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Adult Cancer Survivors at Increased Risk of Psychological Distress


Long-term survivors of cancer that developed in adulthood are at increased risk of experiencing serious psychological distress, according to a report in the Archives of Internal Medicine.

“The number of cancer survivors has steadily increased over the last three decades and is expected to continue to increase …,” the authors write. “As more individuals survive cancer, it is important to understand how cancer and cancer therapies affect long-term quality of life and psychological adjustment.” Karen E. Hoffman, MD, MHSC, of Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston, MA, and colleagues studied participants in the National Health Interview Survey. Participants were asked questions about their history of cancer and assessed using a scale of serious psychological distress. The researchers compared the responses of individuals who had survived five years or longer following the diagnosis of an adult-onset cancer with those of individuals who had never had cancer.

A total of 5.6 percent of cancer survivors screened positive for severe psychological distress within the previous 30 days, compared with 3 percent of those without cancer. “After adjustment for other clinical and sociodemographic variables, long-term survivors who were younger, were unmarried, had less than a high school education, were uninsured, had more comorbidities or had difficulty performing instrumental activities of daily living were more likely to experience serious psychological distress,” the authors write.

A history of cancer may affect current mental health in several ways, the authors note. “Cancer diagnosis and treatment can produce delayed detrimental effects on physical health and functioning, such as secondary cancers, cardiac dysfunction, lung dysfunction, infertility, neurological complications, and neurocognitive dysfunction,” they write. “A cancer history can also affect social adaptation, employment opportunities, and insurance coverage. Adjusting to these functional and life limitations may create long-term psychological stress.”

One-third of survivors with serious psychological distress reported using mental health services, whereas 18 percent said they could not afford mental healthcare during the previous year.

“Because long-term survivors may not be seen by oncologists as frequently as they were during treatment, or at all, the increased risk of serious psychological distress and the need to screen for serious psychological distress should be communicated to primary care physicians and other care providers,” the authors conclude. “Given that cancer survivors with more chronic medical conditions tended to be those most at risk for psychological distress in this study, the findings also underscore the need to integrate medical and behavioral healthcare for survivors.”

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This article was published in Coping® with Cancer magazine, September/October 2009.