Do breast cancer survivors with a recent history of clinical depression report worse experiences with care? A retrospective cohort study using SEER‐CAHPS data

• Published in: Cancer medicine (Malden, MA) MA), 2023-01, Vol.12 (2), p.1949-1960
• Main Authors: Arevalo, Mariana, Pickering, Trevor A., Vernon, Sally W., Fujimoto, Kayo, Peskin, Melissa F., Farias, Albert J.
• Format: Article
• Language: English
• Subjects: Aged; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - epidemiology; Breast Neoplasms - therapy; CAHPS; Cancer Survivors; Cohort analysis; depression; Depression - epidemiology; Depression - etiology; Enrollments; Epidemiology; ethnic groups; Ethnicity; Female; Health care policy; Health maintenance organizations; healthcare disparities; Hispanic Americans; HMOs; Humans; Medical diagnosis; Medical prognosis; Medicare; Mental depression; Mental disorders; mental health; Minority & ethnic groups; Patients; Polls & surveys; Race; Ratings & rankings; Retrospective Studies; Statistical analysis; Surveys; United States - epidemiology; Variables
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.5031

Purpose We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity. Methods Using the Epidemiology and End Results‐Consumer Assessment of Healthcare Providers and Systems (SEER‐CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, getting care quickly, getting prescription drugs, specialist and overall care). We also assessed interactions of depression by race/ethnicity. All models were adjusted for demographics and cancer prognostic and treatment factors. Results Of the 2271 survivors, 7.6% were clinically depressed. After adjusting for covariates, survivors with clinical depression had lower odds of reporting excellent ratings of their ability to get needed care, care by their specialist, and overall care, compared to those without depression (AOR = 0.58, 95% CI: 0.40–0.84; AOR = 0.40, CI: 0.31–0.76; and AOR = 0.61, CI: 0.42–0.89, respectively). Among Hispanics, having depression was associated with higher odds of excellent ratings of one's ability to get needed care (AOR: 5.42, 95% CI: 1.02–28.81). No other statistically significant associations by race/ethnicity were found. Conclusions Breast cancer survivors with depression report poorer patient experiences with care. Further research is needed to understand complexities of ratings of experiences with care among survivors of diverse backgrounds. Implications Survivors with a recent history of clinical depression may benefit from additional supportive care services. Breast cancer survivors with a recent history of clinical depression were less likely to report excellent ratings of care on three domains assessing experiences of care, compared to those without a recent history of depression. Survivors with a recent history of depression appear to be particularly vulnerable to difficulties in some of their healthcare encounters, as reflected by their reported ratings of care.