Physical, emotional, and social health differences between posttreatment young adults with cancer and matched healthy controls

Abstract

PURPOSE Young adults (YAs; ages 18–39) with cancer face interrupted developmental milestones and increased stressors that can adversely influence psychosocial adjustment. Transitioning from active treatment to post-treatment survivorship can be particularly challenging. The purpose of this study is to describe the health-related quality of life (HRQL) and psychological adaptation of YAs post-treatment relative to young adults without cancer. METHODS Three cohorts of YAs of mixed cancer diagnoses (N=120, 0–12 months post-treatment; N=102, 13–24 months post-treatment; and N=113, 25–60 months post-treatment; combined M=31.8 years old, combined gender=68% women) and an age, education, gender, and partner-status matched group of healthy control participants (HCs; N=335) were recruited via an online research panel. All participants completed measures assessing demographic and clinical characteristics, HRQL (physical, emotional, social, and spiritual), and psychological adaptation (anxiety, depression, positive affect, posttraumatic growth). Measure content was slightly modified for applicability to HCs without a cancer history. RESULTS Multivariate analysis of covariance found a significant main effect for group (YAs versus HCs) and a significant group-by-cohort interaction. YAs reported poorer physical (p=.005, d=.22) and emotional well-being (p=.011, d=.20) but better social well-being (p<.001, d=.49). YAs reported comparatively stable scores (p=.74) for posttraumatic growth compared to HCs, who reported greater posttraumatic growth across cohorts (p=.01, d=16). CONCLUSIONS Findings underscore the negative and positive sequelae for YAs and highlight the need for comprehensive assessment among YA survivors of cancer. A matched, HC group allows the HRQL and psychological adaptation of YAs to be placed in context, enabling a more precise determination of the impact of cancer on YAs.

Anxiety and Depression in Cancer Survivors

“…26 Other cohorts of AYA’s that were much larger (between N=300 and N=6000) found that AYA’s reported more distress than controls. 27–29 These inconsistent findings may be due to differing populations of survivors, methodologies or measures used.…”

Goal Navigation, Approach-Oriented Coping, and Adjustment in Young Men with Testicular Cancer

“…Concerns about the achievement of life goals may be especially distressing for adolescents and young adult survivors [4,5], who are negotiating greater autonomy across life domains and are motivated to achieve future goals. Adjustment to challenged goals constitutes adaptive self-regulation [7] and may be particularly critical when cancer occurs in early adulthood [8,9]. Understanding the skills young adult cancer survivors need to navigate challenges to their goals may help facilitate adjustment.…”

Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview.

“…Young adult cancer survivors are a population of particular clinical interest because they have been found to be particularly susceptible to psychological adjustment problems after cancer, with several studies demonstrating higher rates of anxiety and depression compared to same-age peers (Hobbie et al, 2000; Kwak et al, 2013a; 2013b; Michel, Rebholz, von der Weid, Bergstraesser, & Kuehni, 2010; Recklitis et al, 2010; Salsman et al, 2014; Zeltzer et al, 2009). Psychological screening has been recommended to address this risk in YACS (Children's Oncology Group, 2013; Clinton-McHarg et al, 2010; Langeveld, Stam, Grootenhuis, & Last, 2002; Recklitis, O'Leary, & Diller, 2003), but there is limited empirical information to guide selection of screening measures for this population.…”