Receipt of psychological counseling and integrative medicine services among breast cancer survivors with anxiety

PURPOSE: To define the prevalence and risk factors of anxiety and examine rates and predictors of psychotherapy and integrative medicine service use in breast cancer survivors on AIs. METHODS: Observational study of patients with histologically confirmed stage 0 to III hormone receptor-positive breast cancer taking a third generation AI at the time of enrollment. Patients completed self-report measures of anxiety and utilization of psychotherapy and integrative medicine services at a single time-point. We used multivariate logistic regression analyses to identify factors associated with anxiety and receipt of anxiety treatment services. RESULTS: Among the 1,085 participants, the majority were younger than 65 years of age (n=673, 62.0%) and white (n=899, 82.9%). Approximately one-third (30.8%) reported elevated anxiety (≥8 on the anxiety subscale of the Hospital Anxiety and Depression Scale). Of patients with elevated anxiety, only 24.6% reported receiving psychological counseling, 25.3% used integrative medicine services, and 39.8% received either type of treatment since their diagnosis. Patients with an education level of high school or less were less likely to receive psychological counseling (AOR, .43, 95% CI .19–.95) and integrative medicine services (OR, .30, 95% CI .12–.72) than patients with higher levels of education. CONCLUSIONS: Anxiety is common in breast cancer patients treated with AIs yet the majority of anxious patients do not receive evidence-based treatment, even when these treatments are available. Better systematic anxiety screening and treatment initiation are needed to reduce disparities in care by education level.