Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, United States of America.
Prev Med. 2019 Jun;123:152-159. doi: 10.1016/j.ypmed.2019.03.024. Epub 2019 Mar 16.
Serious psychological distress (SPD) can adversely impact health and quality of life after cancer. The purpose of this study is to examine the association between SPD and the receipt of preventive care services and cancer screening among survivors and adults without a cancer history. A total of 12,564 cancer survivors and 160,023 adults without a cancer history as comparison group were identified from the population-based Medical Expenditure Panel Survey (2008-2015). SPD was assessed using the 6-item Kessler Psychological Distress Scale. We examined use of preventive care and cancer screening services in cancer survivors and comparison adults with/without SPD. Multivariable logistic regression models were conducted for each outcome: preventive service (i.e. blood pressure, cholesterol, influenza vaccination, routine and dental check-up) or cancer screening (i.e. mammography, Papanicolau test, colorectal cancer screening) adjusting for demographic, comorbidity, usual source of care covariates. Adjusted odds ratios and 95% confidence intervals were calculated. Prevalence of SPD was 9.8% in cancer survivors compared to 4.6% in comparison adults. Survivors with SPD were more frequent utilizers of medical care, reporting 10 or more visits to the doctor's office in the past 12 months (29.3% vs. 14.1% without SPD). Having SPD was associated with lower odds of being up-to-date with preventive service use and cancer screening among age- and gender-eligible individuals. The magnitude of the effect was greater in adults' age ≥65 years. Better coordination of care and patient-physician discussions are likely needed to improve delivery of recommended preventive services for persons with SPD.
严重心理困扰（SPD）会对癌症患者和非癌症患者的健康和生活质量产生负面影响。本研究旨在探讨 SPD 与癌症幸存者和无癌症史成年人接受预防保健服务和癌症筛查之间的关系。从基于人群的医疗支出调查（2008-2015 年）中确定了 12564 名癌症幸存者和 160023 名无癌症史的成年人作为对照组。使用 6 项 Kessler 心理困扰量表评估 SPD。我们检查了 SPD 患者和无 SPD 的癌症幸存者和对照组成年人对预防保健和癌症筛查服务的使用情况。对于每个结局（即血压、胆固醇、流感疫苗接种、常规和牙科检查）或癌症筛查（即乳房 X 光检查、巴氏涂片检查、结直肠癌筛查），我们都进行了多变量逻辑回归模型，调整了人口统计学、合并症、常规医疗服务提供者的协变量。计算了调整后的优势比和 95%置信区间。与对照组成年人相比，癌症幸存者 SPD 的患病率为 9.8%，而对照组成年人的患病率为 4.6%。有 SPD 的幸存者更频繁地使用医疗保健，在过去 12 个月内有 10 次或更多次去医生办公室就诊（29.3%与无 SPD 的 14.1%）。在符合年龄和性别条件的个体中，患有 SPD 与接受预防服务和癌症筛查的可能性降低有关。这种影响在年龄≥65 岁的成年人中更为明显。为了改善 SPD 患者推荐预防服务的提供，可能需要更好地协调护理和医患讨论。
