Psychological Distress in Long-term Survivors of Adult-onset Cancer: Results from a National Survey

Article Outline

• Purpose/Objective(s)
• Materials/Methods
• Results
• Conclusions
• Copyright

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Purpose/Objective(s) 

Cancer and cancer treatment can alter the meaning of health and life. This study evaluated the prevalence of severe psychological distress (SPD) among long-term survivors of adult-onset cancer and the clinical and sociodemographic factors associated with experiencing SPD.

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Materials/Methods 

We identified 4,712 five-year survivors of adult-onset cancer and 126,841 respondents never diagnosed with cancer using the 2002-2006 National Health Interview Survey, an in-person health survey of the non-institutionalized U.S. population. A K6 scale (a validated screening tool for mental illness) score ≥13 defined SPD. Multivariable logistic regression was used to examine the independent association of SPD and being a cancer survivor, and to identify factors among survivors associated with SPD including age, sex, race/ethnicity, relationship status, education attainment, insurance status, comorbidities, smoking history, and ability to perform independent activities of daily living (IADL). All analyses were conducted using SUDAAN to account for the complex sampling design and were weighted to reflect national estimates.

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Results 

Overall, the 4,712 respondents represent an estimated 6.42 million long-term survivors residing in the U.S. annually. Among survivors, the mean age at cancer diagnosis was 47 yrs and mean age at interview was 62 yrs. The majority were survivors of breast (20%), gynecologic (19%), male genitourinary (12%), and colorectal (8%) cancer. The prevalence of SPD was significantly higher among long-term cancer survivors than respondents never diagnosed with cancer (5.6 vs. 3.0%, p < 0.001). After adjustment, survivors remained significantly more likely to experience SPD [adjusted odds ratio (aOR), 1.4; 95% CI, 1.2-1.7]. Compared to survivors age ≥65 at interview, younger survivors age 45-65 yrs (aOR 2.7, CI 1.8-4.0) and <45 yrs (aOR 5.6, CI 3.3-9.5) were more likely to experience SPD. However, no association was observed between SPD and the number of years since cancer diagnosis. Compared to survivors without comorbidities, those with 1 (aOR 1.7, CI 1.1-2.6) or ≥2 comorbidities (aOR 3.5, CI 2.2-5.6) were more likely to report SPD. Survivors who were not married or living with a partner (aOR CI 1.7, 1.2-2.4), had less than a high school education (aOR 2.1, CI 1.5-3.0), were uninsured (aOR 2.4, CI 1.5-3.7), were current or former smokers (aOR 2.7, CI 1.2-2.5), or had difficulty with IADLs (aOR 3.6, CI 2.5-5.3) were more likely to experience SPD than those without these characteristics.

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Conclusions 

Long-term survivors of adult-onset cancer are at increased risk for SPD. We identified several clinical and sociodemographic factors associated with SPD in long-term cancer survivors. These results may help in targeting high-risk survivors for psychological screening and support.