Mental health services underutilized by cancer patients

November 14, 2005

The prevalence of major psychiatric disorders is as common in cancer patients as they are in the general population, with the exception of panic disorder which had elevated rates compared to the general population (5 percent versus 1.7 percent, respectively). However, fewer than half of advanced cancer patients with major psychiatric complaints receive care from a mental health provider, according to a study published in the December 15, 2005 issue of CANCER (, a peer-reviewed journal of the American Cancer Society. The study, one of the first to relate prevalence and use of mental health services and terminal cancer patients, suggests that Caucasian patients and patients who discuss their psychiatric complaints are more likely to receive care.

Cancer patients have several factors that contribute to emotional distress. Psychiatric disorders left untreated in terminal cancer patients have been demonstrated to worsen the quality of life in such areas as pain control and physical disability, adversely affect treatment compliance and shorten survival. Data suggest that the prevalence of psychiatric disorders in early stage cancer patients is far less than advanced stage cancer patients. However, the prevalence of psychiatric disease in the latter is poorly understood with estimates varying from 3 to 38 percent. In order to improve the quality of life in advanced cancer patients, researchers set out to understand the extent of the problem of psychiatric disease and how mental health services are being utilized.

First author, Nina S. Kadan-Lottick, M.D., M.S.P.H. of the Yale University School of Medicine and the Yale Cancer Center in New Haven, CT, examined data from the Coping with Cancer (CWC) Study. The CWC is an NIH-funded multi-site longitudinal study of advanced cancer patients and caregivers (MH63892, CA106370; PI: H. Prigerson). Two hundred fifty-one patients with a diagnosis of advanced cancer were interviewed to determine the prevalence of major psychiatric disease, the frequency of discussion of emotional complaints with providers and referral to mental health services, and predictors of use of mental health services.

The authors found that about one in ten (12 percent) of 251 patients with advanced cancer met DSM-IV criteria for a current major psychiatric disorder - a prevalence rate similar to the general population. A little over one in four (28 percent) had received mental health treatment since being diagnosed with cancer, and about one in six (17 percent) had talked with a mental health provider. Conversely, more than half (55 percent) of advanced cancer patients with psychiatric complaints had not accessed mental health services. Factors that predicted use of mental health services included race (Caucasians in particular) and most importantly, patients who had discussed emotional complaints with staff.

"Our study," write the authors, "identified the underutilization of mental health services among advanced cancer patients." They conclude, "Discussion of mental health issues with a health care provider allows distress to be detected and is the most important predictor of whether services will be received."
Article: "Psychiatric Disorders and Mental Health Service Use in Patients with Advanced Cancer: A Report from the Coping with Cancer Study," Nina S. Kadan-Lottick, Lauren C. Vanderwerker, Susan D. Block, Baohui Zhang, Holly G. Prigerson, CANCER; Published Online: November 14, 2005 (DOI: 10.1002/cncr.21532); Print Issue Date: December 15, 2005.


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