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Geographical distance predicts psychiatric treatment retention for Hispanic women with comorbid major depression and breast cancer

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Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Depression is among the most common comorbid psychiatric disorders of patients with breast cancer. Depression decreases patient quality of life and, if untreated, can adversely affect cancer treatment. We sought to identify treatment barriers for women with breast cancer receiving psychotherapy for depression. Findings may help policy makers and researchers determine funding and design of future studies involving this population, especially in communities with high rates of health disparities.

Methods

We used data from a randomized trial for women with breast cancer and current DSM-IV non-psychotic unipolar major depressive disorder (MDD). Patients were randomly assigned to 12 weeks of one of three psychotherapies and attrition was assessed by whether subjects completed 12 weekly treatment sessions. We used descriptive analyses and logistic regression to identify treatment barriers. R shiny was used to determine study patient residences.

Results

Of 134 randomized patients, 84 (62.7%) were Hispanic. Fifty-nine patients (44%) either did not start or dropped out of treatment, 49 (83.1%) of them being Hispanic. Being a Hispanic woman, less educated, and geographically distant from treatment significantly predicted attrition. Single Hispanic mothers had significantly higher attrition risk than married and/or childless women.

Conclusion

Identifying barriers to treatment is important to improve treatment adherence for patients with concurrent diagnoses of breast cancer and MDD, especially for traditionally underserved minorities. Additional support such as affordable tele-medicine, multi-language assistance, financial aid for transportation and child-care, and allocation of more funds to address some identified barriers deserve consideration to improve treatment adherence and outcomes.

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Data availability

Data is available upon request.

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Acknowledgements

We would like to thank Daniela Quigee, MS, for her assistance in preparing for this manuscript. This work has been presented at the 14th International Conference of Healthy Policy Statistics, January 2023.

Funding

The authors have not disclosed any funding.

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Authors and Affiliations

  1. New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA

    Ying Chen, John C. Markowitz, Joy T. Zhang & David J. Hellerstein

  2. Columbia University Irving Medical Center (CUIMC), New York, NY, 10032, USA

    Ying Chen, John C. Markowitz, Dawn L. Hershman & David J. Hellerstein

  3. Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse (NIDA), Gaithersburg, MD, 20892, USA

    Carlos Blanco

  4. University of Virginia, Charlottesville, VA, 22904, USA

    Joy T. Zhang

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  1. Ying Chen
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  6. David J. Hellerstein
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Contributions

All authors whose names appear on the submission. Made substantial contributions to the conception or design of the work, or the analysis, or interpretation of data, chart and literature review, data collection. Drafted the work or revised it critically for important intellectual content. Read, commented on previous version of the manuscript, and approved the final vision to be published. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ying Chen.

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Conflict of interest

John C. Markowitz: Reports receiving salary support from New York Psychiatric Institute; grant support from the National Institute of Mental Health, Department of Defense, and David Lynch Foundation. He receives minor book royalties for one of the study psychotherapies from American Psychiatric Publishing, Basic/Perseus Books, and Oxford University Press. David J. Hellerstein: Reports receiving salary support from New York Psychiatric Institute. He receives grant support from Compass Pathways, Relmada, Marinus, Intracellular Therapies, and Beckley Scientific, and from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (M Walker PI) and serves on the scientific advisory board for Reset Pharmaceuticals. He receives book royalties from Columbia University Press and Johns Hopkins University Press. Ying Chen, Carlos Blanco, Dawn L Hershman, Joy T. Zhang have not received any competing interests. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the US government.

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Chen, Y., Markowitz, J.C., Blanco, C. et al. Geographical distance predicts psychiatric treatment retention for Hispanic women with comorbid major depression and breast cancer. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07250-9

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