diagnosis of or treatment for cancer (IOM and NRC, 2006), with implications for their own lives and income. The evidence is not clear as to factors that do and do not affect survivors’ return to work (Spelten et al., 2002). Nonetheless, to the extent that unaddressed mental health problems such as depression or other psychosocial problems associated with their disease affect patients’ desire to continue or return to work or impair their performance on the job, they, their families, and the workplace will be adversely affected financially. Additionally, to the extent that caregivers give up work outside of the home or reduce their work hours to provide care to a loved one, workplace productivity will decrease.
Mental health problems associated with cancer may also have adverse financial effects on the larger economy and on health care providers. However, with respect to effects on the larger economy, the financial costs of failing to deliver psychosocial health services to individuals with cancer have not been studied. Studies that have attempted to quantify the impact of mental health problems on the cost of medical care have been based on the effect of depression and/or anxiety on those with medical illnesses other than cancer (Simon et al., 1995, 2002; Henk et al., 1996). Issues pertaining to reimbursement of psychosocial health services are addressed in Chapter 6.
Having examined the evidence presented in Chapter 1 about the prevalence of psychosocial problems among people with cancer and the extent to which those problems are unaddressed by health care providers, as well as the evidence reviewed in this chapter about how psychosocial problems can adversely affect health, the committee concludes that all cancer patients and their families are at heightened risk for emotional suffering, diminished adherence to treatment, impaired work and social functioning, and as a result, additional threats to their health beyond those directly imposed by their cancer. As many prior studies on disparities in health care have documented (IOM, 2003; Maly et al., 2006), these risks are greater in populations already experiencing such social stressors as poverty, limited education, language barriers, and/or membership in an ethnic or cultural minority.
Failing to address these risks can adversely affect individuals with many different types of illness. However, the trajectory of cancer often poses both an immediate threat to life and threats to lifelong physical, psychological, and social functioning as a result of the chronic physical and psychological impairment and disability that can result from both the illness and its treatment. Moreover, treatment for many cancers can itself be life-threatening.