Abstract 3563: Racial and ethnic disparities in mental health care and psychotropic medication utilization and expenditure among cancer survivors with serious psychological distress
Authors: Hyunjung Lee, So-Yeon Kang, Alexandre Chan, Jason Zheng, Ahmedin Jemal, Farhad Islami
Journal: Cancer Research (2025)

Abstract Background: Although National Comprehensive Cancer Network provides the standardized guideline for mental health screening and treatment during cancer care, mental health care has been still underutilized among cancer survivors. Cancer survivors may experience stress and mental health issues for many reasons, including the unexpected diagnosis; cancer treatment; and fear of reoccurrence and premature death. Access to mental health care is critical to improve their quality of life and avoid unnecessary costs due to mental illness. Although previous research has shown racial and ethnic inequities in mental health services and medication utilization in the general population, few studies have examined these disparities among cancer survivors with serious psychological distress (SPD). Method: Nationally-representative pooled 2012-2021 Medical Expenditure Panel Survey was used. The key outcomes included 1) the total number of each type of office-based visits (psychiatrist, psychologist, and psychotherapy/mental health counseling), 2) expenditures related to these visits, 3) whether medication was prescribed during these visits, and 4) psychotropic medication utilization (purchased). Zero-inflated negative binomial model for count outcomes, two-part regression models for cost outcomes, and logistic regression model for a binary outcome, adjusting for multiple individual socioeconomic factors and health status. Results: Approximately 5% of cancer survivors in 2012-2020 MEPS data had SPD (N=1, 016). Compared with non-Hispanic White (NHW) survivors with SPD, non-Hispanic Black (NHB) with SPD were less likely to receive counseling (−1.74 visit, 95%CI=−2.70, −0.79) and non-Hispanic other (NHO) were less likely to visit psychiatrist (−1.74 visit, 95%CI=−2.70, −0.79). Among cancer survivors who visited office-based mental health professionals, psychotropic medications were more likely to be prescribed to NHB survivors than NHW survivors by 22.2 percentage points (95%CI=9.22, 35.21). The expenditure on mental health visits was lower among NHB survivors than NHW survivors (total cost: $−226, 95%CI=−384, −68; out-of-pocket cost: $-75, 95%CI=−110, −40). Compared with NHW survivors, antidepressants utilization was lower among NHB (−15.0%, 95%CI=−24.8, −5.2) and Hispanic (−9.6%, 95%CI=−18.8, −0.5) and anxiolytics utilization was lower among NHB (−12.5%, 95%CI=−19.8, −5.2) and NHO (−14.9%, 95%CI=−24.7, −5.1) survivors. Conclusions: We found that Black-White disparities existed in number of counseling visits, total and out-of-pocket expenditures, and antidepressant and anxiolytic utilization, and Hispanic or NHO were less likely to utilize antidepressant or anxiolytics, calling for improvements in adherence of mental health treatment and access to psychotropic medication among racial and ethnic minorities. Citation Format: Hyunjung Lee, So-Yeon Kang, Alexandre Chan, Jason Zheng, Ahmedin Jemal, Farhad Islami. Racial and ethnic disparities in mental health care and psychotropic medication utilization and expenditure among cancer survivors with serious psychological distress [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3563.