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Attention to emotional stress essential during cancer treatment, survivorship
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Nearly one in five U.S. cancer survivors take medications for anxiety or depression, according to study results published in the Journal of Clinical Oncology.
Some survivors reported using these agents a decade or more after their diagnosis.
“Although our estimates provide benchmarks for the rates of psychotropic medication use in survivors, they can also inform future research seeking to assess the connections among cancer, medication use and mental health,” Nikki A. Hawkins, PhD, behavioral scientist at CDC’s National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote. “Efforts to improve the psychosocial care of cancer survivors will be aided by continued tracking of the treatment received for mental health.
“Good medical care requires systematic evaluation, screening for new problems and adjusting the prescribed therapies as needed,” the researchers added. “Survivors’ mental health deserves the same detailed, evidence-based and ongoing attention.”
Hawkins and colleagues pooled data from the National Health Interview Survey on cancer survivors (n=3,184) and adults with no history of cancer (n=44,997). Study participants completed the Sample Adult Core Questionnaire and the Adult Functioning and Disability Supplement during 2010 and 2013.
Cancer survivors appeared significantly more likely than adults with no cancer history to report taking medication for anxiety (16.8% vs. 8.6%; P < .001), depression (14.1% vs. 7.8%; P < .001), and either or both conditions combined (19.1% vs. 10.4%; P < .001).
Nearly 2.5 million U.S. cancer survivors reported use of anxiety or depression medications during this time, according to researchers.
HemOnc Today spoke with Hawkins about the findings, the impact they may have on survivorship care, and the interventions she and her colleagues suggest to reduce the likelihood that cancer survivors will need these types of prescribed therapies.
Question: How did this study come about?
Answer: Although many people recover and even thrive after cancer, it is common for cancer survivors to have long-lasting physical and emotional burdens. Antidepressant use in the United States has been on the rise the past several decades and often is considered a barometer of emotional distress among the public. We wanted to find out if these rates were higher among cancer survivors and reasoned that, if they were, it would be an indication of the lingering emotional burden among cancer survivors.
Q: What did the findings suggest?
A: Nineteen percent of cancer survivors reported taking medication for anxiety, depression or both — nearly double the rate of use among adults with no history of cancer (10%). This elevated rate of medication use did not decrease with time. Survivors who were only 1 year past diagnosis showed the same elevated rates of medication use as survivors who were 10 years out from diagnosis.
Q: Did the results surprise you?
A: I was surprised by both findings. First, it was surprising that there was such a big difference between the groups, and that no one had reported or talked about this in the scientific literature. Second, it was surprising that long-term cancer survivors do not seem to get back to normal rates of medication use, even after many years have passed since their diagnosis.
Q: What impact do you think these findings will have on survivorship care?
A: Ideally, these findings would affect several aspects of survivorship care. First, I would hope they reinforce the importance of screening for distress and offering psychosocial care alongside medical care for cancer survivors. Second, because we know that even long-term survivors may be dealing with elevated emotional distress levels, screening tools or discussions about mental health could be revisited over time as a key part of long-term, follow-up survivorship care. Third, we do not know that much about the long-term effects of taking antidepressants and anxiolytics during and after cancer treatment. Now that we know nearly one-fifth of cancer survivors are taking these drugs, it is important that we do more research on the long-term benefits and potential interactions or side effects of using these medications after cancer.
Q: How should front-line clinicians approach this subject with their patients?
A: Routine emotional distress screening for patients with cancer is quickly becoming a standard of care in the United States. Therefore, at a minimum, clinicians should be asking about distress, making sure patients know it is common to seek care for their mental health after a cancer diagnosis and providing suggestions for treatment or support. There are many sources of help available, such as pharmacologic treatments, counseling, psychotherapy, support groups and other services. Clinicians should be familiar enough with the options to help patients develop a plan for care.
Q: What interventions should clinicians consider now to try to reduce the likelihood that their patients will need to use antidepressants during the survivorship phase?
A: A certain level of distress can be an inevitable reaction to a cancer diagnosis and cancer treatments, but clinicians should be aware that the distress itself is treatable. Research suggests that screening for and addressing distress can lead to improved quality of life and better health outcomes for patients with cancer. Ideally, clinicians should begin discussions about mental and emotional well-being along with discussions about cancer treatments so patients can get the support they need early in their cancer care. It is never too late to initiate these discussions. Attention to emotional distress can be beneficial at any stage of cancer treatment or survivorship care. – by Jennifer Southall
Reference:
Hawkins NA, et al. J Clin Oncol. 2016;doi:10.1200/JCO.2016.67.7690.
For more information:
Nikki A. Hawkins, PhD, can be reached at Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F75, Atlanta, GA 30341;email: nhawkins@cdc.gov.
Disclosure: Hawkins reports no relevant financial disclosures.