Mental Health Disorders Associated with Sinonasal and Skull Base Malignancies: A Large Cohort Study

Background Sinonasal and skull base malignancies are rare but have significant morbidity including vision changes, loss of smell, as well as neurological deficits. Treatment involves major surgery with radiation and chemotherapy, all modalities that impart serious side effects. We suspect the diagnosis and treatment of these specific cancers cause significant stress and lead to clinical mental health disorders (MHD) such as anxiety and depression. Large cohorts, such as the National Survey on Drug Use and Health (NSDUH), of the general population estimate prevalence of MHD to be 17.9% in the United States, and we hypothesize the prevalence to be higher in the skull base malignancy patient population.

Objective To examine the prevalence, incidence, sociodemographic, and clinical characteristics of MHD among patients with skull base malignancies utilizing a large-scale database (MarketScan).

Method We performed a retrospective study of sinonasal/skull base cancer patients from the MarketScan database. MarketScan's claim-based data enables large-scale, comprehensive analysis by providing clinical information about the longitudinal care of patients. Only patients with nonmetastatic malignant tumors of the sinonasal and skull base malignancies were included as defined by ICD-9 coding. The ICD-9-CM codes for psychiatric disorders and dispensing records of antianxiety and antidepression medications served as sources for tracking the presence of mental health disorders. Information regarding patient demographics as well as the presence of mental health disorders was recorded. Pearson's chi-square tests for independence were used for comparing the frequency of MHDs pre- and postdiagnosis of sinonasal/skull base malignancies.

Results A total of 6,760 subjects meeting the inclusion criteria served as the study sample. A significant increase in MHDs was reported from pre– to post–cancer-diagnosis period of 22 to 32%, respectively (p < 0.0001). Despite an increase in the prevalence rate, the demographic profile of patients with MHDs postdiagnosis remained similar to prediagnosis. However, in comparing patients who had MHDs to those who did not in the postdiagnosis period, patients with MHDs were more likely to be between 45 and 54 (37 vs. 33%), women (63 vs. 47%), from the Midwest or southern United States (63 vs. 59%) and carry a history of smoking (41 vs. 26%) than those without MHDs. These comparisons were all statistically significant (p < 0.0001).

Conclusion Mental health disorders remain poorly understood in the sinonasal and skull base malignancy population. In a large-scale administrative database, we found a baseline level of 22% MHD, which increased significantly to 32% following the diagnosis. Patients with MHDs were more likely to be women and smokers. The levels of MHDs were higher than the general population according to NSDUH. Psychosocial needs of patients with sinonasal/skull base malignancies should be addressed in treatment discussions routinely to facilitate recovery and improve quality of life.