Mental health conditions among cancer survivors and individuals with and without comorbid chronic conditions: a retrospective claims analysis of patients with employee-sponsored insurance, 2012-2017.

PURPOSE: To assess the prevalence of mental health conditions among cancer survivors and enrollees with and without a history of comorbid chronic conditions other than cancer and to identify factors associated with mental health conditions among cancer survivors.

METHODS

Data from 2012 to 2017 IBM® MarketScan® databases identified enrollees aged 18 years or older with a primary cancer diagnosis (cancer survivor cohort [CSC]). Remaining enrollees were matched by age, sex, health insurance plan type, and presence (chronic condition cohort [CCC]) or absence (no chronic condition cohort [NCCC]) of a comorbid chronic condition other than cancer. Bivariate analysis compared the prevalence of four mental health conditions across cohorts, and logistic regression identified factors associated with mental health conditions among CSC enrollees.

RESULTS

Among 2,662,813 enrollees, 46.2% (n = 244,663) of the CSC, 40.4% (n = 690,364) of the CCC, and 26.1% (n = 111,239) of the NCCC had a mental health condition. Among CSC enrollees with any mental health condition, nearly 1 in 4 were survivors of female breast cancer (24.2%), over 1 in 10 were survivors of prostate cancer (13.3%), lymphoma and leukemia (11.4%), or lung cancer (10.5%), and nearly 9 in 10 (88.8%) had one or more comorbid conditions. After adjusting for sociodemographic and cancer-related characteristics, the adjusted odds of any mental health condition ranged from 1.75 (95% CI 1.72-1.78) among CSC enrollees with one comorbid condition to 5.67 (95% CI 5.50-5.86) among CSC enrollees with 4 or more comorbid conditions.

CONCLUSION

Cancer survivors had increased prevalence of mental health conditions compared to matched enrollees with or without comorbid chronic conditions, and comorbid conditions were strongly associated with increased odds of a mental health diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS: All cancer survivors, particularly those with comorbid conditions, can benefit from mental health symptom screening and treatment facilitation.