Background: Substance use and mental health disorders significantly contribute to disparities in cancer care, particularly in the South Bronx, a region with a large Latinx and Black population. This study evaluates the impact of these disorders on cancer care among newly diagnosed patients at Lincoln Cancer Center.
Methods: This retrospective study included newly diagnosed cancer patients treated from January to November 2022. We assessed delays in diagnosis and treatment, compliance, emergency department visits, unplanned admissions, follow-up loss, and mortality. Substance use and mental health disorders were identified through electronic health record reviews and structured telephone interviews. Data analysis was performed using descriptive statistics and the independent samples T-test in SPSS. Institutional Review Board approval was obtained.
Results: The study included 293 patients: 93 (31.7%) Black, 178 (60.8%) Hispanic, 6 (2.0%) White, and 4 (1.4%) Asian. Among them, 173 (59.0%) had substance use disorders, 58 (19.8%) had mental health disorders, and 44 (15.0%) had both. Patients with substance use disorder experienced treatment delays (73.0 vs. 58.2 days, p = 0.176), more ED visits (1.79 vs. 1.16, p = 0.052), unplanned admissions (0.96 vs. 0.55, p = 0.164), increased no-show rates (26.7% vs. 11.7%, p < 0.001), and higher follow-up loss (OR 1.353, 95% CI 0.812-2.255). Additionally, patients with either substance use or mental health disorder were more likely to not receive any cancer treatment due to follow-up loss or early death prior to initial intervention (OR 1.835, 95% CI 0.937-3.592; OR 1.474, 95% CI 0.711-3.056), higher chance to decline initial treatment (OR 1.414, 95% CI 0.734-2.723; OR 2.334, 95% CI 1.154-4.722), and die within one year of diagnosis (OR 1.193, 95% CI 0.622-2.287; OR 1.311, 95% CI 0.62-2.711).
Conclusions: This study highlights significant disparities in cancer care among South Bronx patients with mental health and substance use disorders. These patients exhibit higher rates of non-compliance and mortality. Notably, most patients with substance use disorders are not attending bridge or substance use clinics, and only 29% of psychiatric patients receiving medication and 12% having regular psychiatric care. These findings underscore the need for integrated mental health services in cancer care and targeted interventions to address these disparities.