Psychological distress and mental health care utilization among Black survivors of adolescent and young adult cancer

Eunju Choi; Amy M Berkman; Aryce Battle; Andrea C Betts; John M Salsman; Joel Milam; Clark R Andersen; Kimberly A Miller; Susan K Peterson; Qian Lu; Christabel K Cheung; J A Livingston; Michelle A T Hildebrandt; Susan K Parsons; David R Freyer; Michael E Roth

doi:10.1002/cncr.35348

Psychological distress and mental health care utilization among Black survivors of adolescent and young adult cancer

Cancer. 2024 Apr 27. doi: 10.1002/cncr.35348. Online ahead of print.

Authors

Eunju Choi¹, Amy M Berkman², Aryce Battle³, Andrea C Betts⁴, John M Salsman⁵, Joel Milam⁶, Clark R Andersen⁷, Kimberly A Miller⁸, Susan K Peterson⁹, Qian Lu¹⁰, Christabel K Cheung¹¹, J A Livingston¹², Michelle A T Hildebrandt¹³, Susan K Parsons¹⁴, David R Freyer¹⁵, Michael E Roth¹⁶

Affiliations

¹ Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
² Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
³ McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA.
⁴ Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁵ Department of Social Sciences and Health Policy, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁶ Department of Epidemiology and Biostatistics, University of California, Irvine, California, USA.
⁷ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁸ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁹ Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁰ Division of Cancer Prevention and Population Sciences, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Institute, Houston, Texas, USA.
¹¹ University of Maryland School of Social Work, Baltimore, Maryland, USA.
¹² Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹³ Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁴ Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
¹⁵ Departments of Pediatrics, Medicine, and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹⁶ Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

PMID: 38676935
DOI: 10.1002/cncr.35348

Abstract

Background: Survivors of adolescent and young adult (AYA) cancer experience significant psychological distress and encounter barriers to accessing mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes among AYA survivors, and none have compared outcomes within a racially minoritized population.

Methods: National Health Interview Survey data (2010-2018) were analyzed that identified non-Hispanic Black (hereafter, Black) survivors of AYA cancer and age- and sex-matched Black noncancer controls. Sociodemographic factors, chronic health conditions, modifiable behaviors (smoking and alcohol use), and psychological outcomes were assessed with χ² tests. Logistic regression models, adjusted for survey weights, were used to evaluate the odds of psychological distress by cancer status after adjusting for covariates. Interactions between variables and cancer status were investigated.

Results: The study included 334 Black survivors of AYA cancer and 3340 Black controls. Compared to controls, survivors were more likely to report moderate/severe distress (odds ratio [OR], 1.64; p < .001), use mental health care (OR, 1.53; p = .027), report an inability to afford mental health care (OR, 3.82; p < .001), and use medication for anxiety and/or depression (OR, 2.16; p = .001). Forty-one percent of survivors reported moderate/severe distress, and only 15% used mental health care. Among survivors, ages 18-39 years (vs. 40-64 years) and current smoking (vs. never smoking) were associated with the presence of moderate/severe distress. Among survivors with distress, high poverty status was associated with reduced utilization of mental health care.

Conclusions: A cancer diagnosis for a Black AYA is associated with greater psychological distress within an already vulnerable population.

Keywords: Black; adolescent and young adult (AYA); cancer survivors; disparities; mental health care; psychological distress.

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States