With Xu Ji, PHD, of Emory University School of Medicine
By Sarah DiGiulio
Millions of Americans are living today who have survived or been diagnosed with cancer. These individuals represent a sizable portion of the U.S. population, so the specific health needs of these individuals needs to be looked at, says Xu Ji, PhD, Assistant Professor in the Department of Pediatrics at Emory University School of Medicine and a member of the Cancer Prevention and Control Research Program at Winship Cancer Institute.
"It is crucial to conduct research to understand the impact of cancer experience on survivors' long-term health status, including mental health status," Ji told Oncology Times in an interview.
Ji and her colleagues recently published data documenting mental health outcomes across individuals of all age groups in a nationally representative U.S. sample of adult survivors of cancer. Mental health outcomes were significantly worse for people with a history of cancer compared with individuals who had never been diagnosed with cancer across several measures (Cancer 2020; doi.org/10.1002/cncr.32988).
The researchers analyzed data from the 2015-2017 National Survey on Drug Use and Health. Their nationally representative sample included 2,656 individuals who had had cancer and 112,952 individuals who had not; everyone was between ages 18 and 64. Across all age groups, cancer survivors had an elevated prevalence of mental health problems in five of the seven outcome measures.
Among young adults (ages 18-34) in particular, 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, compared to their peers with no history of cancer. These observed differences also persisted in adjusted analyses. Similar survivor-comparison differences were seen among the older age groups, but the differences were substantially smaller, Ji said.
1. What does your research tell us about the mental health of people living with cancer?
"Our data provided the first national estimates of a comprehensive series of mental health outcome measures in the U.S. cancer-survivor population. Although the findings were consistent with our hypothesis, we were still surprised by the magnitude of the observed survivor-comparison differences in adverse mental health outcomes, particularly among young adults.
"Several reasons may explain this finding. Cancer and its treatment can have detrimental effects on physical health and functioning. 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 to survivors. Adjustments to these health and financial changes may trigger mental health problems. These adjustments can be particularly devastating for younger survivors, who may not earn as much or may develop concerns about infertility, body image changes, disruptions to peer and romantic relationships, and a forfeited future due to cancer experience and its long-term effects."
2. In what ways are cancer survivorship care efforts and cancer care overall addressing mental health concerns?
"The elevated presence of mental health problems observed among cancer survivors underscores the importance of developing strategies to ensure early detection, screening, and treatment of mental health in this medically vulnerable population.
"Despite the existing recommendations for providing psychosocial care to cancer survivors, many people with cancer still do not receive adequate mental health care. As indicated in recent studies, adequate detection and management of psychosocial problems, including mental health problems, for cancer survivors continue to be essential unmet needs in the oncology field. To meet these needs, there has been a growing evidence base concerning effective models and approaches for integrating behavioral health care into routine survivorship care.
"Nonetheless, there have been few population-based estimates on mental health screening, behavioral health service use, and unmet mental health needs, as well as their changes over time as efforts are being made, among cancer survivors, particularly younger cancer survivors. These are beyond the scope of the present study, but an area we aim to address in the next steps of this research.
"One possible strategy to improve survivors' mental health 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.
"However, 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 should also be built into primary care settings or school clinics for some young adult survivors. This is an area that merits further investigation."
3. So what is the bottom-line message about these findings?
"This population-based study raises important questions regarding the increased risks for developing mental health problems among non-elderly adult cancer survivors, in comparison with the general population [without a history of cancer]. In comparison to those who had no history of cancer, an elevated presence of mental health problems was observed among adult cancer survivors. A clear age gradient has been seen in the likelihood of developing mental health problems among this vulnerable population, with young adult survivors having the highest likelihood of adverse mental health outcomes.
"This study set a foundation of future research toward fully understanding the mechanisms through which cancer experience affects survivors' mental health status. In addition, future research should explore how the time since a cancer diagnosis and cancer therapies might affect mental health outcomes to target high-risk survivor populations for mental health screening and treatment."