Understanding help-seeking behaviour in relation to psychosocial support services among Japanese cancer patients Free

Distributions of treatment status and KPS

	n	%
Current treatment status
Surgery	6	0.8
Chemotherapy	71	10.0
Radiation therapy	2	0.3
Hormone therapy	182	25.6
Others	38	5.3
KPS
Normal, no complaints	408	57.3
Able to carry on normal activities. Minor signs or symptoms of disease	195	27.4
Normal activity with effort	81	11.4
Care for self. Unable to carry on normal activity or to do active work	17	2.4
Requires occasional assistance, but able to care for most of his needs	10	1.4
Requires considerable assistance	1	0.1
Frequency of visiting doctor
Two or more times a week	4	0.6
About once a week	24	3.4
About once a month	149	20.9
About once every 2–3 months	343	48.2
About once every 6 months	148	20.8
Once a year or less	44	6.2

	n	%
Current treatment status
Surgery	6	0.8
Chemotherapy	71	10.0
Radiation therapy	2	0.3
Hormone therapy	182	25.6
Others	38	5.3
KPS
Normal, no complaints	408	57.3
Able to carry on normal activities. Minor signs or symptoms of disease	195	27.4
Normal activity with effort	81	11.4
Care for self. Unable to carry on normal activity or to do active work	17	2.4
Requires occasional assistance, but able to care for most of his needs	10	1.4
Requires considerable assistance	1	0.1
Frequency of visiting doctor
Two or more times a week	4	0.6
About once a week	24	3.4
About once a month	149	20.9
About once every 2–3 months	343	48.2
About once every 6 months	148	20.8
Once a year or less	44	6.2

KPS, Karnofsky Performance Status.

Table 1

Distributions of treatment status and KPS

	n	%
Current treatment status
Surgery	6	0.8
Chemotherapy	71	10.0
Radiation therapy	2	0.3
Hormone therapy	182	25.6
Others	38	5.3
KPS
Normal, no complaints	408	57.3
Able to carry on normal activities. Minor signs or symptoms of disease	195	27.4
Normal activity with effort	81	11.4
Care for self. Unable to carry on normal activity or to do active work	17	2.4
Requires occasional assistance, but able to care for most of his needs	10	1.4
Requires considerable assistance	1	0.1
Frequency of visiting doctor
Two or more times a week	4	0.6
About once a week	24	3.4
About once a month	149	20.9
About once every 2–3 months	343	48.2
About once every 6 months	148	20.8
Once a year or less	44	6.2

	n	%
Current treatment status
Surgery	6	0.8
Chemotherapy	71	10.0
Radiation therapy	2	0.3
Hormone therapy	182	25.6
Others	38	5.3
KPS
Normal, no complaints	408	57.3
Able to carry on normal activities. Minor signs or symptoms of disease	195	27.4
Normal activity with effort	81	11.4
Care for self. Unable to carry on normal activity or to do active work	17	2.4
Requires occasional assistance, but able to care for most of his needs	10	1.4
Requires considerable assistance	1	0.1
Frequency of visiting doctor
Two or more times a week	4	0.6
About once a week	24	3.4
About once a month	149	20.9
About once every 2–3 months	343	48.2
About once every 6 months	148	20.8
Once a year or less	44	6.2

KPS, Karnofsky Performance Status.

The use of psychosocial support services

Of the participants, 325 respondents (45.6%) did not know about their familiar psychosocial support services. Among the others, 240 patients (33.7%) knew about psychosomatic medicine, followed by cancer consulting and support centres (n = 215, 30.2%) and psychiatry (n = 198, 27.8%) (Table 2).

Table 2

Contents of psychosocial support services

	Contents known about by patients		Contents of that participants used
	n	%	n	%
Psycho-oncology	24	3.4	2	0.3
Psychiatry	198	27.8	11	1.5
Psychosomatic medicine	240	33.7	31	4.4
Counselling by therapist	78	11.0	12	1.7
Group therapy	12	1.7	1	0.1
Support group	45	6.3	12	1.7
Cancer consulting and support centre	215	30.2	27	3.8
Regional medical cooperation office	98	13.8	7	1.0
Medical care counselling	181	25.4	16	2.2
Cancer salon	90	12.6	18	2.5
Others	4	0.6	12	1.7

	Contents known about by patients		Contents of that participants used
	n	%	n	%
Psycho-oncology	24	3.4	2	0.3
Psychiatry	198	27.8	11	1.5
Psychosomatic medicine	240	33.7	31	4.4
Counselling by therapist	78	11.0	12	1.7
Group therapy	12	1.7	1	0.1
Support group	45	6.3	12	1.7
Cancer consulting and support centre	215	30.2	27	3.8
Regional medical cooperation office	98	13.8	7	1.0
Medical care counselling	181	25.4	16	2.2
Cancer salon	90	12.6	18	2.5
Others	4	0.6	12	1.7

Table 2

Contents of psychosocial support services

	Contents known about by patients		Contents of that participants used
	n	%	n	%
Psycho-oncology	24	3.4	2	0.3
Psychiatry	198	27.8	11	1.5
Psychosomatic medicine	240	33.7	31	4.4
Counselling by therapist	78	11.0	12	1.7
Group therapy	12	1.7	1	0.1
Support group	45	6.3	12	1.7
Cancer consulting and support centre	215	30.2	27	3.8
Regional medical cooperation office	98	13.8	7	1.0
Medical care counselling	181	25.4	16	2.2
Cancer salon	90	12.6	18	2.5
Others	4	0.6	12	1.7

	Contents known about by patients		Contents of that participants used
	n	%	n	%
Psycho-oncology	24	3.4	2	0.3
Psychiatry	198	27.8	11	1.5
Psychosomatic medicine	240	33.7	31	4.4
Counselling by therapist	78	11.0	12	1.7
Group therapy	12	1.7	1	0.1
Support group	45	6.3	12	1.7
Cancer consulting and support centre	215	30.2	27	3.8
Regional medical cooperation office	98	13.8	7	1.0
Medical care counselling	181	25.4	16	2.2
Cancer salon	90	12.6	18	2.5
Others	4	0.6	12	1.7

Of the 712 participants, 111 had used psychosocial support services (15.6%). Psychosomatic medicine (n = 31, 4.4%), cancer consulting and support centres (n = 27, 3.8%) and cancer salons (n = 18, 2.5%) were commonly used (Table 2). Forty-one participants (5.8%) used at least one of psychosomatic medicine, psychiatry or psycho-oncology department. Additionally, 8 participants were in the Action stage (7.2%), 35 in the Maintenance stage (31.5%) and 68 in Relapse to an earlier stage (61.3%).

Relationships between the use of psychosocial support services and the variables

First, as a result of the examination of those who had used such services (henceforth, ‘experiencers’) and those who had not used such services (henceforth, ‘inexperienced’), participants with the following characteristics were more likely to use such services: younger age (t(710) = −4.114, P = 0.00), female (χ² = 10.553, df = 1, P = 0.001), breast cancer (χ² = 11.055, df = 1, P = 0.001), uterine cancer (P = 0.038), experience with chemotherapy (χ² = 4.538, df = 1, P = 0.033), experience with hormone therapy (χ² = 5.700, df = 1, P = 0.017) and those who do not have a good KPS status (t(710) = 4.252, P = 0.000). Conversely, there were a few users who were prostate cancer patients (χ² = 10.547, df = 1, P = 0.001) (Table 3).

Table 3

Relationships between use of psychosocial support services and variables

	Total (N = 712)		Inexperienced (n = 601)		Experiencers (n = 111)		t/χ²	P	Non-users (n = 669)		Users (n = 43)		t/χ²	P
	M/n	SD/%	M/n	SD/%	M/n	SD/%			M/n	SD/%	M/n	SD/%
Age	58.1	11.9	58.8	11.8	53.8	11.7	−4.114	0.000^**	58.7	11.9	48.8	8.3	−7.333	0.000^***
Sex
Male	353	49.6	312	51.9	39	35.1	10.553	0.001^**	342	51.1	9	20.9	14.734	0.000^***
Female	362	50.8	289	48.1	72	64.9			327	48.9	34	79.1
Housemates
Spouse	504	70.8	432	71.9	72	64.9	2.23	0.135	478	71.4	26	60.5	2.358	0.125
Living alone	96	13.5	77	12.8	19	17.1	1.489	0.222	86	12.9	10	23.3	3.747	0.053^†
Marriage status
Married	520	73.0	445	74.0	75	67.6			493	70.5	27	62.8
Unmarried	104	14.6	84	14.0	20	18.0	—	0.515^a	96	13.7	8	18.6	—	0.345
Separation	56	7.9	45	7.5	11	9.9			50	7.2	6	14.0
Bereavement	32	4.5	27	4.5	5	4.5			30	4.3	2	4.7
Duration since	56.6	55.4	56.9	55.6	54.7	54.2	−0.3867	0.699
Cancer types
Breast	202	28.4	156	26.0	46	41.4	11.055	0.001^**	177	26.5	25	58.1	19.956	0.000^**
Lung	34	4.8	32	5.3	2	1.8	2.557	0.110	34	5.1	0	0	—	0.257^a
Stomach	60	8.4	48	8.0	12	10.8	0.968	0.325	56	8.4	4	9.3	—	0.777^a
Liver	18	2.5	17	2.8	1	0.9	—	0.335^a	18	2.7	0	0	—	0.619^a
Colon	90	12.6	78	13.0	12	10.8	0.399	0.528	88	13.2	2	4.7	2.645	0.104
Kidney	18	2.5	14	2.3	4	3.6	—	0.505^a	16	2.4	2	4.7	—	0.297^a
Prostate	103	14.5	98	16.3	5	4.5	10.547	0.001^**	102	15.2	1	2.3	5.452	0.020^*
Bladder	21	2.9	20	3.3	1	0.9	—	0.228^a	21	3.1	0	0	—	0.631^a
Ovarian	16	2.2	14	2.3	2	1.8	—	1.000^a	16	2.4	0	0	—	0.616^a
Cervical	32	4.5	25	4.2	7	6.3	—	0.318^a	28	4.2	4	9.3	—	0.120^a
Uterine body	24	3.4	16	2.7	8	7.2	—	0.038^a^,*	21	3.1	3	7.0	—	0.172^a
Blood	24	3.4	22	3.7	2	1.8	—	0.564^a	22	3.3	2	4.7	—	0.651^a
Brain	6	0.8	5	0.8	1	0.9	—	1.000^a	6	0.9	0	0	—	1.000^a
Others	129	18.1
Treatment experience
Surgery	478	67.1	397	66.1	81	73.0	2.031	0.154	445	66.5	33	76.7	1.915	0.166
Chemotherapy	233	32.7	187	31.1	46	41.4	4.538	0.033^*	215	32.1	18	41.9	1.735	0.188
Radiation therapy	187	26.3	160	26.6	27	24.3	0.255	0.613	176	26.3	11	25.6	0.011	0.916
Hormone therapy	232	32.6	185	30.8	47	42.3	5.7	0.017^*	211	31.5	21	48.8	5.503	0.019^*
Others	77	10.8
KPS	1.6	0.9	1.6	0.9	2.0	1.0	4.252	0.000^***	1.59	0.9	2.40	1.2	4.499	0.000^***

	Total (N = 712)		Inexperienced (n = 601)		Experiencers (n = 111)		t/χ²	P	Non-users (n = 669)		Users (n = 43)		t/χ²	P
	M/n	SD/%	M/n	SD/%	M/n	SD/%			M/n	SD/%	M/n	SD/%
Age	58.1	11.9	58.8	11.8	53.8	11.7	−4.114	0.000^**	58.7	11.9	48.8	8.3	−7.333	0.000^***
Sex
Male	353	49.6	312	51.9	39	35.1	10.553	0.001^**	342	51.1	9	20.9	14.734	0.000^***
Female	362	50.8	289	48.1	72	64.9			327	48.9	34	79.1
Housemates
Spouse	504	70.8	432	71.9	72	64.9	2.23	0.135	478	71.4	26	60.5	2.358	0.125
Living alone	96	13.5	77	12.8	19	17.1	1.489	0.222	86	12.9	10	23.3	3.747	0.053^†
Marriage status
Married	520	73.0	445	74.0	75	67.6			493	70.5	27	62.8
Unmarried	104	14.6	84	14.0	20	18.0	—	0.515^a	96	13.7	8	18.6	—	0.345
Separation	56	7.9	45	7.5	11	9.9			50	7.2	6	14.0
Bereavement	32	4.5	27	4.5	5	4.5			30	4.3	2	4.7
Duration since	56.6	55.4	56.9	55.6	54.7	54.2	−0.3867	0.699
Cancer types
Breast	202	28.4	156	26.0	46	41.4	11.055	0.001^**	177	26.5	25	58.1	19.956	0.000^**
Lung	34	4.8	32	5.3	2	1.8	2.557	0.110	34	5.1	0	0	—	0.257^a
Stomach	60	8.4	48	8.0	12	10.8	0.968	0.325	56	8.4	4	9.3	—	0.777^a
Liver	18	2.5	17	2.8	1	0.9	—	0.335^a	18	2.7	0	0	—	0.619^a
Colon	90	12.6	78	13.0	12	10.8	0.399	0.528	88	13.2	2	4.7	2.645	0.104
Kidney	18	2.5	14	2.3	4	3.6	—	0.505^a	16	2.4	2	4.7	—	0.297^a
Prostate	103	14.5	98	16.3	5	4.5	10.547	0.001^**	102	15.2	1	2.3	5.452	0.020^*
Bladder	21	2.9	20	3.3	1	0.9	—	0.228^a	21	3.1	0	0	—	0.631^a
Ovarian	16	2.2	14	2.3	2	1.8	—	1.000^a	16	2.4	0	0	—	0.616^a
Cervical	32	4.5	25	4.2	7	6.3	—	0.318^a	28	4.2	4	9.3	—	0.120^a
Uterine body	24	3.4	16	2.7	8	7.2	—	0.038^a^,*	21	3.1	3	7.0	—	0.172^a
Blood	24	3.4	22	3.7	2	1.8	—	0.564^a	22	3.3	2	4.7	—	0.651^a
Brain	6	0.8	5	0.8	1	0.9	—	1.000^a	6	0.9	0	0	—	1.000^a
Others	129	18.1
Treatment experience
Surgery	478	67.1	397	66.1	81	73.0	2.031	0.154	445	66.5	33	76.7	1.915	0.166
Chemotherapy	233	32.7	187	31.1	46	41.4	4.538	0.033^*	215	32.1	18	41.9	1.735	0.188
Radiation therapy	187	26.3	160	26.6	27	24.3	0.255	0.613	176	26.3	11	25.6	0.011	0.916
Hormone therapy	232	32.6	185	30.8	47	42.3	5.7	0.017^*	211	31.5	21	48.8	5.503	0.019^*
Others	77	10.8
KPS	1.6	0.9	1.6	0.9	2.0	1.0	4.252	0.000^***	1.59	0.9	2.40	1.2	4.499	0.000^***

M, mean; SD, standard deviation.

^aFisher’s exact test.

^***P < 0.001.

^**P < 0.01.

^*P < 0.05.

^†P < 0.10.

Table 3

Relationships between use of psychosocial support services and variables

	Total (N = 712)		Inexperienced (n = 601)		Experiencers (n = 111)		t/χ²	P	Non-users (n = 669)		Users (n = 43)		t/χ²	P
	M/n	SD/%	M/n	SD/%	M/n	SD/%			M/n	SD/%	M/n	SD/%
Age	58.1	11.9	58.8	11.8	53.8	11.7	−4.114	0.000^**	58.7	11.9	48.8	8.3	−7.333	0.000^***
Sex
Male	353	49.6	312	51.9	39	35.1	10.553	0.001^**	342	51.1	9	20.9	14.734	0.000^***
Female	362	50.8	289	48.1	72	64.9			327	48.9	34	79.1
Housemates
Spouse	504	70.8	432	71.9	72	64.9	2.23	0.135	478	71.4	26	60.5	2.358	0.125
Living alone	96	13.5	77	12.8	19	17.1	1.489	0.222	86	12.9	10	23.3	3.747	0.053^†
Marriage status
Married	520	73.0	445	74.0	75	67.6			493	70.5	27	62.8
Unmarried	104	14.6	84	14.0	20	18.0	—	0.515^a	96	13.7	8	18.6	—	0.345
Separation	56	7.9	45	7.5	11	9.9			50	7.2	6	14.0
Bereavement	32	4.5	27	4.5	5	4.5			30	4.3	2	4.7
Duration since	56.6	55.4	56.9	55.6	54.7	54.2	−0.3867	0.699
Cancer types
Breast	202	28.4	156	26.0	46	41.4	11.055	0.001^**	177	26.5	25	58.1	19.956	0.000^**
Lung	34	4.8	32	5.3	2	1.8	2.557	0.110	34	5.1	0	0	—	0.257^a
Stomach	60	8.4	48	8.0	12	10.8	0.968	0.325	56	8.4	4	9.3	—	0.777^a
Liver	18	2.5	17	2.8	1	0.9	—	0.335^a	18	2.7	0	0	—	0.619^a
Colon	90	12.6	78	13.0	12	10.8	0.399	0.528	88	13.2	2	4.7	2.645	0.104
Kidney	18	2.5	14	2.3	4	3.6	—	0.505^a	16	2.4	2	4.7	—	0.297^a
Prostate	103	14.5	98	16.3	5	4.5	10.547	0.001^**	102	15.2	1	2.3	5.452	0.020^*
Bladder	21	2.9	20	3.3	1	0.9	—	0.228^a	21	3.1	0	0	—	0.631^a
Ovarian	16	2.2	14	2.3	2	1.8	—	1.000^a	16	2.4	0	0	—	0.616^a
Cervical	32	4.5	25	4.2	7	6.3	—	0.318^a	28	4.2	4	9.3	—	0.120^a
Uterine body	24	3.4	16	2.7	8	7.2	—	0.038^a^,*	21	3.1	3	7.0	—	0.172^a
Blood	24	3.4	22	3.7	2	1.8	—	0.564^a	22	3.3	2	4.7	—	0.651^a
Brain	6	0.8	5	0.8	1	0.9	—	1.000^a	6	0.9	0	0	—	1.000^a
Others	129	18.1
Treatment experience
Surgery	478	67.1	397	66.1	81	73.0	2.031	0.154	445	66.5	33	76.7	1.915	0.166
Chemotherapy	233	32.7	187	31.1	46	41.4	4.538	0.033^*	215	32.1	18	41.9	1.735	0.188
Radiation therapy	187	26.3	160	26.6	27	24.3	0.255	0.613	176	26.3	11	25.6	0.011	0.916
Hormone therapy	232	32.6	185	30.8	47	42.3	5.7	0.017^*	211	31.5	21	48.8	5.503	0.019^*
Others	77	10.8
KPS	1.6	0.9	1.6	0.9	2.0	1.0	4.252	0.000^***	1.59	0.9	2.40	1.2	4.499	0.000^***

	Total (N = 712)		Inexperienced (n = 601)		Experiencers (n = 111)		t/χ²	P	Non-users (n = 669)		Users (n = 43)		t/χ²	P
	M/n	SD/%	M/n	SD/%	M/n	SD/%			M/n	SD/%	M/n	SD/%
Age	58.1	11.9	58.8	11.8	53.8	11.7	−4.114	0.000^**	58.7	11.9	48.8	8.3	−7.333	0.000^***
Sex
Male	353	49.6	312	51.9	39	35.1	10.553	0.001^**	342	51.1	9	20.9	14.734	0.000^***
Female	362	50.8	289	48.1	72	64.9			327	48.9	34	79.1
Housemates
Spouse	504	70.8	432	71.9	72	64.9	2.23	0.135	478	71.4	26	60.5	2.358	0.125
Living alone	96	13.5	77	12.8	19	17.1	1.489	0.222	86	12.9	10	23.3	3.747	0.053^†
Marriage status
Married	520	73.0	445	74.0	75	67.6			493	70.5	27	62.8
Unmarried	104	14.6	84	14.0	20	18.0	—	0.515^a	96	13.7	8	18.6	—	0.345
Separation	56	7.9	45	7.5	11	9.9			50	7.2	6	14.0
Bereavement	32	4.5	27	4.5	5	4.5			30	4.3	2	4.7
Duration since	56.6	55.4	56.9	55.6	54.7	54.2	−0.3867	0.699
Cancer types
Breast	202	28.4	156	26.0	46	41.4	11.055	0.001^**	177	26.5	25	58.1	19.956	0.000^**
Lung	34	4.8	32	5.3	2	1.8	2.557	0.110	34	5.1	0	0	—	0.257^a
Stomach	60	8.4	48	8.0	12	10.8	0.968	0.325	56	8.4	4	9.3	—	0.777^a
Liver	18	2.5	17	2.8	1	0.9	—	0.335^a	18	2.7	0	0	—	0.619^a
Colon	90	12.6	78	13.0	12	10.8	0.399	0.528	88	13.2	2	4.7	2.645	0.104
Kidney	18	2.5	14	2.3	4	3.6	—	0.505^a	16	2.4	2	4.7	—	0.297^a
Prostate	103	14.5	98	16.3	5	4.5	10.547	0.001^**	102	15.2	1	2.3	5.452	0.020^*
Bladder	21	2.9	20	3.3	1	0.9	—	0.228^a	21	3.1	0	0	—	0.631^a
Ovarian	16	2.2	14	2.3	2	1.8	—	1.000^a	16	2.4	0	0	—	0.616^a
Cervical	32	4.5	25	4.2	7	6.3	—	0.318^a	28	4.2	4	9.3	—	0.120^a
Uterine body	24	3.4	16	2.7	8	7.2	—	0.038^a^,*	21	3.1	3	7.0	—	0.172^a
Blood	24	3.4	22	3.7	2	1.8	—	0.564^a	22	3.3	2	4.7	—	0.651^a
Brain	6	0.8	5	0.8	1	0.9	—	1.000^a	6	0.9	0	0	—	1.000^a
Others	129	18.1
Treatment experience
Surgery	478	67.1	397	66.1	81	73.0	2.031	0.154	445	66.5	33	76.7	1.915	0.166
Chemotherapy	233	32.7	187	31.1	46	41.4	4.538	0.033^*	215	32.1	18	41.9	1.735	0.188
Radiation therapy	187	26.3	160	26.6	27	24.3	0.255	0.613	176	26.3	11	25.6	0.011	0.916
Hormone therapy	232	32.6	185	30.8	47	42.3	5.7	0.017^*	211	31.5	21	48.8	5.503	0.019^*
Others	77	10.8
KPS	1.6	0.9	1.6	0.9	2.0	1.0	4.252	0.000^***	1.59	0.9	2.40	1.2	4.499	0.000^***

M, mean; SD, standard deviation.

^aFisher’s exact test.

^***P < 0.001.

^**P < 0.01.

^*P < 0.05.

^†P < 0.10.

Next, as a result of the examination of those who were using services (henceforth, ‘users’) and those who were not currently using them (excluding Relapse to an earlier stage) (henceforth, ‘non-users’), most of the results were similar to those examined based on their usage experience. Participants with the following characteristics were more likely to use such services: younger age (t(53.725) = −7.333, P = 0.000), female (χ² = 14.734, df = 1, P = 0.000), breast cancer (χ² = 19.956, df = 1, P = 0.000), experience with hormone therapy(χ² = 5.503, df = 1, P = 0.019), those who do not have a good KPS status (t(44.980) = 4.499, P = 0.000) and those who live alone (χ² = 3.747, df = 1, P = 0.053). Conversely, there were a few users who were prostate cancer patients (χ² = 5.452, df = 1, P = 0.020).

The stage of HSB for psychosocial support services and distress among inexperienced

Of the inexperienced participants (n = 601), 538 were in the Precontemplation stage (89.5%), 62 were in the Contemplation stage (10.3%) and 1 was in the Preparation stage (0.2%). Of the participants (excluding the Preparation stage), 245 respondents were classified as suffering from adjustment disorders or major depression (40.8%). Approximately 35% of those in the Precontemplation stage had either, 152 had adjustment disorders (28.3%) and 36 had major depression (6.7%), whereas 91.9% of those in the Contemplation stage had either, 31 had adjustment disorders (50.0%) and 26 had major depression (41.9%). A χ² test found significant associations between the stages and distress (χ² = 105.966, df = 2, P = 0.000). There were significantly more people who were classified as suffering from adjustment disorders or major depression in the Contemplation stage; however, there were more people who were classified as without either of them in the Precontemplation stage (Table 4).

Table 4

Relationships between the stage and HADS

	Precontemplation (n = 538)		Contemplation (n = 62)		χ²	P
	n	%	n	%
Adjustment	350	65.1	5	8.1
Adjustment disorders	152	28.3	31	50.0	105.966	0.000^***
Major depression	36	6.7	26	41.9

	Precontemplation (n = 538)		Contemplation (n = 62)		χ²	P
	n	%	n	%
Adjustment	350	65.1	5	8.1
Adjustment disorders	152	28.3	31	50.0	105.966	0.000^***
Major depression	36	6.7	26	41.9

^***P < 0.001.

Table 4

Relationships between the stage and HADS

	Precontemplation (n = 538)		Contemplation (n = 62)		χ²	P
	n	%	n	%
Adjustment	350	65.1	5	8.1
Adjustment disorders	152	28.3	31	50.0	105.966	0.000^***
Major depression	36	6.7	26	41.9

	Precontemplation (n = 538)		Contemplation (n = 62)		χ²	P
	n	%	n	%
Adjustment	350	65.1	5	8.1
Adjustment disorders	152	28.3	31	50.0	105.966	0.000^***
Major depression	36	6.7	26	41.9

^***P < 0.001.

Among them (n = 601), 293 respondents (48.8%) did not know about their familiar psychosocial support services, whereas 186 patients (30.9%) knew about psychosomatic medicine, followed by cancer consulting and support centres (n = 167, 27.8%) and psychiatry (n = 152, 25.3%) (Table 5).

Table 5

Contents of psychosocial support services known by inexperienced

	n	%
Psycho-oncology	20	3.3
Psychiatry	152	25.3
Psychosomatic medicine	186	30.9
Counselling by therapist	58	9.7
Group therapy	11	1.8
Support group	32	5.3
Cancer consulting and support centre	167	27.8
Regional medical cooperation office	73	12.1
Medical care counselling	140	23.3
Cancer salon	66	11.0
Others	4	0.7

	n	%
Psycho-oncology	20	3.3
Psychiatry	152	25.3
Psychosomatic medicine	186	30.9
Counselling by therapist	58	9.7
Group therapy	11	1.8
Support group	32	5.3
Cancer consulting and support centre	167	27.8
Regional medical cooperation office	73	12.1
Medical care counselling	140	23.3
Cancer salon	66	11.0
Others	4	0.7

Table 5

Contents of psychosocial support services known by inexperienced

	n	%
Psycho-oncology	20	3.3
Psychiatry	152	25.3
Psychosomatic medicine	186	30.9
Counselling by therapist	58	9.7
Group therapy	11	1.8
Support group	32	5.3
Cancer consulting and support centre	167	27.8
Regional medical cooperation office	73	12.1
Medical care counselling	140	23.3
Cancer salon	66	11.0
Others	4	0.7

	n	%
Psycho-oncology	20	3.3
Psychiatry	152	25.3
Psychosomatic medicine	186	30.9
Counselling by therapist	58	9.7
Group therapy	11	1.8
Support group	32	5.3
Cancer consulting and support centre	167	27.8
Regional medical cooperation office	73	12.1
Medical care counselling	140	23.3
Cancer salon	66	11.0
Others	4	0.7

Discussion

The purpose of this study was to (i) investigate with the TTM the situation regarding the intention to use such services and the utilization of the contents of psychosocial support services and (ii) to examine factors related to the use of psychosocial support services among cancer outpatients.

The utilization of psychosocial support services among cancer patients

We could grasp the situation regarding the use of psychosocial support services among cancer outpatients in Japan based on our results. Although this survey included services other than psychiatry and psychosomatic medicine, the utilization rate of 15.6% was highly consistent with the results of previous Japanese studies (9,10) and was still lower than Western countries similar to previous studies (7,8). Furthermore, the use rate was 5.8% when limited to psycho-oncology, psychiatry and psychosomatic medicine. It has been pointed out that there is a cultural difference between Japan and the Western countries in the background of the HSB (13,16). For example, Japanese people tend to be more reluctant than American people to seek support from professionals (16). In addition to the culture issue, these rates were lower than in the previous studies, because the situation of our participants might not be as severe as in previous studies, such as lower HADS scores, a lower rate of those currently in treatment and a higher rate of those for whom >5 years had passed since their diagnosis. As mentioned above, we found that not only were psycho-oncology, psychiatry and psychosomatic medicine used, but also several kinds of support services. It might be inferred that the trend in this study of the services used, reporting psychosomatic medicine and cancer consulting at support centres were used more often, was similar to the contents of what cancer patients knew. This is in contrast to a previous study on participants with breast cancer who had subscribed to a mailing list managed by a non-profit organization (17). Additionally, it is thought that the services that relatively many participants had used, such as cancer salons (2.5%), medical care counselling (2.2%), regional medical cooperation offices (1.0%) and support groups (1.7%), were located or held in medical institutions that were visited by the patients; therefore, these services would have been easy to use. However, even though the availability of psychiatric services was known by many participants (27.8%), the usage rate was low (1.5%), which suggests that it is more difficult to use than other services. Japanese reported less indifference to stigma of seeking professional help than Americans (16). Furthermore, one study reported that the label ‘Department of Psychiatry’ (in Japanese, Seishin-ka) itself evokes feelings of stigma in Japan (18). A factor related to resistance to psychiatric stigma was also reported as a barrier for using such services by Japanese cancer patients (19). Additionally, although it is a study targeting Japanese university students, physical symptoms were associated with shortened duration of until psychiatric consultation (20). For these reasons, we might suppose that such a gap would occur.

Factors related to psychosocial support service use

We compared the experiencers with the inexperienced, as well as users with non-users, in terms of demographic variables and variables related to cancer, and most of the results were similar in both examinations. In both, younger and female participants used the services more, which supports previous studies (6,21–23). Females showed a more positive attitude towards receiving mental health services (16,24). In Japan, the number of clinics specializing in psychiatry and psychosomatic medicine has increased considerably between 1996 and 2017 (25). Therefore, it would be possible that younger people might feel less reluctant with these clinics in their daily lives than older people. Additionally, younger Japanese seemed to have a higher stress level than older ones (26), and some studies have shown younger age to be associated with higher levels of distress and unmet needs among cancer patients (27,28). High-level problem awareness does not always lead to use; however, problem awareness is also an important element in the help-seeking process (17,29). Additionally, one Japanese study reported that elderly people tend to seek emotional support from their families (30). Older people showed more negative attitudes towards receiving mental health services (24). Given this background, it would be possible that younger people might seek psychosocial support services.

Regarding the association with cancer types, significantly more use was observed in patients with breast and uterine body cancers (only experiencers), and lower use was observed in patients with prostate cancer. As breast cancer and uterine body cancer are specific to women and prostate cancer is specific to men, especially the old, it would appear that background gender differences affected this outcome, rather than the type of cancer. In this study, those who had experienced hormone therapy had a higher tendency to use such services. In hormonal therapy, patients often take a hormonal agent for several years, which may have side effects on both the mind and body that might influence an increasing number of patients to use such services. However, in this study, all the users of psychosocial support services who had experienced hormone therapy were women, and thus the influence of gender cannot be denied. Additionally, users/experiencers did not show better KPS score than non-users/inexperienced in this study; however, it has also been reported that cancer patients cannot use such services without physical resources (19,29). If their performance status is poor, the mental and physical distress recognized by patients may be presumed to be high, and they thus experience many obstacles in daily life. Therefore, people with such status may have to use psychosocial support services. Furthermore, a significant trend was observed between the use of such services and living alone. It is possible that this is related to the tendency reported in one study in Japan that elderly people with high economic and psychosocial risks tended to prefer formal support sources (30).

About the use stage

Among participants who had used psychosocial support services, most were in the Relapse to an earlier stage (61.3%). Psychosocial support services do not necessarily have to be used continuously once the problem is addressed, which may explain this result. Among the inexperienced, the Precontemplation stage was the most common (89.5%). However, we found that about 40% of the inexperienced, especially about 35% in the Precontemplation stage, were at a higher risk of adjustment disorders or major depression. This result supported previous reports that cancer patients who experience high levels of distress do not necessarily seek help (13,29). According to Cheung et al. (31), only about 70% of those experiencing clinical anxiety and about 40% of those experiencing clinical depressive symptoms were able to accurately capture their symptoms. These would contribute to suggest that the Precontemplation stage should be divided into two stages in future studies. Furthermore, there would be thus a need, especially for high-risk patients, to promote accurately recognizes the seriousness of their problems. In addition, surprisingly, only one person was found to be in the Preparation stage. This result suggests how difficult it is to move from the Contemplation stage to the Preparation stage, and hence, to the use stage.

Conclusion

The utilization of psychosocial support services by Japanese cancer patients is still low. Psychosomatic medicine and cancer consulting and support centres were used more often and were relatively well known. However, even though psychiatry was relatively well known, the usage rate was low, and persistent resistance to the use of psychiatry can thus be inferred. Additionally, cancer patients who suffer from high levels of distress do not necessarily seek help, and thus other modifiable factors should be examined in future studies. Dividing the Precontemplation stage into two stages based on the risk also might be important in future studies.

Limitations

A limitation of this study was that the participants were limited to those who were outpatients and who could use the Internet. However, the study could nonetheless be significant, because we were able to clarify the actual situation for a wider range of psychosocial support services and the distribution of usage stages with TTM, as well factors related the use.

Funding

Japan Society for the Promotional Science, KAKENHI (Grant no. JP15J02668).

Conflict of interest statement

The authors declare that they have no conflict of interest.

Acknowledgement

We used the same data sets as the following: Matsui (32) and Matsui et al. (33). The contents of these papers were edited and a new analysis was added based on the doctoral dissertation of the first author and the following presentation: Matsui et al. (34). (This work was conducted in Graduate School of Human Sciences Osaka University).

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