Cancer Survivors' Experiences of Navigating the Australian Health Care System for Physical and Mental Health Care Needs

Mental healthcare utilisation among individuals with colorectal cancer: population-based cohort studies

Objective

Individuals with colorectal cancer (CRC) have an increased risk of mental disorders, yet mental healthcare utilisation has not been adequately examined. We evaluated mental healthcare utilisation and receipt of minimally adequate treatments for anxiety and/or depression among individuals with and without CRC.

Methods and analysis

We used administrative health databases from British Columbia, Canada, comprised of individuals with CRC and individuals without CRC, matched (1:1 ratio) on age, sex and incident mental disorder(s) (ie, occurring after CRC diagnosis/matched date). Primary outcomes were minimally adequate antidepressant pharmacotherapy (≥84 days' supply) and psychological (≥4 services) treatment.

Results

Among individuals with CRC, 1462 had incident anxiety (mean age 64.6±12.5 years, 59.2% females), 4640 had incident depression (mean age 66.3±12.3 years, 51.2% females). Approximately one in four individuals with CRC were diagnosed with anxiety (23.4%) and/or depression (23.2%) in the first year after CRC diagnosis. Minimally adequate antidepressant pharmacotherapy (36.2%) and psychological treatment (15.9%) for anxiety were significantly lower in CRC patients than in those without CRC (pharmacotherapy adjusted OR (aOR) 0.74; 95% CI 0.61, 0.88; psychological treatment aOR 0.74; 95% CI 0.58, 0.95). Similar findings were observed for depression (pharmacotherapy aOR 0.81; 95% CI 0.74, 0.90). Among individuals with CRC, mental healthcare utilisation persisted up to 10 years post-mental disorder diagnosis.

Conclusions

Individuals with CRC receive less mental health treatment for anxiety and/or depression, compared with those without CRC. Findings raise awareness for the need for ongoing mental healthcare throughout and beyond CRC.

Dietitians' practices and perspectives of the delivery of nutritional care to cancer survivors in the primary care setting

PURPOSE

The number of people living longer after a cancer diagnosis is increasing. Guidelines for cancer survivorship recommend a healthy diet and maintaining a healthy weight post-treatment. While cancer survivors often express the need for professional support for nutrition management, few report seeing a dietitian. This study aimed to explore primary care dietitians' experiences, practices, and perspectives in providing nutritional care to cancer survivors in Australia.

METHODS

This qualitative study used in-depth, semi-structured interviews with primary care dietitians working in private practice and community care. Interviews were recorded and transcribed. A qualitative descriptive methodological approach integrated with a working analytical framework was utilized for coding and data analysis.

RESULTS

Twenty-four dietitians working in primary care participated. Four themes and 13 sub-themes were identified: (1) diversity in dietetic practice and cancer-related care interactions; (2) accessing referral pathways and funding sources in a complex healthcare system; (3) the application of nutrition education, and upskilling in cancer care; (4) client barriers and dietitians' challenges and factors influencing confidence in cancer care.

CONCLUSION

Dietitians in this study highlighted the need for clear referral pathways to primary care particularly as a continuation of cancer-related care following the acute setting. There is a need for tailored support for dietitians supporting people diagnosed with cancer in the primary care setting, including opportunities to upskill in cancer care.

Patterns of mental health service utilisation in people with cancer compared with people without cancer: analysis of the Australian National Study of Mental Health and Wellbeing

PURPOSE

To compare the patterns of mental health service utilisation between people with and without cancer.

METHODS

We performed a cross-sectional study using data of all respondents aged ≥ 25 years from the Australian National Study of Mental Health and Wellbeing 2020-2021 conducted during the COVID-19 pandemic. Comparisons were made between the two groups (cancer versus non-cancer) using logistic regression models.

RESULTS

The study comprised 318 people with cancer (55% female) and 4628 people without cancer (54% female). Cancer survivors had a higher prevalence of reporting poor health (38% versus 16%) and mental distress (18% versus 14%) than people without cancer. There were no significant differences between people with and without cancer in the odds of consulting general practitioner, psychiatrist and other health professionals for mental health, although people with cancer were significantly more likely to consult a psychologist than people without cancer (adjusted odds ratio (aOR) = 1.64, 95%CI = 1.05-2.48). While the odds of being hospitalised for physical health was significantly higher in cancer survivors than people without cancer (aOR = 2.32, 95%CI = 1.78-3.01), there was only a negligible number of people reported being hospitalised for mental health between the two groups. Several factors were associated with higher odds of mental health service utilisation including younger age, unpartnered marital status and presence of a current mental condition.

CONCLUSIONS

Alarmingly, despite experiencing higher prevalence of poor health status and mental distress, cancer survivors did not utilise more mental health services than the general population. That is, there is a higher degree of untreated, or undertreated, distress in cancer than in the general population.

IMPLICATIONS FOR CANCER SURVIVORS

Further research to identify optimal approaches of mental health care delivery for cancer survivors are urgently needed.

Temporal trends in medication and service use patterns for mental health issues among men with prostate cancer

OBJECTIVE

Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5 years before and 5 years after prostate cancer diagnosis.

METHODS

Population-based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n = 13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns.

RESULTS

Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5 years before to 40.3% 5 years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2 years following prostate cancer diagnosis.

CONCLUSION

There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.

Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer.

METHODS

Retrospective cross-sectional study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups.

RESULTS

Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19).

CONCLUSIONS

Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.