Income, Rurality Affected Access to Mental Health Services After Cancer Diagnosis

People living with cancer, especially those in low-income and rural areas, are in need of increased preventive mental health services, according to a recent retrospective study.

“In this study, we noted significant disparities in suicide mortality and its temporal patterning between rural vs. urban counties and high- vs. low-income counties,” study authors wrote. “We found higher suicide mortality following cancer diagnosis among people living in lower-income and rural counties.”

The study looked at more than 5.3 million people with a cancer diagnosis taken from the Surveillance, Epidemiology, and End Results Program 18 (SEER 18) registries; included people were from 635 countries.

Of the included people, 6,357 had died of suicide (standardized mortality ratios [SMR] = 1.41; 95% CI, 1.38 to 1.44). People with cancer in the lowest-income counties had a significantly higher risk for suicide than those in the highest-income counties (SMR 1.94 vs. SMR 1.30). Additionally, those living in rural counties had significantly higher SMR than those in urban counties (SMR = 1.81 vs. SMR = 1.35).

For the entire group SMR was highest within the first year after a cancer diagnosis. However, the researchers found that among those in the lowest-income counties, the risk remained high even after a decade or more from the cancer diagnosis (SMR = 1.83; 95% CI, 1.31 to 2.48).

“A higher risk of financial toxicity may partially explain this finding in low-income individuals with cancer; mental distress from financial toxicity might worsen during the course of cancer survivorship,” the researchers wrote. “This finding warrants further research, especially given the high rates of financial hardship among cancer survivors.”

The researchers also found that suicide risk did not differ according to rurality among low-income counties but among high-income counties there was a significant difference between rural compared with urban counties.

“This finding may indicate that people diagnosed with cancer living in low-income areas lack access to mental health care regardless of the degree of rurality,” the researchers wrote.

They suggested the increased use of telemedicine for medical and mental health as a possible way to increase access to care for patients in low-income and rural counties.