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Mental health outcomes in a national sample of adult cancer survivors in the United States: Has psychosocial care improved?

120 Background: Recent cancer care recommendations include routine mental health (MH) screening and support. We provide national estimates of psychological distress, MH visits, and unmet need (defined as having distress but no MH visit) for MH services among adult cancer survivors. Additionally, we test for temporal differences between years 2005 and 2010 to assess whether the estimates differ before and after important policy recommendations for psychosocial cancer care.


METHODS
This study analyzed cross-sectional data from the National Health Interview Survey (NHIS), years 2005 and 2010, for adults (≥18yrs) in the United States (n=58,585) categorized as having: 1) no chronic disease; 2) chronic disease other than cancer; 3) cancer without co-morbid chronic disease; 4) cancer with co-morbid chronic disease. In these four groups we compared psychological distress, MH visits, and unmet need for MH services. Survey-weighted logistic regression was used to model the dependent variables as functions of disease status, socio-demographic variables and self-reported health status. Estimates are generalizable to the US civilian non-institutionalized population.


RESULTS
Compared to the group with no chronic disease, the cancer with co-morbid chronic disease group had the highest odds of psychological distress (OR 2.78; 95% CI: 2.18, 3.54) and MH visits (OR 1.7; 95% CI: 1.42, 2.05), with no change from 2005 to 2010. The other two groups (cancer without co-morbid chronic disease and chronic disease other than cancer) also had statistically significantly higher odds of both outcomes compared to those with no chronic disease. Among individuals with cancer, estimates of unmet need for MH services were significantly lower in 2010 (OR 1.53; 95% CI: 1.03, 1.88) compared to 2005 (OR 2.89; 95% CI: 2.09, 3.99).


CONCLUSIONS
Individuals with cancer have disproportionate MH needs. We find evidence of MH care quality improvement among individuals with cancer between 2005 and 2010, a time period that coincides with continued policy and clinical attention to psychosocial needs in this population. These efforts appear to have reduced, but not eliminated, unmet need for MH services for individuals with cancer.