Abstract
Purpose: Survivors of cancer diagnosed during adolescence and young adulthood (AYA; aged 15-39) may experience quality of life (QOL) limitations; however, little is known about QOL for AYA survivors who are now middle-aged or among racial/ethnic minority survivors. We evaluated QOL outcomes for AYA cancer survivors relative to a non-cancer comparison group by gender, race/ethnicity, and current age. Methods: Using the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data, we identified 8375 individuals diagnosed with cancer while aged 15-39 years old and 334,759 controls. Participants were currently ≥20 years of age. QOL was measured using four items from the Center for Disease Control's Healthy Days Measure (general health, number of days of poor physical and mental health, and activity limitation days). Multivariable regressions compared these measures for survivors and controls by gender, race/ethnicity, and age, and among survivors to determine cancer-related factors associated with poor QOL. Results: Survivors were more likely to report fair/poor general health than controls (relative risk=1.92; 95% confidence interval: 1.77-2.10; p<0.001). QOL limitations existed by gender and race/ethnicity for survivors. Approximately 30% of survivors currently in their 40s, 50s, and early 60s were in poor health, compared to less than 20% of same-aged controls (both p<0.001). Of survivors with two or more cancers, 41.0% reported poor health, compared to 26.2% with one cancer (p<0.001). Conclusion: AYA cancer survivors have worse QOL compared to the general population and these limitations persist across gender, race/ethnicity, and age. Targeted interventions are essential for improving AYA cancer survivors' health status.
Highlights
70,000 adolescents and young adults (AYAs) aged 15–39 years old are diagnosed with cancer each year in the United States.[1]
While Behavioral Risk Factor Surveillance System (BRFSS) is conducted among adults q18, participants are asked their age of first cancer diagnosis, allowing us to investigate survivors diagnosed in adolescence
We modeled the number of days per month in negative binomial regression models and found that survivors’ number of poor physical, poor mental (IRR = 1.66; 95% confidence interval (CI): 1.55–1.79; p < 0.001), and activity limitation (IRR = 1.82; 95% CI: 1.67–1.98; p < 0.001) days per month exceeded the control group
Summary
70,000 adolescents and young adults (AYAs) aged 15–39 years old are diagnosed with cancer each year in the United States.[1]. Population-based analyses report that AYA cancer survivors’ mental and physical health is poorer than respondents without a cancer history,[15] but little is known about QOL disparities among gender, age, and racial/ethnic subgroups. We report on QOL outcomes for survivors of AYA cancer diagnosed while aged 15–39 from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) dataset compared to unaffected controls. While BRFSS is conducted among adults q18, participants are asked their age of first cancer diagnosis, allowing us to investigate survivors diagnosed in adolescence. BRFSS data provide a unique resource for capturing QOL for a wide age range of AYA survivors, including survivors currently in adolescence and young adulthood, as well as survivors of AYA cancer who are in their 40s, 50s, and 60s. We investigate the impact of understudied cancer factors, such as multiple cancer diagnoses, on AYAs’ QOL
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