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Undertreated emotional distress in older adults with cancer.

165 Background: Depression and anxiety are common among older adults with cancer, and concern about the adequacy of emotional distress management is increasing. We examined receipt of prescription medication (Rx) by older adults with cancer relative to reported activity limitation associated with emotional distress. Methods: Using the 2007-2012 SEER-Medicare Health Outcomes Survey (MHOS) database with a unique linkage to Part D prescription claims, we selected MHOS participants with Part D coverage who were within 5 years of cancer diagnosis. We used claims to identify use of Rx for emotional distress management: anti-depressants, antipsychotics, anxiolytics, and/or sedatives during the 90 days post survey. Participants reported activity limitations (“accomplished less” or “worked less carefully”) within the past 30 days “due to emotional problems.” Limitations were quantified as severe (most/all of the time), moderate (some/little of the time), or none. We used multivariable logistic regression to determine associations of Rx use with degree of activity limitation, controlling for characteristics of cancer, demographics and health status. Results presented are predicted percentages. Results: Reported activity limitation in the study sample (N = 9,105) was 15% severe, 34% moderate, and 52% none. Rx were used by 28% overall, with higher rates for severe (39%) and moderate (33%) compared to no activity limitation (23%), p < .001. Among respondents not using Rx, 13% [32%] reported severe [moderate] activity limitations. Among respondents using Rx, severe [moderate] activity limitation was reported by 20% [39%]. Rx use was lower for male sex, with increasing age, non-white race, with fewer comorbid conditions and without the Part D low-income subsidy. Conclusions: Undertreatment of emotional distress is highly prevalent among older adults with cancer. Many SEER-MHOS respondents reporting moderate or severe activity limitations due to emotional distress did not receive Rx for symptom management, and of those receiving Rx, many still report moderate to severe symptoms. Treatment disparities identified by race/ethnicity, age and sex suggest the need for enhanced emotional distress screening and interventions to reduce treatment barriers.