Most Survivors Not Discussing Psychosocial Needs With Providers

Laura P. Forsythe, PhD, MPH

Less than one-third of all survivors of adult cancers in the United States had discussions with their healthcare providers about their psychosocial care needs, according to a new study published in the Journal of Clinical Oncology.¹

This population-based study of 1777 survivors participating in the 2010 National Health Interview Survey (NHIS) was conducted by researchers at the National Cancer Institute, the Patient-Centered Outcomes Research Institute (PCORI), the Centers for Disease Control and Prevention (CDC), and Wake Forest University School of Medicine.

The study examined the level of psychosocial care being provided in clinical practice, following on the 2008 Institute of Medicine (IOM) report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. In this report, the IOM called for better identification of patients’ psychosocial needs, more effective provider—patient communication concerning those needs, and the implementation of coordinated care plans to link psychosocial services to patients who need them.

The NHIS was an in-person, national survey conducted by the National Center for Health Statistics and the CDC. Trained census workers conducted the computer-assisted personal interviews. Most of the survivors interviewed (61.2%) were aged ≥50 years; breast cancer (20.1%), prostate cancer (15.5%), and melanoma (10.1%) were the most prevalent cancers experienced by those responding to the survey.

Overall, 55.1% of the respondents said that they did not discuss their psychosocial care needs with a healthcare provider, nor did they use professional counseling or support groups (PCSG); 31.4% reported having only a provider discussion, 4.4% reported accessing only PCSG, and 8.9% reported having both a provider discussion and PCSG. From their finding that only 40.2% of survivors had a provider discussion with or without PCSG, the researchers extrapolated that approximately 7.5 million cancer survivors in the US did not discuss their psychosocial functioning with a healthcare provider.

Despite these findings, the researchers reported that the majority of survivors interviewed (74.9%) expressed satisfaction with how their psychosocial needs were met; those who had provider discussion, PCSG, or both, however, were more likely to be “very satisfied,” than those who did not engage in such discussions or support services.

Within the more prevalent cancer site subgroups participating in the survey, breast cancer survivors were more likely to report both a discussion of their psychosocial needs with a provider and PCSG use. About one survivor in six who did not access a PCSG indicated that they were not aware of such services, or they did not have access to them. Notably, unmarried survivors, who often are more in need of psychosocial support, were less likely to report provider discussions.

A possible limitation of the study, the researchers noted, is that recall bias in self-reported data may result in respondents underreporting their engagement in a PCSG or having had provider discussions.

Laura P. Forsythe, PhD, MPH, a program officer at PCORI, and colleagues noted that to the best of their knowledge, this study is the first “to provide population-based data regarding healthcare provider discussions with survivors about psychosocial concerns after cancer.” Given the projected increase in the number of cancer survivors, as well as the enhanced attention on survivorship care in the oncology community, the researchers suggest that these data can be used as a benchmark for measuring the success of future efforts to improve access to psychosocial care among cancer survivors.

In an accompanying editorial,² William F. Pirl, MD, director of the Center for Psychiatric Oncology and Behavioral Sciences at Massachusetts General Hospital in Boston, and colleagues wrote, “Taken together, these findings provide the most compelling evidence to date that heightened psychological distress in many patients with cancer is still unrecognized and untreated.

“If we are proactive, we can use these data to create successful systems in which all cancer survivors will have some discussion with their providers about psychosocial care, whether or not they choose to use psychosocial services.”

1. Forsythe LP, Kent EE, Weaver KE, et al. Receipt of psychosocial care among cancer survivors in the United States. J Clin Oncol. 2013;31(16):1961-1969.
2. Pirl WF, Jacobsen PB, Deshields TL. Opportunities for improving psychosocial care for cancer survivors. J Clin Oncol. 2013;31(16):1920-1921.