Psychological morbidities in adolescent and young adult blood cancer patients during curative‐intent therapy and early survivorship

Abstract

BACKGROUND: Adolescents and young adults (AYAs) with cancer face unique psychosocial challenges. This pilot study was aimed at describing the prevalence of psychological morbidities among AYAs with hematologic malignancies during curative-intent therapy and early survivorship and at examining provider perceptions of psychological morbidities in their AYA patients. METHODS: Patients aged 15 to 39 years with acute leukemia, non-Hodgkin lymphoma, or Hodgkin lymphoma who were undergoing curative-intent therapy (on-treatment group) or were in remission within 2 years of therapy completion (early survivors) underwent a semistructured interview that incorporated measures of anxiety, depression, and posttraumatic stress (PTS). A subset of providers (n 5 15) concomitantly completed a survey for each of the first 30 patients enrolled that evaluated their perception of each subject's anxiety, depression, and PTS. RESULTS: Sixty-one of 77 eligible AYAs participated. The median age at diagnosis was 26 years (range, 15-39 years), 64% were male, and 59% were non-Hispanic white. On-treatment demographics differed significantly from early-survivor demographics only in the median time from diagnosis to interview. Among the 61 evaluable AYAs, 23% met the criteria for anxiety, 28% met the criteria for depression, and 13% met the criteria for PTS; 46% demonstrated PTS symptomatology. Thirty-nine percent were impaired in 1 or more psychological domains. Psychological impairments were as frequent among early survivors as AYAs on treatment. Provider perceptions did not significantly correlate with patient survey results. CONCLUSIONS: AYAs with hematologic malignancies experience substantial psychological morbidities while they are undergoing therapy and during early survivorship, with more than one-third of the patients included in this study meeting the criteria for anxiety, depression, or traumatic stress. This psychological burden may not be accurately identified by their oncology providers. Cancer 2016;122:954-61. V C 2016 American Cancer Society.KEYWORDS: acute leukemia, adolescent and young adult, distress, lymphoma, psycho-oncology, psychosocial oncology, survivorship. INTRODUCTIONAdolescent and young adult oncology (AYAO) is an expanding field that encompasses the epidemiology, biology, therapeutic approaches, and supportive-care needs of adolescents and young adults (AYAs) with cancer. In addition to exploring host and disease-related characteristics of AYAs, there is particular interest in studying the experience of the AYA cancer patient. 1 Emerging literature has described the effect of cancer on specific psychosocial domains recognized as being of great relevance to AYAs, such as fertility, life adjustment, relationships, financial burdens, and employment. 2 However, less is known about the overall psychological effect of cancer itself on the AYA population.The transition from adolescence into young adulthood is associated with increasing autonomy and self-identity formation, and it is often identified as a vulnerable time...

Prevalence of mental disorders and psychosocial distress in German adolescent and young adult cancer patients (AYA)

“…Similar to recent studies based on self‐report questionnaires, we found moderate and severe symptoms of anxiety and/or depression in more than a quarter of AYAs with cancer. In both our and the Muffly et al study, the screening instrument used revealed that more patients had increased depression scores than they did increased anxiety scores. Our CIDI‐O results showed a significantly lower prevalence rate of mood disorders than the PHQ‐9 results did, a phenomenon that is certainly due to the differing nature of those instruments (questionnaire to detect some selected symptoms vs clinical interview to detect psychiatric diagnosis).…”

“…Existing research shows that AYA cancer survivors have a worse quality of life (QoL) than their general population peers, as well as specific problems in areas such as fertility, sexuality, career, and psychological well‐being. The majority of the few studies who examine psychological distress of AYAs with cancer have found that every fourth patient exceeds distress cutoff values during and after medical treatment . Furthermore, AYAs with cancer who have completed medical treatment are more distressed than age‐matched healthy controls .…”

Challenges and opportunities in the care of survivors of adolescent and young adult cancers

“…Similarly, AYA survivors may avoid care because it would require missing work and lower their income, making it difficult to pay household bills. Indeed, in a study of AYA cancer survivors receiving financial assistance grants, 92% of the financial support provided was to support non‐medical costs, of which rent/mortgage accounted for 62% . Such findings suggest that AYA need additional support in order to maintain an appropriate income while receiving recommended care, particularly in settings without universal healthcare …”

Anxiety and Depression in Cancer Survivors

“…22 In a cohort of hematologic malignancy survivors that used semistructured interviews, 23% met criteria for anxiety, 28% met criteria for depression and 13% met criteria for PTSS. 23 In a sample of Australian AYA’s, almost half were classified as being above the cutoff score for PTSS. 24 FOR is also common in young adult cancer survivors.…”