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 aromatase inhibitors (AIs). Methods Observational study of patients with histologically confirmed stage 0–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 1085 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, 0.43, 95% CI 0.19–0.95) and integrative medicine services (OR 0.30, 95% CI 0.12–0.72) 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.