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Patients with Hodgkin lymphoma (HL) are more likely to suffer from mental-health and substance-abuse disorders than the general population. Calling for more attention to mental health, a study published August 2 in Cancer by researchers from Huntsman Cancer Institute at the University of Utah (U of U) found people with the disease had higher risks of anxiety, depression, substance abuse, suicide, and self-inflicted injuries.
"The need now is to determine how to best help them," says lead researcher Randa Tao, MD, radiation oncology specialist at Huntsman Cancer Institute. "We need to think of mental illness with the similar awareness and concern as the physical side effects of a cancer diagnosis and its treatment. Psychosocial well-being needs to be recognized as an important part of cancer survivorship, and more research is needed to support short and long-term mental health in cancer patients."
Tao's interest in the subject was sparked after colleague and co-author Shane Lloyd, MD, assistant professor of radiation oncology at Huntsman Cancer Institute and the U of U School of Medicine, had looked at mental health outcomes in colorectal cancer survivors, finding they were at increased risk of being diagnosed with a mental health disorder after having cancer. Mia Hashibe, PhD, an investigator at Huntsman Cancer Institute, is the senior author of the study
Tao wondered if this carried over to HL, which attacks the immune system and is most prevalent in those 15-39 years old. Known as a highly curable cancer with a long survivorship, HL affects mostly young people who are going through major life events and transitions, such as attending college, beginning careers, and starting families. Deaths from HL have decreased dramatically over the last 50 years, more than any other malignancy, according to the National Cancer Institute. Experts say more than 75% of all newly diagnosed patients can be cured with chemotherapy and radiation. The American Cancer society estimates there are about 8,540 new cases of HL in the country this year.
"A cancer diagnosis is understandably very stressful for anyone, but it can be especially distressing for HL patients who are often young and otherwise healthy," Tao says.
Nicole Mobley, age 25, was diagnosed with HL in January 2021 during COVID. "I started feeling depressed when I started experiencing physical symptoms, like losing my hair. That hit me the hardest. It was a struggle," Mobley says. "It's okay to feel angry and sad. But just how you get out of it is key." She says spending time with her husband, dogs and family helped her recover mentally and emotionally.
For the study, researchers identified patients diagnosed with HL between 1997 and 2014 from the Utah Cancer Registry. In all, 795 patients who had HL were matched with 3,575 individuals from the general population within the Utah Population Database, a source of linked records that includes patient and demographic data.
Anxiety and depression were the most prevalent conditions with substance abuse ranking third.
To gather data, researchers considered long-term mental health outcomes and risk factors for the development of disorders in determining that such disorders may shorten patients' lives. In patients with HL, the 10-year survival rate was 70% in patients who had a mental health diagnosis compared with 86% in those without one.
The main risk factor associated with being diagnosed with mental health disorders was undergoing hematopoietic stem cell transplantation, a treatment that replaces bone marrow with healthy cells. The replacement cells can either come from their own body or from a donor. The therapy process can be grueling, with longer stays in hospitals.
Previous studies of HL patients have documented they are at elevated risks of cardiovascular disease, malignancy recurrence, and other quality-of-life changes stemming from their diagnosis and treatment, including fatigue and nausea. However, not much was known about their psychological well-being. "Future studies are needed to understand the causes of these mental health disorders and to discover potential interventions to improve mental health in patients with HL," Tao adds.
The study was supported by the National Institutes of Health/National Cancer Institute including P30 CA042014, the Huntsman Cancer Institute, and the Cancer Control and Population Sciences Program (Huntsman Cancer Institute Cancer Center Support Grant P30CA042014). This research was also supported by the Utah Cancer Registry, which is funded by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (Contract No. HHSN261201800016I) and the US Centers for Disease Control and Prevention’s National Program of Cancer Registries (Cooperative Agreement No. NU58DP006320), and Huntsman Cancer Foundation.