Research published by Niazi et al in JNCCN—Journal of the National Comprehensive Cancer Network indicates a need to increase mental health and chemical dependency support capabilities at cancer centers across the United States. Previous studies have determined that people diagnosed with cancer within the past decade seem to have a higher prevalence of substance use disorders than those with no recent cancer diagnosis.

Analysis Results

Researchers from the Mayo Clinic used the American Hospital Association, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to analyze the psychosocial support being offered by more than 1,000 cancer centers across the United States. They found that most centers offered mental health services (85.4%), but less than half offered chemical dependency services (45.5%); even fewer offered both (44.1%).

Factors associated with increased adjusted odds of offering mental health services were teaching status, being a member of a hospital system, and having more beds. Higher population estimate, higher percentage of uninsured patients, and higher Mental Health Professional Shortage Area level in the health services area were associated with decreased odds of offering mental health services.

Government-run and nonprofit centers had increased odds of offering chemical dependency services compared with for-profit centers. Those that were members of hospital systems and had more beds also had increased odds of offering these services. A higher percentage of uninsured patients in the health services area was associated with decreased odds of offering chemical dependency services.

“[Patients with cancer] commonly experience mental health and chemical dependency issues. If clinicians and patients do not identify and treat these conditions, they can lead to poorer quality of life, increased complications, additional caregiver burden, and even reduced survival. The resulting increase in resource utilization can also lead to increased out-of-pocket expenses and costs to payers,” said lead researcher Shehzad K. Niazi, MD, FRCPC, a psychiatrist at the Mayo Clinic in Florida.

Dr. Niazi continued: “As one possible solution, cancer center clinicians could establish formal referral relations with community partners where available. The recent dramatic uptake in telehealth may provide new opportunities for providing these services to more patients as well.”

According to the findings, centers located in more diverse areas were less likely to offer mental health and chemical dependency services.

Additional Commentary

"When you think about the context of a person’s life, there are going to be factors that help and those that hinder how they go through cancer treatment. It is critical to screen, assess, and intervene for factors beyond the treatment-related side effects for patients in active treatment and in survivorship, as detailed in the NCCN Guidelines^® for Distress Management,” commented Cheyenne Corbett, PhD, of the Supportive Care & Survivorship Center, Center for Onco-Primary Care, Duke Cancer Institute, who was not involved in this research. “While there is now a recognition that this care is critical, and there are accreditation standards to ensure psychosocial screening and intervention, there are still many barriers to providing mental health and chemical dependency care for patients facing the impact of cancer on their lives.”

Dr. Corbett—a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) Panel for Distress Management—continued: “The investigators have described the need for psychosocial services at cancer centers across the country and shone a light on the differences in their availability. It is our duty to address these differences with innovative and collaborative approaches within and beyond the walls of our individual cancer centers."

Disclosure: For full disclosures of the study authors, visit jnccn.org.