Factors Influencing Engagement in Psycho-Oncology Services at a Comprehensive Cancer Center

Background: Psychological distress is common among cancer patients, yet some patients referred to psycho-oncology services do not engage in care. Identifying factors associated with engagement may improve supportive care access and reduce disparities. We evaluated sociodemographic and clinical predictors of psychotherapy utilization among patients referred by oncologists or self-referred to psycho-oncology. Methods: We retrospectively reviewed adults with cancer referred to psycho-oncology services between December 2022 and August 2024, with follow-up through December 2025. The primary outcome was attendance versus nonattendance at the initial psychotherapy appointment. Secondary analysis evaluated total psychotherapy visits. Logistic regression and negative binomial regression identified predictors of initial attendance and subsequent utilization, respectively. Results: Among 404 eligible patients, 98 (24.3%) attended no appointments. Median utilization was 2 visits (IQR, 1–5) over 25.7 months (IQR, 15.1–34.1) of follow-up. In multivariable analysis, nonattendance was associated with lack of religious affiliation (Adjusted OR (aOR), 22.7; 95% CI, 8.52–60.5), less than college education (aOR, 7.56; 95% CI, 2.99–19.3), and referral for anxiety alone (aOR, 4.47; 95% CI, 1.72–11.6), depression alone (aOR, 4.15; 95% CI, 1.19–14.4), or other indications (aOR, 34.8; 95% CI, 9.39–129.1) versus combined anxiety and depression (all p ≤ 0.03). Higher visit rates were associated with virtual visits (Incidence rate ratios (IRR), 2.92; 95% CI, 2.20–3.89), physician referral (IRR, 2.05; 95% CI, 1.49–2.81), later referral, religious affiliation (IRR, 4.05; 95% CI, 2.79–5.88), anxiety/depression referral, and targeted therapy (all p < 0.01). Conclusions: Psycho-oncology engagement varies by educational, social, clinical, and referral factors. Telehealth was associated with greater utilization, while referral timing and source may represent modifiable targets for improving engagement and access to supportive care.