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

doi:10.1002/cncr.35348

. 2024 Sep 1;130(17):3011-3022.

doi: 10.1002/cncr.35348. Epub 2024 Apr 27.

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

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
PMCID: PMC11309887 (available on 2025-09-01)
DOI: 10.1002/cncr.35348

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

Eunju Choi et al. Cancer. 2024.

. 2024 Sep 1;130(17):3011-3022.

doi: 10.1002/cncr.35348. Epub 2024 Apr 27.

Authors

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
PMCID: PMC11309887 (available on 2025-09-01)
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.

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Conflict of interest statement

Conflict of Interest: ACB reports consulting for Your Local Epidemiologist.

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References

1. NIH: National Cancer Institute. Adolescents and Young Adults with Cancer. Accessed September 27, 2023, https://www.cancer.gov/types/aya
1. Kaul S, Avila JC, Mutambudzi M, Russell H, Kirchhoff AC, Schwartz CL. Mental Distress and Health Care Use Among Survivors of Adolescent and Young Adult Cancer: A Cross-Sectional Analysis of the National Health Interview Survey. Article. Cancer. Mar 2017;123(5):869–878. doi:10.1002/cncr.30417 - DOI - PubMed
1. Phillips-Salimi CR, Andrykowski MA. Physical and mental health status of female adolescent/young adult survivors of breast and gynecological cancer: a national, population-based, case-control study. Support Care Cancer. Jun 2013;21(6):1597–604. doi:10.1007/s00520-012-1701-7 - DOI - PMC - PubMed
1. Chao C, Bhatia S, Xu L, et al. Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer. J Clin Oncol. Sep 20 2020;38(27):3161–3174. doi:10.1200/JCO.20.00722 - DOI - PMC - PubMed
1. Berkman AM, Mittal N, Roth ME. Adolescent and young adult cancers: unmet needs and closing the gaps. Curr Opin Pediatr. Feb 1 2023;35(1):84–90. doi:10.1097/MOP.0000000000001200 - DOI - PubMed

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[1] NIH: National Cancer Institute. Adolescents and Young Adults with Cancer. Accessed September 27, 2023, https://www.cancer.gov/types/aya

[2] NIH: National Cancer Institute. Adolescents and Young Adults with Cancer. Accessed September 27, 2023, https://www.cancer.gov/types/aya

[3] Kaul S, Avila JC, Mutambudzi M, Russell H, Kirchhoff AC, Schwartz CL. Mental Distress and Health Care Use Among Survivors of Adolescent and Young Adult Cancer: A Cross-Sectional Analysis of the National Health Interview Survey. Article. Cancer. Mar 2017;123(5):869–878. doi:10.1002/cncr.30417 - DOI - PubMed

[4] Kaul S, Avila JC, Mutambudzi M, Russell H, Kirchhoff AC, Schwartz CL. Mental Distress and Health Care Use Among Survivors of Adolescent and Young Adult Cancer: A Cross-Sectional Analysis of the National Health Interview Survey. Article. Cancer. Mar 2017;123(5):869–878. doi:10.1002/cncr.30417 - DOI - PubMed

[5] Phillips-Salimi CR, Andrykowski MA. Physical and mental health status of female adolescent/young adult survivors of breast and gynecological cancer: a national, population-based, case-control study. Support Care Cancer. Jun 2013;21(6):1597–604. doi:10.1007/s00520-012-1701-7 - DOI - PMC - PubMed

[6] Phillips-Salimi CR, Andrykowski MA. Physical and mental health status of female adolescent/young adult survivors of breast and gynecological cancer: a national, population-based, case-control study. Support Care Cancer. Jun 2013;21(6):1597–604. doi:10.1007/s00520-012-1701-7 - DOI - PMC - PubMed

[7] Chao C, Bhatia S, Xu L, et al. Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer. J Clin Oncol. Sep 20 2020;38(27):3161–3174. doi:10.1200/JCO.20.00722 - DOI - PMC - PubMed

[8] Chao C, Bhatia S, Xu L, et al. Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer. J Clin Oncol. Sep 20 2020;38(27):3161–3174. doi:10.1200/JCO.20.00722 - DOI - PMC - PubMed

[9] Berkman AM, Mittal N, Roth ME. Adolescent and young adult cancers: unmet needs and closing the gaps. Curr Opin Pediatr. Feb 1 2023;35(1):84–90. doi:10.1097/MOP.0000000000001200 - DOI - PubMed

[10] Berkman AM, Mittal N, Roth ME. Adolescent and young adult cancers: unmet needs and closing the gaps. Curr Opin Pediatr. Feb 1 2023;35(1):84–90. doi:10.1097/MOP.0000000000001200 - DOI - PubMed

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

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

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