Mental Health Linked to Emotional and Physical Distress in Older Patients With Metastatic Cancer

Older patients with metastatic cancer face psychosocial concerns that may increase their risk for anxiety and depression, findings from a recent study demonstrated.

Some predictors of the risk for anxiety or depression in patients 65 years and older with metastatic cancer included symptom burden and impact; concerns about body image and healthy lifestyle; intimacy and relationships; and communication with the health care team, as demonstrated by the results of a study presented at the 2023 Annual American Psychosocial Oncology Society (APOS) Conference.

“Anxiety and depression can be difficult to identify in older cancer patients using traditional screening measures that ask patients only about feelings of fear and sadness,” Melissa F. Miller, senior director of research at Cancer Support Community, said in an interview with CURE®. “Our findings suggest there are additional complex physical, psychological and social impacts of cancer in older adults that may also help us identify patients at risk for mental health problems. Routinely screening for key concerns during cancer care appointments to identify specific issues and connect patients to needed support has the potential to prevent acute mental health crises in older adults with metastatic disease.”

Risk for Depression, Anxiety

Miller and colleagues analyzed data from 314 older adults (mean age, 72 years; 61% women) living with metastatic cancer from the Cancer Experience Registry, which is conducted through Cancer Support Community.

“The Cancer Experience Registry is a research study designed to understand the broad impact of cancer including the emotional, physical, practical and financial impact,” Miller said. “The study is open to anyone diagnosed with cancer, and any family or friend who's provided care to someone with cancer. It’s an open-enrolling study, and cancer patients, survivors and caregivers are invited to join.”

Findings from the Cancer Experience Registry found that 43% of older adults with metastatic cancer reported depression or anxiety that were at levels suggestive of clinical risk.

Of the older adults with metastatic cancer in this study, 43% reported depression or anxiety at levels suggestive of clinical risk; 23% were at risk for both anxiety and depression and 14% of patients were flagged for being at risk for anxiety only.

“That’s an important finding,” Miller said. “We see anxiety and depression often co-occur, but there was also a substantial proportion of older adults with cancer flagged at risk for anxiety only. Recommendations to routinely screen for depression, but not anxiety, in older adults may miss a large proportion in this population who need support for mental wellness.”

Access to Care

Even though the data demonstrate that many older patients with metastatic cancer are at risk for anxiety and depression, patients unfortunately are not accessing the supportive care they need.

Miller and colleagues presented another poster at APOS on barriers to accessing care for emotional and mental health concerns in patients with cancer. The study included 658 adult patients, of whom 39% were older adults (aged 65 years and older) with cancer.

The findings demonstrated that the biggest barrier to seeking mental health care was on a systems level, including the inability to obtain timely appointments or being able to schedule appointments when needed, financial costs and the knowledge of where to seek care. Other barriers that patients reported included the patient thinking the problem would go away on its own.

Miller said that she hopes health care providers are asking about emotional and mental health concerns and providing a space where patients feel comfortable with their cancer care team discussing these concerns, but if providers aren’t, patients need to know they can speak up.

“Sharing their concerns with their cancer care team (doctor, nurse, social worker) is a good start,” she said. “Discussing available resources, treatments for feeling anxious or depressed (medications, counseling, support groups), and seeking referrals to mental health professionals should be part of the conversation. Mental health professionals may be available where cancer treatment is received, or cancer patients, survivors and caregivers can seek support from advocacy organizations which offer free or low-cost in person or virtual patient services.”

Although patients should feel at ease when speaking about these concerns, Miller said the responsibility should also be on the health care team.

“We don’t want to put the onus on patients, however; we want our system to be doing the job,” she said. “The cancer care community has an opportunity to join forces to more holistically support the mental health needs of cancer patients.”

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