Cancer

1. Rajeshwari S. Punekar, Ph.D., M.P.H
Scott & White Healthcare
Temple, TX

2.  Cancer diagnosis has negative psychological
impact on cancer survivors and their family
members1,2,3.
 Lower mental health status of cancer
survivors’ spouses 4,5,6,7.
 Few studies examining use of mental health
services and prescribed psychotropic
medicines among cancer survivors’ spouses 8

3.  To describe the utilization patterns of mental
health services and psychotropic medications
among cancer survivors’ spouses.
 To compare use of mental health services and
psychotropic medications between cancer
survivors’ spouses and spouses of non-
cancer individuals.

4. 1999-2008 2001-2009 NHIS-MEPS link files 2001-2009
NHIS MEPS-HC
Spouses- 1,592 Spouses-226

5.  Ambulatory mental health visits =the total
annual number of mental health visits made
to outpatient department, or physician’s
office.
 Use of psychotropic medicines =the total
annual number of psychotropic medication
prescriptions.
 Survey design adjusted Logistic regression
model

6. Characteristics Age 25-64 Age 65+
Cancer Non-cancer Cancer Non-cancer
(N=0.2 (N=2 million) (N=0.3 (N=12
million) million) million)
% % % %
Ambulatory mental health 12 8 10 8
visits a
Psychotropic medicines
Antidepressants 16 13 17 14
Antipsychotics 2 1 4 2
Anxiolytics, hypnotics and 8 5 8 7
sedatives a
CNS stimulants 0 1 1 0
Total a 20 16 23 20
a Spouses of cancer and non-cancer individuals, ages 25-64, are significantly different at p=0.05 level
b Spouses of cancer and non-cancer individuals, 65 and above, are significantly different at p=0.05 level

7. Predictors Ambulatory mental health Prescribed psychotropic
visits medicines
25-64 65+ 25-64 65+
OR OR OR OR
Cancer survivor 1.49* 1.21 1.16 1.03
Time since diagnosed with
cancer (TSD)
TSD is less than 1 year 1.97* 0.49 2.25 0.29
TSD between 1 year and 5 1.22 0.55 1.56 0.56
years
TSD between 6 years and 1.81 1.25 1.13 0.80
10 years
TSD between 11 years and 1.64 1.16 1.67 1.18
20 years
Cancer sites
Breast cancer 1.58 0.52 1.85 1.02
Gynecological cancer 2.49 1.04 2.00 0.52
Lung cancer 0.67 0.64 0.24 0.81
Prostate cancer 0.81 0.56 0.79 0.80
Other cancer 0.51 0.76 0.44 1.27
Colorectal cancer survivors who have been diagnosed with cancer for more than 21 years is the
reference group.
* significantly different at p=0.05 level

8.  Higher percentage of younger age cancer
survivors’ spouses use ambulatory mental
health services and psychotropic medicines
 Cancer diagnosis within a year is a significant
predictor of ambulatory mental health
services utilization.
 Cancer diagnosis and cancer-related factors
are not significant predictors for using
prescribed psychotropic medicines.

9.  No information about the stage of cancer
and the type of treatment.
 No information about the mental health
status of cancer survivors and their spouses
prior to cancer diagnosis
 Smaller sample sizes for patients with less
prevalent cancer sites such as brain and
bone cancers
 Use of psychotherapeutic medications and
mental health visits is self-reported

10.  Identify mental health issues in cancer
survivors’ spouses and refer them to
appropriate psycho-oncology therapy.
 Cancer survivors’ spouses should be made
aware of psychological challenges involved
with cancer diagnosis.
 Encourage cancer survivors’ spouses to
pursue pharmacotherapy to overcome their
mental health issues.

11. Future studies:
 Use of mental health services and prescribed
psychotropic medicines among VA cancer
patients
 Cancer patients and provider communications
about mental health issues and barriers to
access mental health services

13. 1. Badger, T., Braden, C., Mishel, M., & Longman, A. (2004). Depression burden,
psychological adjustment, and quality of life in women with breast cancer: Patterns
over time. Research in Nursing & Health, 27(1), 19-28.
2. Ben, E., & Valerie, C. (2004). The psychological impact of a cancer diagnosis on
families: The influence of family functioning and patients' illness characteristics on
depression and anxiety. Psycho-Oncology, 13(8), 562-576.
3. Ferrario, S., Zotti, A., Massara, G., & Nuvolone, G. (2003). A comparative assessment of
psychological and psychosocial characteristics of cancer patients and their caregivers.
Psycho-Oncology, 12(1), 1-7.
4. Ganz, P. A. (2002). Adult Cancer Survivors: Understanding Late Effects Of Cancer And
Its Treatment: National Cancer Policy Board.
5. Edwards, B., & Clarke, V. (2004). The psychological impact of a cancer diagnosis on
families: The influence of family functioning and patients' illness characteristics on
depression and anxiety. Psycho-Oncology, 13(8), 562-576.
6. Ezer, H. (2003). Predictors of adaptation in wives during the initial psychosocial phase
of prostate cancer. Unpublished Ph.D., Universite de Montreal (Canada), Canada.
7. Wagner, C., Bigatti, S., & Storniolo, A. (2006). Quality of life of husbands of women
with breast cancer. Psycho-Oncology, 15(2), 109-120.
8. Vanderwerker, L., Laff, R., Kadan-Lottick, N., McColl, S., & Prigerson, H. (2005).
Psychiatric disorders and mental health service use among caregivers of advanced
cancer patients. J Clin Oncol, 23, 6899-6907.