Trajectories of Psychological Distress in Adolescent and Young Adult Patients With Cancer: A 1-Year Longitudinal Study
Abstract
Purpose: To examine prevalence and changes in symptoms of psychological distress over 1 year after initial cancer diagnosis in adolescent and young adult (AYA) patients with cancer. Sociodemographic and clinical predictors of changes in distress were examined. Patients and Methods: In this multisite, longitudinal, prospective study of an ethnically diverse sample, 215 patients age 14 to 39 years were assessed for psychological distress within the first 4 months of diagnosis and again 6 and 12 months later. Linear mixed models with random intercept and slope estimated changes in distress, as measured by the Brief Symptom Inventory-18 (BSI-18). Results: Within the first 4 months of diagnosis, 60 respondents (28%) had BSI-18 scores suggesting caseness for distress. On average, distress symptoms exceeded population norms at the time of diagnosis, dipped at the 6-month follow-up, but increased to a level exceeding population norms at the 12-month follow-up. A statistically significant decline in distress over 1 year was observed; however, the gradient of change was not clinically significant. Multivariate analyses revealed that the reduction in distress over time was primarily a function of being off treatment and involved in school or work. Notably, cancer type or severity was not associated with distress. Conclusion: Findings emphasize the importance of early psychosocial intervention for distress in AYAs as well as the need to manage treatment-related symptoms and facilitate AYAs' involvement in work or school to the extent possible. Continued research is needed to understand how distress relates to quality of life, functional outcomes, treatment, and symptom burden throughout the continuum of care.
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For many young adult cancer survivors, the impact of treatment is significant and long-lasting, including physical symptoms such as pain and fatigue, psychological distress, and increased risk of long-term health problems such as second cancers and early-onset cardiovascular disease.
“For many YA cancer survivors, the impact of treatment is significant and long-lasting, including difficult physical symptoms (e.g., pain, fatigue) [4–6], psychological distress [6–10], and an increased risk of long-term health problems (e.g., second cancers, early-onset cardiovascular disease) [11–13].”
From Improving symptom management for survivors of young adult cancer: rationale and study protocol for a pilot randomized controlled trial (2024) · cites this paper as [8]
Adolescents and young adults are most likely to experience depression, heightened anxiety, distress, and posttraumatic stress disorder in their first 12-24 months after completing treatment.
“Adolescents and young adults are most likely to experience depression, heightened anxiety, distress, and posttraumatic stress disorder in their first 12-24 months after completing treatment, which poses significant unmet mental health needs in the period after cancer treatment [2-4].”
Young adults treated for cancer have significant and unique psychosocial needs.
“In addition to this disproportionate disease burden, there are significant and unique psychosocial needs for adolescents and young adults diagnosed with cancer [2].”
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Self-citation
- Authors
- Kwak, M., Zebrack, B. J., Meeske, K. A., Embry, L., Aguilar, C., Block, R., Hayes-Lattin, B., Li, Y., Butler, M., & Cole, S.
- Affiliations
- University of Southern California (US)
- Minyoung Kwak and Brad J. Zebrack, University of Michigan School of Social Work; Yun Li, University of Michigan and University of Michigan Comprehensive Cancer Center, Ann Arbor; Melissa Butler, University of Michigan, Dearborn, MI; Kathleen A. Meeske, University of Southern California, Children's Hospital Los Angeles, Los Angeles; Steven Cole, HopeLab Foundation, Redwood City, CA; Leanne Embry and Christine Aguilar, University of Texas Health Science Center at San Antonio, San Antonio, TX; Rebecca Block...
- Venue
- Journal of Clinical Oncology
- Published
- 2013-06-10
- Volume
- 31
- Issue
- 17
- Pages
- 2160-2166
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2106939934
- Cited by
- 234
- References
- 53
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 21 · 2023: 21 · 2022: 19 · 2021: 21 · 2020: 19 · 2019: 28 · 2018: 24 · 2017: 22 · 2016: 17 · 2015: 11 · 2014: 13 · 2013: 2
- FWCI
- 13.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Sociology and Political Science › Family Support in Illness
- Keywords
- psychological distress, adolescent and young adult cancer, cancer survivors, Brief Symptom Inventory-18, predictors of distress, treatment discontinuation, psychosocial interventions, quality of life
- MeSH terms
- Adolescent, Adult, Female, Humans, Longitudinal Studies, Male, Neoplasms, Prospective Studies, Quality of Life, Stress, Psychological, Prevalence, Survivors, Young Adult
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