title: Equity in the use of publicly subsidized psychotherapy among elderly Danish cancer patients--a register-based cohort study.
abstract: Approximately 30% of cancer patients suffer from psychological distress, and psychotherapy has been shown to be effective in alleviating it. Based on the 'Behavioral Model of Health Service Use', we investigated equity in the use of publicly subsidized psychotherapy in a cohort of Danish cancer patients. We present descriptive data on patients' use of psychotherapy and examine characteristics of those who used this service.
  
  
  METHODS
  The study population comprised 3646 participants in the prospective Diet, Cancer and Health cohort, diagnosed with a first cancer between 2003 and 2009, aged 56-80 years. Data on cancer diagnosis, psychotherapy use and comorbid conditions were obtained from registers, whereas data on demographics, social support and health status were obtained from questionnaires. Cox proportional hazards regression was used to identify factors related to use, which were subsequently evaluated with regard to equity.
  
  
  RESULTS
  Subsidized psychotherapy was used by 2.3% of the cancer patients. Longer education (> 10 years compared to < 8) was associated with greater likelihood of initiating psychotherapy [hazard ratio (HR), 1.97; 95% confidence interval (CI), 1.06-3.65], as was previous psychotherapy use compared to no previous use (2.86; 1.32-6.20). Patients with partners who did not reliably provide emotional support were significantly more likely to use psychotherapy than those without a partner (2.36; 1.05-5.30), a difference not found for those with partners who did provide support. Further, a higher SF-36 mental component score (0.96; 0.94-0.98, per point increase), and older age were associated with less use (65-69 years: 0.43; 0.21-0.89, 70-74 years: 0.17, 0.07-0.41; > 74 years: 0.07, 0.01-0.57, compared to < 60 years).
  
  
  CONCLUSIONS
  The results allow several possible interpretations. We found that mental health plays a role for accessing subsidized psychotherapy, suggesting that use of psychotherapy is predicted by need and thus characterized by equity. However, education and previous psychotherapy use also play a role, suggesting elements of inequity.
authors.affiliation: Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark. heymann@cancer.dk
authors.forename: Annika B
authors.initials: AB
authors.lastname: von Heymann-Horan
authors.forename: Pernille E
authors.initials: PE
authors.lastname: Bidstrup
authors.forename: Luise C
authors.initials: LC
authors.lastname: Kristiansen
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Andersen
authors.forename: Peter
authors.initials: P
authors.lastname: Elsass
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D011613:Psychotherapy / Q000191:economics* / Q000706:statistics & numerical data; D012042:Registries; D011795:Surveys and Questionnaires