Digest Commentator: Andrea Johnson, PhD (C), School of Social Work, University of British Columbia

Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

As more adolescents and young adults (AYAs) (ages 15-39) are surviving a diagnosis of cancer, greater attention is being directed towards their psychosocial wellbeing as cancer survivors. Over the past decade, there has been increasing research and practice interest in the prevalence of mental health outcomes (eg. mood and anxiety disorders) experienced by this cohort after treatment. There is a small but robust literature base that has demonstrated peaks of psychological distress experienced by AYAs following treatment completion. However, what remains unknown are the associations between developmental life stage, cancer survivorship, and mental health outcomes for people diagnosed with cancer. Specifically, are AYAs at greater risk for adverse mental health outcomes when compared to cancer-free AYAs and older adult cancer survivors. This article reports on a study designed to answer this question.

The Canadian Community Health Survey (CCHS) was used as a population-based instrument in this study. This survey collects annual health-related data from Canadians of different ages. The final sample size in this study was 239, 316 and this included four combined annual cycles (2007-2010) of respondents. This sample was dichotomized into AYAs (ages 15-39) and older adults (ages 40+). Outcomes of interest in this study were: self-perceived general health status, self-perceived mental health status, and self-reported mood and anxiety disorders diagnosed by a professional. Weighted logistic regression was used to analyze the relationships between age, cancer survivorship, and psychosocial outcomes of respondents.

Cancer survivorship was found to be strongly associated with poor self-perceived mental health and mood and anxiety disorders among AYAs. AYA survivors of cancer were more likely to report mood and anxiety disorders than both AYAs without a history of cancer and older adults who were cancer survivors. This increased prevalence held for both self-perceptions of mental health and self-reported clinically diagnosed mood and anxiety disorders. Notably, 15.1% of AYA cancer survivors and 5.4% of AYAs without cancer reported a diagnosis of anxiety. 14.8% of AYA cancer survivors and 5.7% of AYAs without cancer reported a diagnosis of a mood disorder.

This study advances understanding of the mental health outcomes of AYA cancer survivors. It clearly argues that it is the intersection between developmental stage and a history of cancer that leaves AYA cancer survivors vulnerable to distress.

Why I liked the article: I really liked how this study compared psychological outcomes between AYAs with and without cancer. The psychological distress observed of AYA cancer survivors may be wrongly dismissed in practice as typical “storm and stress” expected of AYAs. The adverse mental health outcomes experienced by AYAs in this survey however surpassed those of AYAs without cancer. There remain significant gaps in AYA psychosocial oncology care. Greater efforts must be made to both understand and respond to the psychological distress experiences of AYAs.

Article: Lang, M.J., Giese-Davis, J., Patton, S.B. & Campbell, J.T. (2017). Does age matter? Comparing post-treatment psychosocial outcomes in young adult and older adult cancer survivors with their cancer-free peers. Psycho-Oncology. Advance online publication. doi:10.1002/pon.4490.

Journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611