Mental Distress and Cognition among Long-term Survivors of Adolescent and Young Adult Cancer in the United States

Abstract

Patients diagnosed with cancer as adolescent and young adult (AYA) are at risk for a range of long-term psychosocial sequelae both due to diagnosis and associated treatments, including radiation therapy. However, late effects of therapy in this population, particularly on mental distress and cognitive dysfunction are understudied. We therefore sought to characterize the prevalence of cognitive dysfunction and mental distress among long-term AYA cancer survivors. Using data from the National Health Interview Survey between 2010-2017, multivariable logistic regression analyses defined the association between AYA cancer diagnosis (defined as those reporting a diagnosis of cancer between the ages of 15-39 at least 10 years prior to survey administration) and cognitive dysfunction and mental distress, as defined by the 6-item Kessler Psychological Distress Scale. Among AYA cancer survivors, the association between mental distress and cognitive dysfunction was assessed via multivariable logistic regression. The weighted prevalence of cognitive dysfunction and mental distress was estimated. Among 89,141 participants, 1,039 (1.2%) were AYA cancer survivors diagnosed ≥ 10 years prior to survey administration. Prior cancer diagnosis was associated with greater odds of cognitive dysfunction (AOR 1.54, 95% CI 1.29-1.84) and mental distress (AOR 1.87, 95% CI 1.57-2.23). Notably, the prevalence of having cognitive dysfunction and mental distress was 24.1% and 29.2% in cancer survivors as compared to 14.3% and 16.0% in the general population. Among survey participants reporting a cancer diagnosis, increasing mental distress was associated with greater odds of cognitive dysfunction (AOR 3.57, 95% CI 2.25-5.65 for moderate cognitive distress, AOR 14.30, 95% CI 7.42-27.58 for severe mental distress) and cognitive dysfunction was associated with having mental distress (AOR 5.00, 95% CI 3.28-7.61). Among AYA cancer survivors with cognitive dysfunction, 27.6% (95% CI21.7%-34.5%) had difficulty remembering, 13.2% (95% CI 8.6%-19.7%) had difficulty concentrating, and 59.1% (95% CI 51.6%-66.3%) reported difficulty in both areas. Furthermore, among cancer survivors with cognitive dysfunction, the prevalence of low/none, moderate and severe mental distress was 41.3% (95% CI 34.2%-48.8%), 35.3% (95% CI 28.4%-42.8%) and 23.4% (95% CI 17.7%-30.4%), respectively. Long-term survivors of AYA cancer have higher rates of cognitive dysfunction and mental distress as compared to the general population, which appear to be highly intercorrelated among AYA cancer survivors. Providers and patients should be given adequate access to screening tools and counseling services for psychosocial and neurocognitive issues, which should be integrated into standard AYA cancer survivorship care.