Thursday, June 22, 2023

Childhood Cancer Survivors Have Greater Risk of Some Mental Disorders in Adulthood

Children, adolescents, and young adults who survive cancer may be more likely to experience depression, anxiety, and psychotic disorders such as schizophrenia after cancer remission compared with their peers and siblings who did not have cancer, according to a study published today in JAMA Pediatrics.

“It is well established that a diagnosis of cancer and subsequent treatment may be highly traumatizing for all age groups, especially for children in their formative years,” wrote Ainsley Ryan Yan Bin Lee, M.B.B.S., of the Yong Loo Lin School of Medicine at the National University of Singapore and colleagues. “Detecting those [children, adolescents, and young adults with cancer] at a higher risk for prolonged distress by studying the risk and risk factors is crucial to facilitate appropriate and timely psychological interventions.”

Lee and colleagues conducted a systematic review of studies published from 2000 to 2022 in PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central. The studies measured risk and/or severity of depression, anxiety, psychotic disorders, and death by suicide in children, adolescents, and young adults with cancer compared with those who did not have cancer, which could include family members or matched controls. The studies included both patients currently receiving treatment for cancer and cancer survivors. Those actively receiving cancer treatment were no older than 25 years, and those who were cancer survivors received their cancer diagnoses when they were no older than 25 years.

The authors analyzed 52 studies. Youth with cancer had a significantly increased lifetime risk of severe depression symptoms, anxiety, and psychotic disorders compared with both family members and matched controls. Additional findings include the following:

  • The risk of severe depression or anxiety symptoms was elevated regardless of the participant’s age at cancer diagnosis.
  • Depression severity was elevated in both youth receiving active cancer treatment and cancer survivors.
  • Anxiety severity was elevated in youth receiving active cancer treatment, but not in cancer survivors.
  • Certain subpopulations of youth with cancer or a history of cancer had a significantly increased risk of suicide mortality, particularly those diagnosed between the ages of 15 and 19 years.
  • Several studies found significant associations between lower educational levels and increased risk of mental illness or suicide; lower income and increased risk of depression, anxiety, or both; and partnership status and lower risk of depression and anxiety.

The authors concluded by urging policymakers and health care professionals to be cognizant of vulnerable subgroups who may develop severe psychiatric illnesses following a cancer diagnosis.

“The results of this study offer the interprofessional [children, adolescent, and young adult] oncology community an opportunity: we can put the debate about survivors’ mental health risks to rest,” wrote Abby Rosenberg, M.D., M.S., M.A., and Anna Muriel, M.D., M.P.H., of the Dana-Farber Cancer Institute in Boston in an accompanying commentary. “We can accept that these patients are more likely to suffer from clinically significant depression, anxiety, [and] psychotic disorders, and—in some cases—are at higher risk of death by suicide. We can therefore devote our energies to determining how to meet the needs of each patient in real time, targeting those most at risk.”

For related information, see the Psychiatric News article “Expert’s Corner: Best Practices for Treating Cancer Patients With Psychiatric Symptoms” and the Psychiatric Services article “Impact of Psychiatric Diagnoses and Treatment on Postoperative Outcomes Among Patients Undergoing Surgery for Colorectal Cancer.


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