($ 0-27,300 )

Outpatient

$ 13,500 ($ 0-35,300 )

1.29 ( 1.23-1.36 ) $ 8,000 ($ 0-27,300 )

$ 14,300 ($ 0-36,700 )

1.33 ( 1.24-1.42 )

1.05 ( 0.99-1.11 )

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