Mental health diagnoses and survival in older patients with melanoma: A SEER-Medicare linked cohort study

Summary: Mental health diagnoses (MHD) affected 1 in 5 adults in the United States in 2024. MHD are associated with decreased survival in some cancers, but little is known about MHD and survival in melanoma. This study aimed to estimate the prevalence and survival impact of pre-existing MHD in a SEER-Medicare linked cohort of patients aged 67+ with melanoma diagnosed in 2003-2016. Pre-existing MHD (depression, anxiety, schizophrenia, bipolar disorder) during up to two years of continuous Medicare enrollment prior to melanoma diagnosis were identified using 1 inpatient or 2 outpatient ICD-9/10 codes. Five-year overall and melanoma-specific survival were estimated and compared by mental health diagnoses using multivariable Cox models. Among 178,848 patients with melanoma, 16,989 (9.5%) had pre-existing MHD: 6.0% depression, 5.4% anxiety, 0.7% schizophrenia, 0.5% bipolar disorder. 5-year overall and melanoma-specific survival were 62.6% (95% CI: 61.8-63.5%) and 90.5% (89.9-91.0%) for patients with MHD and 75.6% (75.3-75.8%) and 91.8% (91.6-91.9%) for patients without, respectively. Adjusting for sociodemographic factors and staging, MHD were associated with higher risk of overall mortality (aHR: 1.44, 95% CI: 1.40-1.49) and melanoma-specific mortality (aHR: 1.11, 95% CI: 1.04-1.19). Pre-existing MHD are associated with lower overall and melanoma-specific survival in older patients with melanoma. This study is limited by the use of ICD codes to identify MHD and results may not be generalizable to non-Medicare populations. Future research should examine tailored multidisciplinary interventions aimed to optimize care and outcomes in patients with MHD and melanoma. Jonathan Gunasti¹, Kalina Machado¹, Julia Rogers¹, Xiaojie Zhi², Ashley McCook-Veal², LePaige Godfrey², David Gibbs¹, Marissa L. Baranowski¹, Jeffrey Switchenko², Howa Yeung¹ 1. Department of Dermatology, Emory University School of Medicine, Atlanta, GA, United States. 2. Emory University Winship Cancer Institute, Atlanta, GA, United States. Clinical Research: Epidemiology and Observational Research