Study: Rare cancer patients nearly three times more likely to develop anxiety and depression than common cancer patients

A recent study of the psychological outcomes of over 57,470 patients with rare cancers showed that they have higher risk of developing mental health issues compared to patients with common cancers.

The systematic review and meta-analysis of these patient cases, led by Assistant Professor Valerie Yang, Consultant Medical Oncologist at the National Cancer Centre Singapore (NCCS) and Joint Research Clinician and Group Leader at the A*STAR Institute of Molecular and Cell Biology (IMCB) indicate that patients with rare cancers are significantly more likely to develop anxiety and depression, and have higher incidence of suicides and post-traumatic stress disorder (PTSD).

Rare cancers, defined as those affecting fewer than 6 out of 100,000 people per year, often pose unique diagnosis, treatment and research challenges. Because there is low incidence of each type of rare cancer, there is often a lack of awareness among the public and medical professionals of these diseases, leading to delayed diagnoses and limited treatment options. Due to the lack of support and resources tailored to their specific condition, patients with rare cancers may experience isolation which can negatively impact their mental health.

Although there have been numerous studies looking at the psychological outcomes of patients with common cancers, this was the first study to systematically examine the psychological impact of suffering from a rare cancer compared to a common cancer. As there are fewer individuals with rare cancers, clinicians may also be less attuned to the psychological challenges faced by these patients.

This study, published in eClinicalMedicine, showed that rare cancer patients are nearly three times more likely to develop anxiety and depression as compared to patients with common cancers.

This group also has a high incidence of suicide (over 300 per 100,000 people) and post-traumatic stress disorder (18%). Importantly, the authors identified specific risk factors in patients with rare cancers who may develop these negative psychological outcomes. This includes having advanced disease, chemotherapy treatment, lower income and social status.

"The prevalence of poor mental health in patients with rare cancers highlights the need for early identification and intervention. Increased awareness among health care professionals is crucial to help identify patients with psychological concerns and monitor patients' mental well-being during the course of their treatment.

"While each individual diagnosis might be rare, as a whole, rare cancers actually account for 25% of all cancers. This, coupled with the rising burden of rare cancers globally, highlights the critical need for more support for this group of patients," said Dr. Yang.

Mr. Soh Kim Hai, a patient of Dr. Yang's who was diagnosed with Stage IV Soft Tissue Sarcoma in July 2022, is a patient who struggled to cope with the disease. After diagnosis, he lost his job and a place to live which was provided by his workplace. The resulting fear and uncertainty severely impacted his mental health. He was supported by medical social workers at NCCS for help and got emotional support.

During the sessions, he shared his stress about his living conditions and was assisted to find a new place to live. After the move, on the suggestion of his brother, he took up painting, which has provided a much-needed cathartic outlet for his emotions and helped his mental well-being.

Despite the current lack of treatments for patients with rare cancers, novel approaches in translational research and personalized medicine are gradually improving outcomes for rare cancer patients, offering hope for more effective treatments and better quality of life.

Dr. Yang also leads the Translational Precision Oncology Laboratory at IMCB, in close clinical collaboration with NCCS and Singapore General Hospital (SGH), as well as scientific collaborations with National University of Singapore (NUS) and A*STAR's Bioinformatics Institute (BII) and Singapore Immunology Network (SIgN). The collaborative team has built a translational research program to find better ways to treat these patients.

The research team is now working closely with the clinical team to develop strategies, such as early identification of patients for referral to medical social workers, to better support patients with rare cancers. These strategies, if proven successful, can then be applied to manage the psychological needs of all vulnerable patient populations.