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Young Cancer Survivors Have an Increased Risk of Mental Health Disorders

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A diagnosis of cancer and subsequent treatment experience constitute a traumatising period for many patients, especially younger groups in their formative years, for whom the process may result in long-lasting psychological consequences.

A team led by Assistant Professor Cyrus Ho from the Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), conducted a review and analysis that comprehensively evaluated 52 studies of psychological outcomes and deaths by suicide in over 20,000 childhood, adolescent and young adult cancer patients and survivors, compared to their siblings, parents and non-cancer counterparts. The team also comprised Professor Roger Ho from the Department of Psychological Medicine, Dr Ainsley Ryan Lee, an alumnus of NUS Medicine, as well as Phase III medical students, Low Chen Ee and Yau Chun En.

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Published in JAMA Pediatrics, the review and analysis found that childhood, adolescent and young adult cancer patients and survivors are at an increased lifetime risk of developing depression, anxiety and mental health illnesses even after remission of cancer, when compared to their siblings and demographically-matched non-cancer counterparts. For depression and anxiety, the risk was particularly higher in cohorts above the ages of 30 and 25 years old respectively. It was also found that certain groups, such as those diagnosed with cancer in their older adolescent years, aged 15 to 19 years old, were at increased risk of death by suicide.

Asst Prof Cyrus Ho, said, “Receiving a diagnosis of cancer, going through treatment and trying to survive cancer, is altogether a challenging process for cancer patients, and even survivors. For adolescents and young adults, this process often means a loss of opportunities in life, as they miss out on education, and social interactions, which are critical formative experiences in their years of growing up. In addition, they have to cope with changes in their appearance, dietary habits and lifestyles, all of which can be especially difficult adjustments to make, at the age where most of their peers seem to enjoy the freedom to explore these areas of life.”

The team also found that while depression is more pervasive after treatment, anxiety is observed to be more predominant during the process of treatment. As anxiety is a reactive response that develops more quickly, it is often a more prominent symptom in the early stages, when patients receive the cancer diagnosis and begin treatment. Over time, when anxiety is not treated, it can lead to depression, which continues even into the years of early survivorship, when patients are in remission.

Reference: Lee ARYB, Low CE, Yau CE, Li J, Ho R, Ho CSH. Lifetime burden of psychological symptoms, disorders, and suicide due to cancer in childhood, adolescent, and young adult years: A systematic review and meta-analysis. JAMA Pediatrics. 2023. doi: 10.1001/jamapediatrics.2023.2168

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