Question

differentiate between physical and social health of an individual
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Answer 1

Young adults (YAs; ages 18–39) with cancer face interrupted developmental milestones and increased stressors that can adversely influence psychosocial adjustment. Transitioning from active treatment to post-treatment survivorship can be particularly challenging. The purpose of this study is to describe the health-related quality of life (HRQL) and psychological adaptation of YAs post-treatment relative to young adults without cancer.

METHODS

Three cohorts of YAs of mixed cancer diagnoses (N=120, 0–12 months post-treatment; N=102, 13–24 months post-treatment; and N=113, 25–60 months post-treatment; combined M=31.8 years old, combined gender=68% women) and an age, education, gender, and partner-status matched group of healthy control participants (HCs; N=335) were recruited via an online research panel. All participants completed measures assessing demographic and clinical characteristics, HRQL (physical, emotional, social, and spiritual), and psychological adaptation (anxiety, depression, positive affect, posttraumatic growth). Measure content was slightly modified for applicability to HCs without a cancer history.

RESULTS

Multivariate analysis of covariance found a significant main effect for group (YAs versus HCs) and a significant group-by-cohort interaction. YAs reported poorer physical (p=.005, d=.22) and emotional well-being (p=.011, d=.20) but better social well-being (p<.001, d=.49). YAs reported comparatively stable scores (p=.74) for posttraumatic growth compared to HCs, who reported greater posttraumatic growth across cohorts (p=.01, d=16).

CONCLUSIONS

Findings underscore the negative and positive sequelae for YAs and highlight the need for comprehensive assessment among YA survivors of cancer. A matched, HC group allows the HRQL and psychological adaptation of YAs to be placed in context, enabling a more precise determination of the impact of cancer on YAs.

Keywords: survivorship, quality of life, young adults, controlled comparison study, posttraumatic growth

INTRODUCTION

The five-year cancer survival rate for adolescents and young adult (YAs) aged 15 to 39 years old has not improved in almost three decades and contrasts markedly with improvements observed in the five-year survival rates of younger and older age groups.1 Accordingly, studies of older cancer survivors 2, 3or adult survivors of childhood cancer4, 5 represent the majority of psychosocial oncology survivorship research. The limited studies available on YAs have focused on healthcare needs,6, 7 positive and negative life impact of cancer,8 and fertility concerns.9 More recently, research has included the post-diagnosis (6–14 months) health-related quality of life (HRQL) of adolescents and YAs with cancer,10but additional work is needed to further understand their post-treatment HRQL and general psychological adaptation as they transition from the end of treatment to a stage of monitoring (i.e., re-entry) and beyond.

Cancer survivors of all ages likely experience common life disruptions secondary to cancer (e.g., goal interference and altered interpersonal relationships and body-sexual image); however, the specific impact and meaning attributed to these disruptions may vary across developmental life stages.11 Given the unique emotional and social life changes that take place during young adulthood (e.g., developing a positive body image and sexual identity, dating and building social networks, making decisions about higher education, careers, and family), a cancer diagnosis and treatment for YAs may be especially disruptive.12Furthermore, similar to other medically underserved groups such as racial and ethnic minorities, YA cancer survivors face challenges related to healthcare access, including restricted or delayed medical care due to having the highest uninsured rate of any age group in the U.S.13