Mental health challenges for adult survivors of adolescent and young adult (AYA) cancers: cause of concern?

Introduction

About 90000 adolescent and young adults between ages 15 and 39 years receive new cancer diagnosis every year in the USA. Brain maturation, relationship development, education and career development are a few of the numerous milestones which develop in the AYA age group. Hence, other than facing challenges with these milestones, the AYA cancer individuals are disproportionately impacted by issues such fertility, cardiotoxicity and financial burnout. 

Existing literature reports up to 40% and 20% individuals with AYA cancers experience depressive and anxiety symptoms respectively. These rates are likely to exacerbate susceptibility to biopsychosocial challenges during ongoing care and post-treatment survivorship period. There is paucity of data on impact of AYA cancer on mental health of survivors as they age into later adulthood. Latest National Cancer Institute study estimated that 44% of the 2.1 million middle aged AYA cancer survivors had their initial diagnosis 20 or more years ago indicating long-term survivorship of this cohort. 

Study objectives

• Understanding the prevalence of mental health challenges and trajectories of middle-aged or older adults with history of AYA cancer
• Compare mental health prevalence and trajectories in survivors of AYA cancer with those who received a cancer diagnosis in adulthood and those who never had cancer.

Method and data source

This cohort analyzed Health and Retirement Study (HRS) data which followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines. HRS dataset was chosen because of its

• National representation
• Longitudinal design
• Sizable subgroup of individuals with a history of AYA cancer

Data from a total of 42405 respondents were assesses of which 39668 participants were found eligible to be included for analyses for the purpose of this research. 

The table below highlights participants characteristics with prevalence rates of specific outcomes outlined in this study.

Key findings

• This study clearly reports a significantly greater prevalence and severity of depression and anxiety in AYA cancer survivors compared to adult survivors and those who did not have cancer. The researchers also found depression to last across all age periods in the AYA cancer survivors substantiating the prolonged and disproportionate impact of cancer related long-term adverse effects.

Considering growing number of cancer cases each year in all ages, as well as advancements in therapeutics, a growing number of survivors can be expected to need mental health support based on the study findings. 

• The research also highlights that female participants had higher prevalence rates than males across HRS waves, across cancer cohorts possibly owing to AYA-specific breast cancers. 
• The general and adult cancer populations of this research demonstrated a U-shaped anxiety trajectory. This was unlike AYA cancer cohort that demonstrated a flattening of symptoms over time, especially into older adulthood (ages >75 years and older) suggesting either survival bias or developing better strategies over time. 

Clinical implication

The researchers quote, “Clinicians are encouraged to be aware of the vulnerability to depression among individuals with a history of AYA cancer while also integrating the U-shaped nature of the depression trajectory into patient education and depression prevention.”

Limitations

This study relies on self-reported data which may have introduced recall bias, particularly for historical cancer diagnoses. 

Mental health outcomes may have been influenced as the HRS does not capture important detailed cancer treatment and surveillance information.

The researchers expect possibility of confounding by unknown factors in this study.  

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834242

This article was published on JAMA network open on May 19, 2025.

Author: Anao Zhang, PhD, University of Michigan School of Social Work.