Survivors of adolescent and young adult (AYA) cancers are at a higher risk for adverse mental health outcomes, according to study data published in the Journal of Clinical Oncology. Specifically, these patients were found to have a higher propensity for outpatient mental health visits and severe psychiatric episodes compared with matched control patients.

The study included 2208 AYA cancer survivors identified in Ontario, Canada. Participants were aged 15 to 21 years when diagnosed with 1 of 6 common cancers between 1992 and 2012. The investigators compared these survivors’ outcomes with those of 10,457 matched control patients.

Five-year survivors were found to have a 30% higher rate of outpatient mental health visits vs controls (671 per 1000 person-years vs 506 per 1000 person years). The adjusted rate ratio (RR) was 1.3 (95% CI, 1.1-1.5; P =.006). These visits were driven mainly by visits related to anxiety disorders, the researchers noted.

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The risk for a severe psychiatric episode was also significantly increased among survivors compared with controls (adjusted HR, 1.2; 95% CI, 1.1-1.4; P =.008). The cumulative 15-year incidence was 17.4% among survivors and 13.9% among controls.

“Risk of a psychotic disorder-associated severe event was doubled in survivors (HR, 2.0; 95% CI, 1.3-2.4; P =.007) although absolute risk remained low(15-year cumulative incidence, 1.7%; 95% CI, 1.0-2.7),” the researchers said, adding that this finding was “unexpected and concerning.”

Data from a multivariable analysis showed that AYA survivors who were treated for their cancer at an adult center had substantially higher outpatient visit rates compared with survivors who had been treated in a pediatric setting (RR, 1.8; 95% CI, 1.0-3.1; P =.04).

“This is particularly striking as our observation began at least 5 years after the initial cancer diagnosis, by which time patients with AYA treated in a pediatric center would have transitioned into the adult system,” the researchers wrote.

Certain demographic factors were also associated with increased rates of outpatient visits including female versus male sex and an increased rate of mental health visits prior to cancer diagnosis. 

Disclosures: One of the study authors disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the original study.


De R, Sutradhar R, Kurdyak P, et al. Incidence and predictors of mental health outcomes among survivors of adolescent and young adult cancer: a population-based study using the IMPACT Cohort. J Clin Oncol. Published online January 25, 2021. doi:10.1200/JCO.20.02019