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Psychological stress in young cancer survivors associated with higher medical costs

Reuters Health - 11/01/2022 -Psychological distress among adolescent and young adult (AYA) cancer survivors may lead them to seek more care, which may burden them with medical expenses, a U.S. study suggests.

An analysis of data from more than 1,700 AYA cancer survivors and almost three times as many matched controls with no history of cancer revealed that psychological distress was nearly twice as common among those who had been diagnosed with cancer between the ages of 15 and 39, researchers report in Cancer.

"We hope to inform survivorship care plans and guidelines to address the long-term psychological needs of AYA cancer survivors," said Dr. Ola Abdelhadi of the University of California, Berkeley, School of Public Health.

"Our findings highlight the importance of including psychological surveillance and treatment in survivorship care plans of AYA cancer survivors," she told Reuters Health by email. "Specifically, the American Society of Clinical Oncology recommends that survivorship care plans acknowledge that survivors often face emotional or mental health issues, provide a list of local and national resources developed at individual sites and advise those experiencing any of these issues to address them with their oncology or primary care provider."

To take a closer look at the psychological and financial burdens faced by AYA survivors, Dr. Abdelhadi and her colleagues turned to the household component of the 2011-2016 Medical Expenditure Panel Survey (MEPS), which collected data from a nationally representative sample of non-institutionalized U.S. citizens.

The researchers focused on survivors who were diagnosed with cancer between the ages of 15 and 39. Psychological distress was reported among 11.5% of the AYA cancer survivors, significantly more than in the 5.8% in the control group (adjusted odds ratio, 1.78).

The psychological distress in AYA survivors, which did not differ by time from diagnosis or the type of malignancy, did not diminish much over the long term, with 11.2% still reporting distress 20 or more years after diagnosis.

On multivariable analysis, the researchers found that AYA cancer survivors with psychological distress were significantly more likely than those without psychological distress to have public health insurance, to exercise less regularly, to smoke, to have chronic conditions and to be unmarried.

Annual medical expenditures among AYA cancer survivors without psychological distress averaged $5,324; psychological distress was associated with an additional $4,415. Those with psychological distress also had an average of 2.80 additional office visits and received 11.58 additional prescription medications/medication renewals.

"I think this is a really important study for a number of reasons," said Dr. Jean Marie Tersak, director of the cancer-survivorship program at UPMC Children's Hospital of Pittsburgh. "First, while we've known for some time that AYA cancer survivors are at increased risk of psychological distress, this uses a different approach to look at it: hospital expenses and healthcare utilization. This helps define a framework and foundation for future research."

The study also "helps demonstrate that these cancer survivors have unique needs compared to the general population," said Dr. Tersak, who was not involved in the research. "If you're going to develop interventions and services you need to target the different needs of this population."

"Two other things stand out," Dr. Tersak said. "The distress is longstanding. If you look 20 years after cancer treatment they are still having distress, so it doesn't peak and then go back down. Also, the researchers were able to correlate the distress with other health risk behaviors, like increasing smoking and decreasing exercise. These are also opportunities for intervention."

Dr. Kathy Ruble, director of the survivorship program in pediatric oncology at Johns Hopkins Medicine in Baltimore, Maryland, applauded the authors for showing that psychological distress among AYA cancer survivors was long lasting.

"Even as clinicians we sometimes forget that it doesn't go away," she told Reuters Health by phone. "People sometimes forget to screen patients for psychological health."

"One of my last questions at the end of a visit is to ask if patients have any anxiety and so many times this very together person falls apart," said Dr. Ruble, who also was not involved in study. "The distress is there right under the surface. If you don't ask about it, it won't come up."

Many things can contribute to the distress, Dr. Ruble said. Some patients aren't able to live on their own because they can't get a full-time job, she added. "They're seeing their cohort of peers getting full-time jobs and careers and being very independent and they are still having to latch onto their parents for support."

Making matters worse, Dr. Ruble said, is the current shortage of psychiatrists and psychologists. "Sometimes it's nearly impossible or impossible to get the psychological help they need," she added.

SOURCE: https://bit.ly/335y48v Cancer, online January 10, 2022.

By Linda Carroll

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