Examining the impact of substance use and mental health disorders on cancer care in urban underserved communities.

Abstract

e13789 Background: Substance use disorders and mental illness significantly contribute to disparities in cancer care, particularly within underserved populations. This study evaluates the impact of substance use and mental illness on cancer care outcomes at Lincoln Medical Center in the South Bronx, a predominantly Latinx and Black community with high rates of substance use and mental illness. Methods: A retrospective analysis was performed on patients newly suspected of or diagnosed with cancer at Lincoln Medical Center from January to December 2022. Exclusions included patients without biopsies, those transferred to other hospitals, and cases of non-malignant tumors. Collected data encompassed demographics, substance use, mental illness, follow-up adherence, emergency department visits, hospital admissions, diagnosis and treatment delays, and one-year mortality. Descriptive statistics, independent samples t-test, and Chi-square test were used to assess associations between variables. Institutional Review Board approval was obtained. Results: Out of 495 patients, 151 were excluded, leaving 344 for analysis: 32.3% Black, 58.7% Hispanic, and 9.0% other ethnicities. Among these, 56.4% reported substance use and 19.9% had a mental illness. Substance use was linked to higher rates of lost follow-up or treatment discontinuation (χ² = 11, p < 0.01), increased emergency visits (1.73 vs. 1.32, p = 0.046), and more psychiatric disorders (40% vs. 17%, p < 0.001). Cocaine use significantly delayed cancer diagnosis (121.1 vs. 58.9 days, p = 0.002). Depression and bipolar disorder were associated with increased drug use (1.59 vs. 0.11, p < 0.001; 2.25 vs. 0.23, p = 0.007), while anxiety reduced treatment delays (50.9 vs. 81.1 days, p = 0.017). Patients who died within a year of diagnosis had more psychiatric illnesses (0.52 vs. 0.26, p < 0.001), greater substance use (1.31 vs. 0.82, p = 0.007), higher no-show rates (0.47 vs. 0.26, p < 0.001), more emergency visits (2.77 vs. 1.35, p < 0.001), and increased hospitalizations (1.69 vs. 0.56, p < 0.001). Conclusions: Substance use and mental illness adversely affect cancer care outcomes in underserved populations, leading to delays in diagnosis and treatment, reduced adherence to follow-up, increased healthcare utilization, and higher mortality rates within one year of diagnosis. Addressing these comorbidities is crucial to mitigating disparities in cancer care.