Changing patterns in mental health visit utilization and spending among US cancer survivors post-COVID.

Abstract

667 Background: One in four cancer survivors (CS) suffers from depression. However, patterns of mental health service use and associated financial burden among cancer survivors in the post-pandemic era remain poorly characterized. We examined the change in utilization and spending on office-based mental health visits (MHVs) in CS before and after COVID-19. Methods: Using the 2019 and 2022 Medical Expenditure Panel Survey (MEPS), a nationally representative cohort, adult CS were identified (excluding non-melanoma skin cancers). Psychological distress was defined as a Kessler-6 score > 13. MHVs and spending were analyzed using event-level data. Multivariable linear regression models adjusted for age, sex, race, spousal status, income, and insurance status identified factors associated with MHV receipt and spending. Weighted analyses accounted for the complex survey design; p ≤ 0.05 was considered significant. Results: We identified 1,973 CS (weighted at 20.8 million) in 2019 and 1,776 CS (21.1 million) in 2022, with psychological distress prevalences of 13.8% and 10.8%, respectively. CS receiving MHV declined from 10.3% in 2019 to 9.8% in 2022, and from 33.5% to 25.0% among distressed CS. In multivariable analyses, women had higher odds of MHV use than men (aOR 1.75, p<0.001), and younger CS had greater odds compared with those ≥65 years (18-45 years: aOR 8.40; p<0.001, 45-64 years: aOR 3.05; p<0.001). Among CS receiving MHVs, mean per-person inflation-adjusted expenditures increased from $1,332 in 2019 to $2,037 in 2022 (expenditure ratio 1.61, p=0.007). Spending was higher among Black compared with White CS (expenditure ratio 2.15, p=0.031). Younger age groups also had higher expenditures (18-45: ratio 3.61, p=0.003; 45-64: ratio 2.49, p<0.001). Out-of-pocket expenditures remained stable overall ($306 vs $330; p=0.51), but were lower among Black versus White CS (ratio 0.27, p=0.014) and higher among younger individuals (18-45: 4.48, p=0.013; 45-64: 4.70, p=0.002). Conclusions: This is the first nationally representative study to examine shifts in mental health service use and spending among US CS following COVID-19. Policies such as the American Rescue Plan Act could explain the observed increase in MHV spending post-COVID. However, these findings highlight substantial sociodemographic differences in mental health service use and financial burden among cancer survivors, underscoring the need to address barriers to equitable, affordable care.