Investigating the association between self-reported comorbid anxiety and depression and health service use in cancer survivors

Background
Anxiety and depression have a higher prevalence in cancer survivors than in the general population and are associated with lower quality of life, poorer survival and an increased risk of suicide. Anxiety and depression are also highly comorbid among cancer survivors and associated with increased health service use. As such, it is important to consider both anxiety and depression and health service use in cancer survivors.

Objective
Our objective was to explore the association between anxiety and depression and health service utilisation, both cancer-specific and general doctor visits, in cancer survivors.

Methods
Data from a Dutch cancer registry were analysed to determine the association between anxiety and depression (measured using the Hospital Anxiety and Depression Scale) and health service use. Negative binomial regression models, controlling for patient demographics, comorbidities and cancer-related variables were estimated.

Results
Cancer survivors (n = 2538), with a mean age of 61.1 years and between 0.7 and 10.9 years since diagnosis, were included in the analysis. Increasing levels of anxiety and depression were associated with increased health service use. Having severe levels of anxiety was associated with more frequent visits to the general practitioner (p < 0.001). Severe depression in cancer survivors was associated with more frequent visits to the specialist (p < 0.001).

Conclusion
Anxiety and depression in cancer survivors, particularly severe anxiety and depression, were associated with increased health service use. Treatment of anxiety and depression in cancer survivors has the potential to reduce overall health service use and associated costs and improve health outcomes for cancer survivors.