Mental health service utilization among long-term cancer survivors
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Although generally well-adjusted, a subset of cancer survivors have been observed to experience ongoing psychological distress. There has been little study of mental health care utilization among cancer survivors, however.
Materials and methods
We identified a cohort of cancer survivors continuously enrolled in a managed care organization who were alive at least 5 years after a diagnosis of cancer and without evidence of recurrence. We matched them each to four controls without a history of cancer based on age, sex, and clinic location. We then obtained their health care claims and evaluated their health care utilization along with explanatory variables such as cancer type, non-cancer comorbid conditions, and types of health care providers seen.
One thousand one hundred eleven survivors were matched to 4,444 controls. Cancer survivors were more likely than controls to have a mental health diagnosis (33.5 vs. 30.3%, p < 0.05), accounted for mostly by anxiety and sleep disorders. Other predictors of receiving any mental health diagnosis on multivariable analysis were age: Odds Ratio (OR) 0.99 (95% Confidence Interval (CI) 0.99–0.99) for each year; male sex: OR 0.87 (95% CI 0.77–0.99), and comorbidity: OR 0.56 (95% CI 0.49–0.64) for each point on the Charlson scale. The largest subgroup was breast cancer survivors, who were more likely to have a diagnosis of major affective disorder than were female survivors of other cancers. Survivors had more outpatient medical visits in general (mean 27.4 versus 21.9, p < 0.001) and specifically more mental health visits (2.5 versus 1.7 on average, p < 0.001) than did controls.
Long-term cancer survivors have increased rates of mental health care utilization. Given the size and growth of the survivor population, this represents a significant amount of ongoing distress with important health resource allocation implications for policy makers.
- Burgess, C., Cornelius, V., Love, S. (2005) Depression and anxiety in women with early breast cancer: Five year observational cohort study. BMJ 330: pp. 702 CrossRef
- Carney, C. P., Woolson, R. F., Jones, L. (2004) Occurrence of cancer among people with mental health claims in an insured population. Psychosomatic Medicine 66: pp. 735-743 CrossRef
- Charlson, M. E., Sax, F. L., MacKenzie, C. R. (1986) Morbidity during hospitalization: Can we predict it. Journal of Chronic Diseases 40: pp. 705-712 CrossRef
- Charlson, M. E., Pompei, P., Ales, K. L. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases 40: pp. 373-383 CrossRef
- Deyo, R. A., Cherkin, D. C., Ciol, M. A. (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology 45: pp. 613-619 CrossRef
- Field, T. S., Cernieux, J., Buist, D. (2004) Retention of enrollees following a cancer diagnosis within health maintenance organizations in the Cancer Research Network. Journal of the National Cancer Institute 96: pp. 148-152 CrossRef
- Hewitt, M., Breen, N., Devesa, S. (1999) Cancer prevalence and survivorship issues: Analyses of the 1992 National Health Interview Survey. Journal of the National Cancer Institute 91: pp. 1480-1486 CrossRef
- Hewitt, M., Rowland, J. H. (2002) Mental health service use among adult cancer survivors: Analyses of the National Health Interview Survey. Journal Clinical Oncology 20: pp. 4581-4590 CrossRef
- Honda, K., Goodwin, R. D. (2004) Cancer and mental disorders in a national community sample: Findings from the National Comorbidity Survey. Psychotherapy and Psychosomatics 73: pp. 235-242 CrossRef
- (2005). Institute of Medicine: From cancer patient to cancer survivor: Lost in transition. Washington: National Academies.
- Keating, N. L., Norredam, M., Landrum, M. B. (2005) Physical and mental health status of older long-term cancer survivors. Journal of the American Geriatrics Society 53: pp. 2145-2152 CrossRef
- Klabunde, C. N. (2000) Development of a comorbidity index using physician claims data. Journal of Clinical Epidemiology 53: pp. 1258-1267 CrossRef
- Kornblith, A. B., Ligibel, J. (2003) Psychosocial and sexual functioning of survivors of breast cancer. Seminars in Oncology 30: pp. 799-813 CrossRef
- Kosten, T. R., Bryant, K., Rounsaville, B. J. (1990) The SCID: A clinical instrument for assessing psychiatric disorders. NIDA Research Monograph 105: pp. 213-219
- Massie, M. J. (2004). Prevalence of depression in patients with cancer. Journal of the National Cancer Institute Monographs, 57–71.
- Nekhlyudov, L., Li, R., Fletcher, S. W. (2005) Information and involvement preferences of women in their 40s before their first screening mammogram. Archives of Internal Medicine 165: pp. 1370-1374 CrossRef
- Polsky, D., Doshi, J. A., Marcus, S. (2005) Long-term risk for depressive symptoms after a medical diagnosis. Archives of Internal Medicine 165: pp. 1260-1266 CrossRef
- Ross, L., Johansen, C., Dalton, S. O. (2003) Psychiatric hospitalizations among survivors of cancer in childhood or adolescence. New England Journal of Medicine 349: pp. 650-657 CrossRef
- Wagner, E. H., Greene, S. M., & Hart, G. (2005). Building a research consortium of large health systems: the Cancer Research Network. Journal of the National Cancer Institute. Monographs, 3–11.
- Mental health service utilization among long-term cancer survivors
Journal of Cancer Survivorship
Volume 1, Issue 2 , pp 156-160
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- Cancer survivorship
- Mental health
- Health services research
- Outcomes research
- Administrative data
- Claims data
- Industry Sectors
- Author Affiliations
- 1. Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- 2. Lance Armstrong Foundation Adult Survivorship Clinic, Perini Family Survivor Center, Dana-Farber Cancer Institute, Boston, MA, USA
- 4. Center for Outcomes and Policy Research, Dana-Farber Cancer Center, 44 Binney St., Boston, MA, 02115, USA
- 3. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA