Older patients with metastatic cancer face psychological stressors that may increase their risk of anxiety and depression, a recent study has found.

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

“It can be difficult to detect anxiety and depression in older cancer patients using traditional screening measures that only ask patients about feelings of fear and sadness,” said Melissa F. Miller, senior director of research at Cancer Support Community, in an interview with CURE®. . “Our findings suggest that cancer has additional complex physical, psychological, and social effects in older adults that may help us identify patients at risk for mental health problems. Timing of cancer care appointments is key to identifying specific problems and connecting patients with needed support. Routine screening for anxiety has the potential to prevent acute mental health crises in older adults with metastatic disease.”

Risk of depression, anxiety

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

“The Cancer Experience Registry is a research study designed to understand the broad impact of cancer, including emotional, physical, practical and financial impacts,” Miller said. “The survey is open to anyone with cancer and family or friends caring for someone with cancer. This is an open-enrollment study, and cancer patients, survivors and caregivers are invited to participate.”

Among older adults with metastatic cancer in this study, 43% reported depression or anxiety at levels indicative of clinical risk; 23% were at risk for both anxiety and depression, and 14% of patients were identified as only at risk for anxiety.

“This is an important finding,” Miller said. “We see that anxiety and depression often co-occur, but a significant proportion of older adults with cancer are at risk only for anxiety. Recommending routine screening for depression, but not anxiety, may miss a large proportion of this population of older adults who need support for emotional well-being. .”

Access to care

Although data show that many elderly patients with metastatic cancer are at risk for anxiety and depression, unfortunately patients are not accessing the supportive care they need.

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

Results showed that the biggest barriers to getting mental health care were at the system level, including inability to get timely appointments or being able to schedule appointments when needed, financial costs, and knowledge of where to seek care. Other barriers reported by patients included patients thinking the problem would go away on its own.

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

“Sharing their concerns with their cancer care team (doctors, nurses, social workers) is a good start,” she said. “Discussing available resources, treatment for feeling anxious or depressed (medication, 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 available, or cancer patients, Survivors and caregivers can seek support from advocacy organizations that provide free or low-cost in-person or virtual patient services.”

While patients should feel comfortable talking about these concerns, Miller said the onus should also be on the healthcare team.

“But we don’t want to put the onus on patients; We want our system to be doing the job,” he 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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