Mental Health and Care Utilization in Survivors of Adolescent and Young Adult Cancer
Menée aux Etats-Unis par questionnaire auprès de 29 793 témoins et de 369 adolescents et jeunes adultes ayant survécu à un cancer (âge moyen : 20,5 ans), cette étude analyse leur santé mentale et leur utilisation de soins psychiques (psychothérapie, médicaments)
Background: Adolescent and Young Adult (AYA) cancer survivors experience mental health challenges, yet little is known about the evolution of these difficulties. This study explored mental health symptoms and utilization among long-term AYA cancer survivors. Methods: Using 30,432 respondents from the 2019 National Health Interview Survey (NHIS), this study compared adults with a history of AYA cancer (diagnosed between 15-39) to adults without AYA cancer. Mental health symptom severity was measured by Patient Health Questionnaire—8 (PHQ8) and Generalized Anxiety Disorder—7 (GAD7) questionnaires. Care utilization constituted psychotherapy and mental health medication use. Inverse propensity score weights were used to balance demographics and were combined with survey weights. Descriptive statistics, multivariable generalized linear models, and structural equation modeling (SEM) with 2-sided tests were used for analysis. Results: 639 AYA survivors (AYAS) were compared to 29,793 controls. Survivors were on average 20.5 years (SE 0.74) since their cancer diagnoses. After adjusting for survey and propensity score weights, AYAS reported more severe depression (IRR 1.42, 95% CI 1.09-1.84, p < .01) and anxiety (IRR 1.85, 95% CI 1.55-2.21, p < 0.001). They were more likely to use psychotherapy (OR 1.91, 95% CI 1.16-3.17, p < 0.05) and mental health medications (OR 1.89, 95% CI 1.15-3.11, p < 0.05). Time since diagnosis was negatively associated with symptoms and utilization. SEM demonstrated mediation of utilization effect by symptom severity. Conclusions: AYAS experience worse mental health in late survivorship, despite small improvements over time. We highlight the importance of survivorship care that addresses the long-term mental health needs of AYA cancer survivors.