Session Item

To identify the proportion of Emergency Department (ED) visits in cancer patients associated with a Mental/Substance Use Disorder (MSUD) and the subsequent healthcare costs. 

 Nationally representative data on ED visits from 2009-2018 was obtained from the Nationwide Emergency Department Sample (NEDS). We identified cancer related visits with or without a MSUD using the Clinical Classifications Software diagnoses documented during the ED visit. Survey adjusted frequencies and proportions of ED visits among adult cancer patients with or without a MSUD was evaluated. Survey adjusted multivariable logistic regression models were used to examine demographic and clinical predictors of the presence of an MSUD and the likelihood of admission for patients with a primary MSUD. 

Among 50,810,552 ED visits with a cancer diagnosis between 2009-2018, 10,896,241 (21%) were associated with a MSUD. Cancer patients with an associated MSUD diagnosis were more likely to be female (54% versus 49.4%), younger (median: 58 versus 66), more likely to have Medicaid insurance (14% versus 9.4%), and more likely to be admitted as an inpatient (65% versus 49%). Of the 951,477 visits associated with a chief complaint of an MSUD, 5,779 resulted in death either in the hospital (96%) or ED (4%). The majority of those visits were associated with male sex (n=3,766) and the median age was 62 years. The three most common MSUD diagnoses among cancer patients were alcohol related disorders, anxiety disorders, and depressive disorders. Alcohol related disorders were more common among patients with tumors of the liver, head and neck, and gastrointestinal tract . Anxiety and depressive disorders were most common among patients with thyroid cancer, Hodgkin’s Disease, breast, uterine, and ovarian cancers.  Opioid related disorders were found more commonly in patients with secondary malignancies, multiple myeloma, pancreatic cancer, and cancer of the bone and connective tissue. The total costs associated with a primary MSUD between 2009-2018 was $3,018,279,540. Alcohol-related disorders, suicidal ideation or attempt, anxiety disorders, and depressive disorders made up 64% of all costs  associated with a primary MSUD. Younger age (OR: 0.99, 95% CI: 0.98-0.99, p<0.001) and female sex (OR: 1.34, 95% CI: 1.32-1.35, p<0.001) were associated with higher odds of having an MSUD. 

Our findings demonstrate a high burden of psychiatric and substance use illness in the cancer population and provide the rationale for early psychosocial intervention to support these patients.