Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Abstract

Objectives: We previously showed that integrating psychological care into gynecologic oncology outpatient clinics is feasible, highly acceptable to patients, and allows for more equitable access to mental health services. Among patients who participated in integrated care, we aimed to better understand disparities in distress and coping based on insurance status. Secondary objectives were to assess differences in patients’ coping strategies based on two validated indices of neighborhood socioeconomic disadvantage (ADI) and segregation (isolation index). Methods: From May to August 2018, patients attending outpatient gynecologic oncology appointments at an NCI-designated cancer center were offered free, integrated psycho-oncology care. The patients were asked to complete the following validated measures: National Comprehensive Cancer Network (NCCN) Distress thermometer and problem list, PROMIS Depression and Anxiety, SF-12 quality of life (QOL), and Brief COPE. Patients’ addresses were converted to geographic coordinates via ArcGIS World Geocoding Service and linked to census tracts and block groups to evaluate the area deprivation index (ADI) and isolation index. Chi-square analyses were utilized for demographic comparisons. Independent sample t-tests were used to test differences between insurance status and isolation index, ADI, types of problems reported, and types of coping strategies. Correlational analyses were conducted to test the relationship between the isolation index and coping strategies. Results: Among 100 participants, the mean age was 53 years (SD: 14). Of them, 25% were Black and 46% met criteria for high distress (NCCN score >4) with no differences based on insurance status. The most frequently endorsed causes of distress were physical and emotional problems, including fatigue (58%), worry (57%), nervousness (45%), sleep (39%), fears (38%), neuropathy (38%), sadness (35%), and depression (34%). Patients with no/Medicaid insurance (n=40) endorsed more practical problems compared to women with private/ Medicare insurance (n=60) (p=.01). Patients with no/Medicaid insurance also reported higher levels of depression (p=.04) and lower QOL (physical, p=0.007; mental, p=0.006) compared to patients with private/Medicare insurance. Both individual and neighborhood socioeconomic disparities negatively influenced patients’ coping skills. Compared to patients with private/Medicare insurance, patients with no/Medicaid insurance lived in neighborhoods with higher ADI (p=0.001), isolation index scores (p=.008), and reported more frequent use of avoidant coping strategies (p=.003), such as denial (p=.001), substance use (p=.008), behavioral disengagement (p<.001), and self-blame (p=.03). However, a higher isolation index score was associated with increased usage of avoidant coping strategies among participants regardless of insurance status (p=.05). Conclusions: Patients with no/Medicaid insurance endorsed higher depression scores, poorer QOL, and unhealthy coping strategies than those with private/Medicare insurance. Neighborhood socioeconomic disadvantage indices are correlated with negative coping strategies. Our findings support the value of the integrated care model, with efforts particularly targeted at underserved populations who may benefit the most from integrated psychological care. Objectives: We previously showed that integrating psychological care into gynecologic oncology outpatient clinics is feasible, highly acceptable to patients, and allows for more equitable access to mental health services. Among patients who participated in integrated care, we aimed to better understand disparities in distress and coping based on insurance status. Secondary objectives were to assess differences in patients’ coping strategies based on two validated indices of neighborhood socioeconomic disadvantage (ADI) and segregation (isolation index). Methods: From May to August 2018, patients attending outpatient gynecologic oncology appointments at an NCI-designated cancer center were offered free, integrated psycho-oncology care. The patients were asked to complete the following validated measures: National Comprehensive Cancer Network (NCCN) Distress thermometer and problem list, PROMIS Depression and Anxiety, SF-12 quality of life (QOL), and Brief COPE. Patients’ addresses were converted to geographic coordinates via ArcGIS World Geocoding Service and linked to census tracts and block groups to evaluate the area deprivation index (ADI) and isolation index. Chi-square analyses were utilized for demographic comparisons. Independent sample t-tests were used to test differences between insurance status and isolation index, ADI, types of problems reported, and types of coping strategies. Correlational analyses were conducted to test the relationship between the isolation index and coping strategies. Results: Among 100 participants, the mean age was 53 years (SD: 14). Of them, 25% were Black and 46% met criteria for high distress (NCCN score >4) with no differences based on insurance status. The most frequently endorsed causes of distress were physical and emotional problems, including fatigue (58%), worry (57%), nervousness (45%), sleep (39%), fears (38%), neuropathy (38%), sadness (35%), and depression (34%). Patients with no/Medicaid insurance (n=40) endorsed more practical problems compared to women with private/ Medicare insurance (n=60) (p=.01). Patients with no/Medicaid insurance also reported higher levels of depression (p=.04) and lower QOL (physical, p=0.007; mental, p=0.006) compared to patients with private/Medicare insurance. Both individual and neighborhood socioeconomic disparities negatively influenced patients’ coping skills. Compared to patients with private/Medicare insurance, patients with no/Medicaid insurance lived in neighborhoods with higher ADI (p=0.001), isolation index scores (p=.008), and reported more frequent use of avoidant coping strategies (p=.003), such as denial (p=.001), substance use (p=.008), behavioral disengagement (p<.001), and self-blame (p=.03). However, a higher isolation index score was associated with increased usage of avoidant coping strategies among participants regardless of insurance status (p=.05). Conclusions: Patients with no/Medicaid insurance endorsed higher depression scores, poorer QOL, and unhealthy coping strategies than those with private/Medicare insurance. Neighborhood socioeconomic disadvantage indices are correlated with negative coping strategies. Our findings support the value of the integrated care model, with efforts particularly targeted at underserved populations who may benefit the most from integrated psychological care.