Physical, emotional, and social health differences between posttreatment young adults with cancer and matched healthy controls

Abstract

Background: Young adults (YAs; ages 18-39 years) with cancer face interrupted developmental milestones and increased stressors that can adversely influence psychosocial adjustment. Transitioning from active treatment to posttreatment 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 after treatment, relative to young adults without cancer.

Methods: Three cohorts of YAs of mixed cancer diagnoses (N = 120, 0-12 months after treatment; N = 102, 13-24 months after treatment; and N = 113, 25-60 months after treatment; combined M = 31.8 years old, combined sex = 68% women) and an age-, education-, sex-, 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: controlled comparison study; posttraumatic growth; quality of life; survivorship; young adults.

Figure 1

HRQL Score by Age Cohort 18–24 years old, 25–29 years old, 30–39 years old Note: Mean scores were adjusted for gender, ethnicity, and education. Higher scores indicate better HRQL. *=p<.05, **=p<.01.

Figure 2

Posttraumatic Growth Scores by Group and Cohort YA Group, HC Group Note: Mean scores were adjusted for age, gender, ethnicity, and education. HCs reported higher scores across cohorts (p=.01).

Figure 3

Psychological Adjustment Scores by Age Cohort 18–24 years old, 25–29 years old, 30–39 years old Note: Mean scores were adjusted for gender, ethnicity, and education. Higher scores indicate better psychological adjustment (i.e., less depression and anxiety). **=p<.01, ***=p<.001.