Long-Term Cancer Survivors More Likely to Have Severe Psychological Distress

Nick Mulcahy

September 24, 2008

September 24, 2008 — Long-term survivors of adult-onset cancers have nearly twice the rate of severe psychological distress (SPD) as people without a cancer diagnosis, according to a new national study presented at the annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) 50th Annual Meeting, in Boston, Massachusetts.

The prevalence of SPD was significantly higher among long-term cancer survivors (5.6%) than among people never diagnosed with cancer (3.0%) in the study, said Karen Hoffman, MD, lead author of the study and a radiation oncologist at the Harvard Radiation Oncology Program at Harvard Medical School, in Boston.

"We hope that this [study] will encourage physicians to evaluate their patients for psychological stress," she told reporters at a press conference.

SPD is defined as distress that causes moderate to serious problems functioning in social, work, or school situations, added Dr. Hoffman.

Younger Patients at Highest Risk

In the study, there was no association between the number of years since the cancer diagnosis and the increased risk for distress among survivors.

However, the researchers identified several clinical and sociodemographic factors associated with SPD in long-term cancer survivors.

The most pronounced factor is a younger age at diagnosis. Long-term cancer survivors younger than 45 years of age at diagnosis are 5.6 times more likely to experience SPD than survivors 65 years and older at diagnosis. People 45 to 65 years old at diagnosis are 2.7 times more likely to have SPD than those 65 years and older.

"I would speculate that younger people are more susceptible because of a vulnerability of youth that in part comes from the feeling of not having lived a full life. The concept of fairness comes into play. An older person may be likely to feel that they lived most of their life. A younger person may be likely to feel cheated," Louis Harrison, MD, chairman of the department of radiation oncology at Beth Israel Medical Center, in New York City, New York, and chairman of the ASTRO board of directors, told Medscape Oncology.

The study also indicates that survivors who had the following characteristics are more likely to experience SPD than those without the characteristics:

  • Not married or living with a partner (1.7 times more likely)

  • Current or former smokers (2.7 times more likely)

  • Less than a high school education (2.1 times more likely)

  • Uninsured (2.4 times more likely)

  • Difficulty with instrumental activities of daily living (3.6 times more likely)



Approximately 1 in 18 long-term cancer survivors report SPD, said Dr. Hoffman. Long-term cancer survival was defined as having lived 5 years or more after an initial cancer diagnosis. There are an estimated 6.42 million long-term survivors living in the United States.

"We don't know exactly why some long-term cancer survivors have SPD," said Dr. Harrison.

"You would not believe how strong some survivors are," he commented about the pride and positive sense of accomplishment that some survivors declare. "It's a complex mix of emotions," Dr. Harrison observed.

Using data from the 2002 to 2006 National Health Interview Survey, the researchers reviewed health information from 4712 long-term survivors of adult-onset cancer and 126,841 respondents never diagnosed with cancer. Among survivors in the study, the mean age at cancer diagnosis is 47 years and the mean age at the interview time is 62 years. The majority were survivors of breast (20%), gynecologic (19%), male genitourinary (12%), and colorectal (8%) cancer.

Researchers told reporters that they identified individuals with severe psychological distress on the basis of how frequently they felt nervous, restless, hopeless, worthless, and that everything wasan effort.

The researchers have disclosed no relevant financial relationships.

American Society for Therapeutic Radiology and Oncology (ASTRO) 50th Annual Meeting: Abstract 225. Presented September 23, 2008.

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