Barriers to timely mental health care in cancer patients: A national analysis.

Abstract

e24060 Background: Patients diagnosed with cancer often face significant mental health challenges, yet many do not receive necessary care due to financial barriers. Mental health is critical to cancer survivorship, as unmet mental health needs can adversely impact treatment adherence, quality of life, and overall outcomes. This study aims to identify predictors of unmet and delayed mental health needs among cancer patients, with an emphasis on financial, social, and systemic factors. Methods: Using data from the 2023 National Health Interview Survey (NHIS), we conducted a retrospective cohort study of individuals diagnosed with one or more cancers who reported needing mental health counseling or therapy but did not receive it due to cost or experienced delays in mental health care due to cost. Key variables included demographics, mental health status, financial barriers in paying medical bills, lack of insurance coverage, unemployment, decreased social functioning, and transportation delays. Statistical analyses included descriptive statistics, ANOVA, and multiple linear regression to identify predictors of unmet and delays in mental care needs. Results: Among 3,800 cancer patients, 2.66% (101 patients) reported unmet mental health care due to cost, and 2.84% (108 patients) experienced delays in mental health care due to cost within the past 12 months. The study population was predominantly female (57%) and White (88.16%), with smaller proportions of Black/African American (6.66%), Asian (1.63%), and American Indian/Alaska Native (AIAN) participants (0.74%). The mean age was 68.43 years (median = 71, SD = 13.03). The regression model explained 3.4% of the variance (R² = 0.034), with delayed medical care due to cost emerging as the strongest predictor (p < 0.0001). Other significant predictors included problems paying medical bills (p = 0.0044) and uninsured status (p = 0.0180). Non-citizens faced significantly greater barriers to care, with higher rates of unmet needs (p < 0.0001) and delays (p < 0.0001). Transportation delays were also key barriers to both unmet needs and delays (p < 0.0001 for both outcomes). Lower education levels were associated with increased unmet needs (p < 0.0001) and delays (p < 0.0001). A higher frequency of depression was strongly associated with unmet needs (p < 0.0001) but did not significantly affect delays (p = 0.153). Decreased participation in social activities significantly predicted delays (p < 0.0001) but was not associated with unmet needs (p = 0.612). Gender, race, age, urban/rural status, and unemployment status were not significant predictors. Conclusions: Unmet and delayed mental health needs among cancer patients are driven by financial barriers, citizenship status, transportation delays and education level. Policies to expand insurance coverage, improve transportation access, and support vulnerable populations may further enhance timely mental health support for cancer survivors.