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Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey

From the National Cancer Policy Board, Institute of Medicine, Washington, DC, and Office of Cancer Survivorship, National Cancer Institute, National Institutes of Health, Bethesda, MD.

Address reprint requests to Maria Hewitt, DrPH, National Cancer Policy Board, Institute of Medicine, 500 5th St, NAS 308, Washington, DC 20001; mhewitt{at}nas.edu

PURPOSE: Analyses were conducted to obtain national estimates of mental health service use, unmet need for such services, and the prevalence of mental health problems among individuals reporting a cancer history.

METHODS: Of a nationally representative sample of 95,615 adults in the United States interviewed as part of the 1998, 1999, and 2000 National Health Interview Survey, 4,878 reported a history of cancer (excluding superficial skin cancer). Analyses assessed whether cancer survivors relative to those without a self-reported history of cancer had increased use of mental health services and had increased reports of unmet need for such services. Analyses were also conducted to ascertain demographic and health characteristics associated with service use and unmet need.

RESULTS: Compared with individuals without a cancer history, cancer survivors reported significantly greater contact in the past year with a mental health provider (7.2% v 5.7%). Cancer survivors were more likely to have used mental health services (odds ratio, 1.60 among those without other chronic illnesses and 3.04 among those with other chronic illnesses), and mental health service use was significantly greater among those who were under age 65 and diagnosed at younger ages, were formerly married, or had other comorbid chronic conditions. If all cancer survivors with mental health problems or who needed but could not access mental health services due to cost had received such care, mental health service use would have increased from 7.2% to 11.7%, a 62% increase in use.

CONCLUSION: Cancer seems to be one of several chronic illnesses that precipitates the need for and use of mental health services. Improvements are needed in recognizing mental health problems among cancer survivors and reducing barriers to psychosocial service use.

The analysis, opinions, and assertions contained herein are those of the authors and are not to be construed as reflecting the views or position of the National Academy of Sciences, the Institute of Medicine, or the National Research Council.

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