Survivors of Adolescent and Young Adult Cancers May Be at Increased Risk of Adverse Mental Health Outcomes

Patients Treated at Adult Cancer Centers at Greater Risk
For immediate release
January 25, 2021


Rachel Cagan

 ASCO Perspective
"These important findings underscore the need to incorporate psychological health assessments and integrate psychosocial health into care for young cancer survivors," said Lidia Schapira, MD, FASCO, ASCO expert in cancer survivorship.


ALEXANDRIA, Va. – Survivors of adolescent and young adult cancers may be at increased risk of experiencing adverse mental health outcomes, with patients treated at adult cancer centers at higher risk than those treated at pediatric cancer centers, according to a study published today in the Journal of Clinical Oncology.

“Though adolescents and young adults with cancer are a vulnerable population with unique needs, most will survive the disease,” said Sumit Gupta, MD, PhD, Staff Oncologist and Clinician Investigator at The Hospital for Sick Children and senior author of the study. “The long-term impact of cancer and cancer therapy in this population is not well studied, in particular the impact on mental health.”

This study examined patients age 15 to 21 years old at the time of diagnosis. Patients had acute leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012 in Ontario. Researchers defined two primary mental health outcomes: a low severity visit, any outpatient visit for a mental health complaint to a family physician or any outpatient visit for a psychiatrist; or a severe psychiatric episode, any mental health-related emergency department visit, hospitalization, or suicide.

In this population-based retrospective, matched cohort study, researchers matched 2,208 five-year survivors of adolescent or young adult cancer with 10,457 individuals without a history of cancer based on age, sex, and area of residence. They found survivors experienced a 30% higher rate of outpatient mental health visits and a 20% increased risk of a severe psychiatric episode compared to those without a history of cancer. Anxiety and adjustment disorders accounted for most outpatient visits among survivors, while the severe psychiatric episodes experienced by survivors were more likely to be associated with schizophrenia or other disorders. While the absolute risk of severe psychiatric disorders, including schizophrenia, remained low, the relative risk was twice as high among survivors.

A total of 1,607 (72.8%) survivors received initial cancer therapy in an adult cancer center. This group of patients had an 80% higher rate of outpatient mental health visits compared to those who were treated at pediatric centers. Dr. Gupta notes that more research is needed to determine why this was the case and to identify the interventions that could be effective in addressing it.

View disclosures for Dr. Schapira:

Disclosures for the study authors can be found in the full study.



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