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Mental distress often untreated among adolescent, young adult cancer survivors
Survivors of adolescent and young adult cancer appeared more likely to report mental distress than those who never had cancer, yet many survivors did not receive the mental health services they need, according to study results published in Cancer.
“Our analysis shows that survivors of adolescent and young adult cancer require mental health-related support,” Sapna Kaul, PhD, assistant professor in the department of preventive medicine and community health at University of Texas Medical Branch, told HemOnc Today. “There is a strong need to establish effective ways in which we integrate mental health with oncology care to provide more targeted mental health screening and counseling to high-risk cancer survivors.”
Kaul and colleagues examined the prevalence of mental distress among 875 adolescent and young adult cancer survivors included in the National Health Interview Surveys between 2013 and 2014. All survivors received their initial cancer diagnosis at least 5 years earlier.
Researchers compared the survivors with age-matched individuals who never had cancer.
Survivors appeared more likely than those who never had cancer to report both moderate (23.2% vs. 16.9%) and severe (8.4% vs 3%) mental distress. Nearly 75% of survivors with moderate distress and 52% of survivors with severe distress indicated they did not receive care from mental health professionals within the previous year.
HemOnc Today spoke with Kaul about the study results and their implications.
Question: What prompted this research?
Answer: I have a keen interest in studying health outcomes of adolescent and young adult cancer survivors. These patients — a unique population — are diagnosed with cancer between the ages of 15 and 39 years, a key period of development and social growth. In our previous research, we found these patients report a greater burden of health conditions than with their peers from the general population. We questioned if there is a similar effect in terms of mental distress among this patient population.
Q: What did you find?
A: Adolescent and young adult cancer survivors were significantly more likely to report mental distress than their peers from the general population. Nearly one-third of survivors reported at least moderate mental distress. Although survivors reported using mental health care more often than their peers, only about 14% of survivors said that they had talked to a mental health professional within the previous year. These findings suggest mental health concerns of this patient population are undertreated.
Q: What are the potential explanations of your findings?
A: Prevalence of greater distress among cancer survivors could be caused by a multitude of reasons. They may experience distress because of treatment-related fatigue, or due to fear of cancer relapse and death. Moreover, adolescent and young adult cancer survivors can experience psychosocial changes during the phase of treatment and survivorship, which also may influence their risk for mental distress.
Q: Did any of the findings surprise you?
A: We were surprised by the gap in mental health care delivery. Nearly 75% of survivors with moderate distress and 52% of survivors with severe distress reported not speaking with a mental health professional in the previous year. These are significant numbers and suggest that these survivors may not be receiving necessary mental health counseling.
Q: How should these findings change clinical practice?
A: We need to spread awareness regarding the risk for mental distress among adolescent and young adult cancer survivors, and this information is extremely important for physicians who care for these patients. Mental health screening and counseling should be an important component of cancer care and primary care. Help from mental health professionals and online tools can help these survivors deal with distress.
Q: What should future research entail?
A: Patients self-reported these data. Although we used a validated instrument to quantify nonspecific mental distress, future research should examine cancer-specific distress measures for this patient population. In addition, we examined a cross-sectional dataset; however, distress may vary over time. Future studies should use longitudinal data to evaluate the course of distress among these patients.
Q: Is there anything else that you would like to mention?
A: In this study, we also identified survivor characteristics associated with greater mental distress. For example, survivors with greater comorbidity reported distress more often. Similarly, survivors who were current smokers reported severe distress more often than nonsmokers. Therefore, an effective strategy will include targeting survivors who face a greater risk for distress with appropriate mental health resources. – by Jennifer Southall
Reference:
Kaul S, et al. Cancer. 2017;doi:10.1002/cncr.30417.
For more information:
Sapna Kaul, PhD, can be reached at University of Texas Medical Branch, 301 University Blvd., Ewing Hall, Suite 1.128, Galveston, TX 77555; email: sakaul@utmb.edu.
Disclosure: Kaul reports no relevant financial disclosures.