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Adolescent and Young Adult Cancer Survivors Are at Increased Risk for Adverse Mental Health Outcomes

Effect Especially Pronounced in Those Treated at Adult Centers


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According to the National Cancer Institute, in 2020, 89,500 adolescents and young adults (AYAs) aged 15 to 39 were diagnosed with cancer, and of these, 84.6% are expected to survive their cancer for 5 years after diagnosis. However, the results from a study by De et al published in the Journal of Clinical Oncology showed that many of AYA cancer survivors experienced substantially higher rates of adverse mental health outcomes, including a 30% higher rate of outpatient mental health visits and a 20% increased risk of a severe psychiatric episode compared to their counterparts without a history of cancer. In addition, survivors treated in adult cancer centers experienced substantially higher (80%) outpatient mental health visits compared with those treated in pediatric settings.

Long-term surveillance for mental health disease is justified in AYA cancer survivors, and effective interventions during or after cancer treatment are needed, according to the study findings.

Study Methodology

The researchers conducted a retrospective population-based study using the IMPACT cohort. They analyzed data on 2,208 adolescent and young adults aged 15 to 21 in Ontario, Canada, diagnosed with six common cancers between 1992 and 2012, and compared them with 10,457 matched controls. Patients were diagnosed with acute leukemia, Hodgkin and non-Hodgkin lymphoma, bone sarcoma, soft-tissue sarcoma, and testicular cancer.

The linkage to provincial health-care data allowed the researchers to analyze rates of outpatient (family physician and psychiatrist) visits for psychiatric indications and time to severe psychiatric events, including emergency room visits, hospitalization, and suicide. Demographic-, disease-, and treatment-related predictors of adverse outcomes—including treatment setting—were examined.

KEY POINTS

  • Survivors of AYA cancers experienced higher rates of outpatient mental health–related visits and a higher risk of severe psychiatric events, including psychosis-related severe events.
  • AYA patients treated at adult cancer centers experienced higher long-term outpatient visit rates compared to AYA patients treated at pediatric centers.
  • Long-term surveillance for mental health disease is justified in AYA cancer survivors. Effective interventions during or after cancer treatment are needed.

Results

The researchers found that among 2,208 survivors and 10,457 matched controls, 5-year survivors experienced higher rates of outpatient mental health visits than controls (671 visits per 1,000 person-years vs 506; adjusted rate ratio [RR] = 1.3, 95% confidence interval [CI] = 1.1–1.5, P = .006). Risk of a severe psychiatric episode was also increased among survivors (adjusted hazard ratio [HR] = 1.2, 95% CI = 1.1–1.4, P = .008). Risk of a psychotic disorder–associated severe event was doubled in survivors (HR = 2.0, 95% CI = 1.3–2.4, P = .007), although absolute risk remained low (15-year cumulative incidence = 1.7%, 95% CI = 1.0–2.7). In multivariable analysis, survivors treated in adult centers experienced substantially higher outpatient visit rates compared with those treated in pediatric settings (RR = 1.8, 95% CI = 1.0–3.1, P = .04).

“Survivors of AYA cancer are at substantially increased risk of adverse mental health outcomes, with those treated in adult centers at particular risk. Although absolute incidence was low, survivors were at increased risk of psychotic disorder–associated severe events. Long-term mental health surveillance is warranted, as is research into effective interventions during or after cancer treatment,” concluded the study authors.

Sumit Gupta, MD, PhD, of The Hospital for Sick Children, is the corresponding author of this study.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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