Elevated Mental Health Problems Observed Among Cancer Survivors

A population-based study published in Cancer found an elevated presence of mental health problems among adult cancer survivors compared to the general population.

This study emphasizes the importance of developing strategies to ensure the early detection of mental illness and to improve access to mental health treatment for cancer survivors.

“These findings provide implications for future programs and policies aimed at effectively preventing and detecting mental illness and reducing unmet [mental health] treatment needs for this vulnerable population,” the authors wrote.

Using the 2015 to 2017 National Survey on Drug Use and Health (NSDUH), researchers identified respondents aged 18 to 64 years and compared mental health outcomes between those with a history of cancer and those without a history of cancer. Outcomes included past-year major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness.

In total, investigators compared 2656 cancer survivors and 112,952 individuals without cancer. Across each age group, survivors were found to have an elevated prevalence of mental health problems in 5 of the 7 outcome measures.

Among young adults in particular (aged 18-34 years), survivors were more likely to experience major depressive episodes (18.1% vs 9.6%), serious psychological distress (34.2% vs 17.9%), suicidal thoughts (10.5% vs 7.0%), any mental illness (41.1% vs 23.3%), and serious mental illness (13.2% vs 5.9%) in the past year (P < 0.05), compared to their counterparts with no history of cancer. These observed differences also persisted in adjusted analyses (P < 0.01).

Similar survivor-comparison differences were seen among the older age groups, but to a lesser degree. Of the total survivor cohort though, young adult survivors had the greatest likelihood of experiencing mental health problems across all outcome measures (P < 0.05).

“Cancer and its treatments can have detrimental effects on physical health and functioning,” the authors wrote. “The costly care and long-term follow-up care needed, along with limited access to health insurance through employment due to a cancer history, may impose substantial financial burdens. Adjustments to these health and financial changes may trigger [mental health] problems.”

In particular, researchers suggested that these adjustments can be especially devastating for younger survivors, who may not earn as much or who may also develop concerns about infertility, body image changes, disruptions to peer and romantic relationships, and a forfeited future as a result of cancer and its long-term effects. Furthermore, the investigators suggested that more research is necessary to explore these unmeasured mechanisms.

While receipt of a timely diagnosis and treatment may alleviate mental health symptoms and improve quality of life early on for cancer survivors, strategies to ensure the early detection and treatment of mental health in this vulnerable patient population is crucial. One possible strategy to improve mental health according to the researchers could be to integrate routine psychological screening into cancer survivor clinics.

“Integrating behavioral health and medical care into cancer survivorship clinics may benefit survivors by providing multidisciplinary treatment for better disease management,” the authors wrote. “Moreover, because many long-term survivors may not seek care from oncologists or at least not as often as they did during active treatments, [mental health] screening and counseling could also be built into primary care settings or school clinics for some young adult survivors.”

Though the NSDUH data did not provide some necessary information, including the age of the survivors at the time of their cancer diagnosis, this study still raises important questions regarding the increased risks for developing mental health problems among nonelderly adult cancer survivors.

“Future research should determine how the time since a cancer diagnosis and cancer therapy might affect [mental health] outcomes among nonelderly adult survivors to target high-risk survivor populations for [mental health] screening and treatment,” the authors wrote.

Reference:

Ji X, Cummings JR, Marchak JG, Han X, Mertens AC. Mental Health Among Nonelderly Adult Cancer Survivors: A National Estimate. Cancer. doi:10.1002/cncr.32988.