Mental health service utilization among long-term cancer survivors

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.

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.