Mental Disorders Among Adolescents and Young Adults With Cancer: A Canadian Population–Based and Sibling Cohort Study

Author:

Oberoi Sapna123ORCID,Garland Allan456ORCID,Yan Adam P.78ORCID,Lambert Pascal39,Xue Lin9,Decker Kathleen359ORCID,Israels Sara J.123,Banerji Shantanu310ORCID,Bolton James M.611,Deleemans Julie M.12,Garand-Sheridan Bronwen13ORCID,Louis Deepak14,Lix Lisa M.5ORCID,Mahar Alyson L.61516

Affiliation:

1. Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

2. Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada

3. CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada

4. Department of Internal Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada

5. Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

6. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada

7. Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

8. Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA

9. Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada

10. Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

11. Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada

12. Department of Oncology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada

13. AYA Canada, Canada

14. Section of Neonatology, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

15. School of Nursing, Queen's University, Kingston, Ontario, Canada

16. Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada

Abstract

PURPOSE To compare the cumulative incidence of mental disorders among adolescents and young adults (AYAs) diagnosed with cancer with the general population and their unaffected siblings. METHODS A retrospective, population-based, matched cohort design was used to investigate the impact of cancer diagnosis on mental disorders among individuals age 15-39 diagnosed between 1989 and 2019. Two cancer-free cohorts were identified: matched population-based and sibling cohorts. Outcomes included incidence of mood and anxiety disorders, substance use disorders, suicide outcomes, psychotic disorders, and any of the preceding four categories within 5 years of cancer diagnosis. Competing risk regression was used to estimate adjusted subhazard ratios (aSHR) and 95% CIs. RESULTS Among 3,818 AYAs with cancer matched to the population-based cancer-free cohort, individuals with cancer were more likely to be diagnosed with incident mental disorders than those without cancer; the risk was highest immediately after a cancer diagnosis and decreased over time with aSHR [95% CI] for mood and anxiety disorders at 0-6 months (11.27 [95% CI, 6.69 to 18.97]), 6-12 months (2.35 [95% CI, 1.54 to 3.58]), and 12-24 months (2.06 [95% CI, 1.55 to 2.75]); for substance use disorders at 0-6 months (2.73 [95% CI, 1.90 to 3.92]); for psychotic disorders at 0-6 months (4.69 [95% CI, 2.07 to 10.65]); and for any mental disorder at 0-6 months (4.46 [95% CI, 3.41 to 5.85]), 6-12 months (1.56 [95% CI, 1.14 to 2.14]), and 12-24 months (1.7 [95% CI, 1.36 to 2.13]) postcancer diagnosis. In sibling comparison, cancer diagnosis was associated with a higher incidence of mood and anxiety and any mental disorder during first 6 months of cancer diagnosis. CONCLUSION AYAs with cancer experience a greater incidence of mental disorders after cancer diagnosis relative to population-based and sibling cohorts without cancer, primarily within first 2 years, underscoring the need to address mental health concerns during this period.

Publisher

American Society of Clinical Oncology (ASCO)

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