Preventive care service use among cancer survivors with serious psychological distress: An analysis of the medical expenditure panel survey data

Abstract

Serious psychological distress (SPD) can adversely impact health and quality of life after cancer. The purpose of this study is to examine the association between SPD and the receipt of preventive care services and cancer screening among survivors and adults without a cancer history. A total of 12,564 cancer survivors and 160,023 adults without a cancer history as comparison group were identified from the population-based Medical Expenditure Panel Survey (2008-2015). SPD was assessed using the 6-item Kessler Psychological Distress Scale. We examined use of preventive care and cancer screening services in cancer survivors and comparison adults with/without SPD. Multivariable logistic regression models were conducted for each outcome: preventive service (i.e. blood pressure, cholesterol, influenza vaccination, routine and dental checkup) or cancer screening (i.e. mammography, Papanicolau test, colorectal cancer screening) adjusting for demographic, comorbidity, usual source of care covariates. Adjusted odds ratios and 95% confidence intervals were calculated. Prevalence of SPD was 9.8% in cancer survivors compared to 4.6% in comparison adults. Survivors with SPD were more frequent utilizers of medical care, reporting 10 or more visits to the doctor's office in the past 12 months (29.3% vs. 14.1% without SPD). Having SPD was associated with lower odds of being up-to-date with preventive service use and cancer screening among age-and gender-eligible individuals. The magnitude of the effect was greater in adults' age ≥65 years. Better coordination of care and patient-physician discussions are likely needed to improve delivery of recommended preventive services for persons with SPD.

Annual Out-of-Pocket Expenditures and Financial Hardship Among Cancer Survivors Aged 18–64 Years — United States, 2011–2016

“…Donatus U. Ekwueme, PhD 1 ; Jingxuan Zhao, MPH 2 ; Sun Hee Rim, PhD 1 ; Janet S. de Moor, PhD 3 ; Zhiyuan Zheng, PhD 2 ; Jaya S. Khushalani, PhD, MBBS 1 ; Xuesong Han, PhD 2 ; Erin E. Kent, PhD 3,4 ; K. Robin Yabroff,PhD 2 In the United States in 2019, an estimated 16.9 million persons are living after receiving a cancer diagnosis (1). These cancer survivors face many challenges, including functional limitations, serious psychological distress (2), and other lasting and late effects of cancer treatments. Because of the high cost of cancer therapy, many cancer survivors are more likely to face substantial out-of-pocket health care expenditures and financial hardship, compared with persons without a history of cancer (3,4).…”

The current status of survivorship care provision at the state level: a Wisconsin-based assessment

“…Survivors of all ages experience challenges accessing mental health care, especially younger cancer survivors and those that are uninsured or have a history of distress [ 29 , 30 ]. Cancer survivors with serious psychological distress are less likely to stay up-to-date with important preventive services, which may negatively impact early identification of subsequent cancers [ 31 ]. Additionally, multiple respondent sites reported using National Comprehensive Cancer Network (NCCN) distress guidelines, which recommend distress screening for patients in all clinical settings [ 32 ].…”

A Qualitative Exploration of Prostate Cancer Survivors Experiencing Psychological Distress: Loss of Self, Function, Connection, and Control

“…Scores ≤19.25 are suggested to indicate poor well-being (Ng, Kristjanson, & Medigovich, 2006). The K6 is a measure that assesses non-specific psychological distress and has been used previously in individuals with cancer (Oba et al, 2017;Rim et al, 2019;Zhao, Li, Li, & Balluz, 2013). A cut-off score of ≥19 indicates severe psychological distress (Prochaska, Sung, Max, Shi, & Ong, 2012).…”