Distress rates have been found to be around 43%, as indicated by a study of five comprehensive cancer centers and as measured by the Distress Thermometer (Jacobsen, et ah, 2005). Furthermore, few studies have examined the current health care utilization among cancer patients as predicted by distress. Thus, population-based data from the NHIS (2004) was analyzed using SUDAAN software 1) to ascertain the current levels of distress as measured by the Kessler 6 scale experienced by cancer survivors based upon demographic characteristics, family structure, physical comorbitities, and cancer-related variables, and 2) to determine whether distress rates reported among cancer survivors predict current health care utilization, both mental and physical. Results indicated that cancer patients were significantly more distressed when compared to individuals with other chronic diseases and healthy individuals, F (2,339) = 586.39, p < .0001.

Furthermore, gynecological cancers reported the highest levels of distress. Age (8= -.01), education F (2,339) = 9.74, p = .0001, and physical comorbidities were found to be salient predictors of distress in covariate-adjusted analyses. After controlling for demographic, physical comorbidity, and cancer-related variables, distress among cancer patients significantly increased the likelihood of seeing a mental health professional (OR = 2.80, 95%CI = 2.13-3.67), as well as number of ER visits over the past 12 months (OR = 1.47, 95%CI = 1.21-1.78). However, when compared to healthy and other chronic disease groups, healthy individuals were the most likely to see a mental health professional as predicted by distress levels (OR = 3.58, 95%CI =3.02-4.24). Yet, number of ER visits for cancer patients increased the most as distress increased when compared to healthy and other chronic disease patients (B=.35, p < .05).

Findings from the proposed study will be used to develop interventions in alleviating distress among cancer survivors living with clinically meaningful distress and will provide useful information to health care providers based upon the need and current use of health care services. Future directions in research include evaluating possible moderators of distress and health care utilization, such as cost and insurance-related factors.

LLU Discipline

Experimental Psychology




School of Science and Technology

First Advisor

Jason Owen

Second Advisor

James Banta

Third Advisor

Kendal Boyd

Degree Name

Master of Arts (MA)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Neoplasms -- psychology; Neoplasms -- diagnosis; Disease-Free Survival; Anxiety Disorders; Stress Disorders, Post-Traumatic.



Page Count

xi; 87

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives