New Survey Identifies Underutilization of Mental Health, Palliative Care Support Services for Patients With Cancer


Mental health was recognized as a priority by most oncologists. However, few felt they had the proper resources to provide adequate support. In addition, palliative care was found to be prescribed or referred too late.

Bruce Feinberg, DO

Bruce Feinberg, DO

A new survey revealed that patients with cancer are not being referred for mental health and palliative care services in accordance with their identified need, according to findings reported in Oncology Insights.

Most patients receiving cancer-related treatment exhibit some degree of mental health distress, according to a survey of over 240 US oncologists. Findings show that approximately 90% of oncologists are concerned about how the mental distress of their patients will impact their overall health outcomes.

In addition, despite a consensus among surveyed oncologists that earlier introduction to palliative care results in better health outcomes for patients with advanced cancer, less than half of participants expressed belief that additional training and resources for clinicians are necessary. This is despite studies that show that a significant portion of patients with cancer are referred to palliative care too late.

The study consisted of surveyed responses from 240 oncologists from a mix of community and hospital-based practices across the United States. Responses were collected between September 2021 and October 2021.

The most common types of observed mental health distress included anxiety disorder and depression. These 2 manifestations of distress were observed by more than 80% of study participants. However, personality, posttraumatic stress, and addiction disorders were also reported as prevalent among this population.

Furthermore, although most respondents shared a concern about patient outcomes due to mental health, only 51% percent shared they frequently refer patients for mental health treatment and 48% there are not enough adequate recourses available to support the mental health needs of these patients.

Responses also revealed that the surveyed practices were split regarding screening for mental illness. Approximately 36% of respondents use the National Comprehensive Cancer Network (NCCN) Distress Thermometer, 29% prefer other validated instruments (Patient Health Questionnaire, Psychological Screen for Cancer, Edmonton Symptom Assessment System), and 35% reported using no screening instruments at all. Regarding prescription intervention, 93% of participants reported prescribing antidepressants and 95% reported prescribing anxiolytics to their patients.

Furthermore, the findings highlighted variability between oncologist awareness vs actions. For example, only 61% of physicians reported that they frequently discuss mental health with their patients. Although one-quarter of practice have some form of mental health support incorporated into their health care system, nearly half of respondents shared that the resources available are not adequate for the severity of the need.

The survey also queried about available mental health services or counseling across the various institutions. In total, 45% of respondents shared they have a social worker(s), 26% have a clinical psychologist(s), and 27% refer patients to specialists in the community. Seven percent reported that their institution has APP(s) dedicated to counseling and mental health services, 9% have a mental health service program within their system. Only 16% of participants reported that they can and prefer to refer patients to specialists within their health care system.

“In total, the fact that oncologists have high levels of awareness of mental health distress among patients with cancer is encouraging,” said Bruce Feinberg, DO, vice president, chief medical officer, Cardinal Health Specialty Solutions. “However, the responses about referrals and interventions indicate that oncologists still need to take additional steps to ensure that patients will consistently receive the mental health care they need.”

Mental health supportive care was not the only topic addressed in the survey. The survey also explored oncologists’ views on the effective use of palliative care for patients with advanced cancer. Although 68% of oncologists confirmed that earlier introduction of palliative services is linked to better outcomes for patients with advanced cancer, only 43% expressed interest in additional clinician training about having discussions with patients with advanced cancer about these services, and only 45% felt that clinicians need better data and predictive analysis to help identify when referral to a palliative care team is appropriate. Seventeen percent shared that they refer patients to palliative care at the time of diagnosis.

The NCCN and ASCO offer extensive guidelines outlining palliative care use and appropriate timing of referrals. However, a small percentage of respondents referred patients at the time of metastatic disease diagnosis.

Among those whose patients were receiving palliative care services, only about 25% to 50% of the patients were also receiving active treatment (answers varied per oncologist response) and 21% of oncologists shared that they only offered palliative care to their patients when feel they are approaching end of life.

“In addition to the need for patient education, the responses to our survey suggest there are opportunities for expanded provider education and to equip oncologists with better data and analytics to improve timely use of palliative care in patients with advanced cancer,” said Ajeet Gajra, MD, MBBS, FACP, vice president and chief medical officer, Cardinal Health Specialty Solutions.


Oncology insights: views from specialty physicians nationwide on mental health and palliative care impacts for patients with cancer. Cardinal Health Specialty Solutions. December 2021. Accessed December 21, 2021.

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