AYA Cancer Survivors Experience Mental Health Impact Long After Treatment

HealHeal Spring 2021

Survivors of adolescent or young adult cancer diagnosis experience a 20% higher risk of a psychotic episode and a 30% higher chance of an outpatient mental health visit compared to individuals with no history of cancer.

Survivors of an adolescent or young adult (AYA) cancer diagnosis – specifically those treated in adult cancer centers – experience poorer long-term mental health outcomes compared to those of the same age who have not had a cancer diagnosis, according to data published in Journal of Clinical Oncology.

Previous studies have found a higher risk of psychiatric diagnoses among survivors. “Our study confirms this elevated risk and shows that it exists across a spectrum of severity (outpatient visits or hospitalizations) and is prolonged (the increased burden of outpatient visits was seen 15 years after five-year survivorship),” the authors say.

AYA patients often become long-term cancer survivors, but studies on their mental health status is rare and often looked over. Researchers in this study aimed to evaluate the long-term mental health effects in survivors of AYA cancers, analyzing factors such as demographic, disease, treatment and treatment setting.

READ MORE: How COVID-19 Has Impacted Anxiety, Mental Health in Patients with Cancer

Using the Initiative to Maximize Progress in Adolescent and Young Adult Cancer Therapy database, researchers studied 2,208 survivors (surviving at least five years after last cancer event), who had cancer sometime between 1992 and 2012, and 10,457 matched controls with no cancer history. All individuals included were aged between 15 and 21 and from Ontario, Canada.

The researchers sought to identify outpatient visits, such as a visit to a family physician or psychiatrist for a mental health complaint, as well as severe psychotic episodes, including emergency department visits hospitalization or suicide. Rates of each were compared between the AYA survivor group and the matched controls.

Survivors experienced a 30% higher rate of outpatient mental-health visits compared to the control group. Most visits were linked to anxiety disorders, which supports findings from a previous study that found that survivors had a 60% higher risk of anxiety and adjustment disorders than their siblings.

Females, those with outpatient mental health visits prior to cancer diagnosis and treatment with methotrexate all were associated with an increased rate of outpatient visits for survivors.

Among survivors there was a 17.4% incidence of a severe psychiatric event and 13.9% among the control population at 15 years after the five-year survivorship. Survivors had a 20% higher risk of a psychiatric event and had a significantly higher chance of association with schizophrenia or another psychotic disorder.

READ MORE: The Role of Mental Health in Cancer Outcomes

Rural residence and prior mental healthcare visits were associated with severe psychotic episodes among survivors.

Interestingly, authors note that survivors who were treated at an adult’s cancer treatment center had an 80% increased rate of outpatient mental health visit compared to survivors who were treated at a pediatric center.

“Available psychological support may vary between pediatric and adult settings, given differences in patient volumes, although this has not been well studied,” authors note.

Researchers say that future studies should examine if psychological support during treatment is associated with improved long-term mental health. That may help advocate the need for psychological resources in AYA patients during and after cancer treatment.

“Further studies should endeavor to understand mechanisms underlying these associations and to identify interventions both during and after treatment, which can mitigate this risk,” authors conclude.

Limitations of this study include lack of outcomes from mental services provided by non-physicians such as social workers, no data on patients who cannot or choose to not have access to health care and other potential factors to poor mental health such as race, ethnicity or sexual orientation.

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