Study: Mental Health Trajectories Among US Survivors of Adolescent and Young Adult Cancer as They Age
Adolescent and young adult cancer survivors exhibit persistently elevated levels of depression and anxiety throughout their lifespan, but only symptoms of anxiety tend to stabilize in their later years, say University of Michigan researchers.
The findings appear in a new study published in JAMA Network Open that sheds light on the lingering mental health struggles faced by people who were first diagnosed with cancer between ages 15-39.
In the United States, more than 2.1 million adult survivors of cancer were diagnosed in adolescence and young adulthood. The mental health burden during treatment has been well documented, but the long-term mental health trajectories of these survivors into later adulthood have not been explored.
Given the continuously rising number of young cancer survivors, the research is important in recognizing and addressing these enduring challenges to enhance their quality of life, the researchers said.
"The study highlights a critical need for continuous psychological support for this unique group," said Anao Zhang, U-M associate professor of social work and the study's first author.
Zhang and colleagues used nationally representative data from the Health and Retirement Study from nearly 40,000 participants, which is generalizable to more than 100 million residents in the U.S over age 50. They were divided into three groups: participants with a history of adolescent/young adult cancer, cancer diagnosed as adults, and no cancer history. The respondents answered questions about their mental health, including depression and anxiety, among others.
Using growth curve models to track the participants' symptoms, the study found a pronounced "U-shaped curve" in depression symptoms throughout life, with adolescent/young adult survivors having significantly higher levels.
This suggests that the stressors related to their cancer experiences leave a lasting mark, Zhang said.
In contrast, the study showed that anxiety symptoms among these survivors tend to stabilize over time, hinting at a potential development of resilience.
Adult survivors of adolescent and young adult cancer exhibited the worst mental health concerns in middle and older adulthood when compared with those diagnosed with cancer in adulthood and those without cancer. At a younger age, this group faced disproportionate challenges, such as issues involving fertility or reproductive capacity, cardiotoxicity and financial toxicity, according to the study.
The researchers noted that cancer clinicians should recognize the mental health burden for the population in middle age and older adulthood.
In addition to Zhang, study authors included Emily Urban-Wojcik, statistician lead, and Meghan Seewald, data and design core manager, both at U-M's Eisenberg Family Depression Center; and Bradley Zebrack, professor of social work and researcher at the U-M Institute for Healthcare Policy and Innovation.
The dataset used was funded by the National Institute on Aging (NIA U01AG009740 and NIA R01AG073289) and the Social Security Administration.
