Psychiatric Disorder Incidence among Adolescents and Young Adults Aged 15-39 with Cancer: Population-Based Cohort.

Abstract

Adolescent and young adult (AYA) cancer survivors face physical and psychological sequelae related to having cancer decades after treatment completion. It is unclear if AYA cancer survivors are at increased risk for late psychiatric disorders. We used the Alberta AYA Cancer Survivor Study that includes five-year survivors of cancer diagnosed at 15-39 years of age during 1991 to 2013. The primary outcome was incidence of psychiatric disorder (composite outcome) including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders that were identified using coding algorithms for administrative health databases. A validated coding algorithm identified people who experienced a suicide attempt or event of self-harm. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder. Among 12,116 five-year AYA cancer survivors (n = 4,634 [38%] males; n = 7,482 [62%] females), 7,426 (61%; n = 2,406 [32%] males; n = 5,020 [68%] females) were diagnosed with at least one of five psychiatric disorders occurring at least three years after cancer diagnosis. Survivors of all cancer types were most often diagnosed with anxiety (males, 39.0%, 95% confidence interval [CI] 37.6-40.4); females, 54.5%, 95%CI 53.3-55.6), depressive (males, 32.7%, 95%CI 31.3-34.0; females, 47.0%, 95%CI 45.8-48.1), and trauma- and stressor-related disorders (males, 13.5%, 95%CI 12.5-14.5; females, 22.5%, 95%CI 21.6-23.5). diagnosis. Anxiety, depressive, and trauma- and stressor-related disorders are common amongst five-year survivors of AYA cancer. Primary, secondary, or tertiary preventive strategies for AYAs diagnosed with cancer, particularly at an early age, are needed to mitigate risk of potentially severe outcomes due to psychiatric disorders.