(640) Preexisting Mental Health Disorders and Survival Outcomes in Young Adults with HNSCC

Introduction: Young adults face unique mental health comorbidities that may influence cancer treatment adherence, therapeutic outcomes, and survival. This study investigates whether preexisting mental health disorders impact overall survival and post-diagnosis substance use disorder development in young adults diagnosed with Head and Neck Squamous Cell Carcinoma (HNSCC).

Methods: This retrospective cohort study analyzed TriNetX database records of patients between the ages of 18-45 years old diagnosed with HNSCC between 2005 to 2025. Patients with mental health diagnoses documented at least one day prior to HNSCC were matched 1:1 with controls without mental health conditions, adjusting for age, sex, race/ethnicity, insurance, smoking status, and comorbidities. The outcomes of interest were mortality over 5, 10 and 20 year follow-up intervals and post-diagnosis substance use disorders. Risk ratio with corresponding 95% confidence intervals were calculated and Kaplan-Meier analyses were performed to assess survival differences between cohorts, with statistical significance set at p< 0.05.

Results: Among 39,155 matched pairs, patients with preexisting mental health disorders demonstrated increased five-year mortality (RR=1.386; 95% CI:1.068, 1.678). Post-diagnosis substance use disorders occurred more frequently in the mental health cohort (RR= 1.367; 95% CI: 1.021, 1.832). These results were consistently significant at 5, 10, and 20 year follow-up intervals.

Conclusions: Young adults with HNSCC and preexisting mental health disorders exhibit decreased survival and elevated risk of developing substance use disorders following cancer diagnosis compared to matched controls. These findings highlight the need for integrated behavioral health screenings, multidisciplinary care coordination, and tailored pain management plans in this high-risk population. Regular mental health screenings and psychiatric support may improve treatment adherence, reduce substance-related complications, and overall enhance outcomes for young adult HNSCC patients with psychiatric comorbidities.