Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75390-9303, USA.
The Hockaday School, Dallas, TX, USA.
J Cancer Surviv. 2021 Oct;15(5):776-784. doi: 10.1007/s11764-020-00969-6. Epub 2021 Jan 7.
Patients diagnosed with cancer as adolescent and young adult (AYA) are at risk for a range of long-term psychosocial sequelae, which have been poorly studied. We sought to characterize the prevalence of cognitive dysfunction and psychological distress among long-term AYA cancer survivors.
Using data from the National Health Interview Survey between 2010 and 2018, multivariable logistic regression analyses defined the association between AYA cancer diagnosis and cognitive dysfunction and psychological distress, as defined by the 6-item Kessler Psychological Distress Scale. Among AYA cancer survivors, the association between psychological distress and cognitive dysfunction was assessed via multivariable logistic regression.
Among 230,675 participants, 2646 (1.1%) were AYA cancer survivors diagnosed > 10 years prior to survey administration. Prior AYA cancer diagnosis was associated with greater odds of cognitive dysfunction (AOR 1.61, 95% CI 1.41-1.82; 27.8% vs. 16.4%) and psychological distress (AOR 1.60, 95% CI 1.41-1.83; 26.6 vs. 15.3%) as compared to individuals without a cancer history. Among survey participants reporting a cancer diagnosis, greater psychological distress was associated with greater odds of cognitive dysfunction (AOR 12.31, 95% CI 7.51-20.18 for severe psychological distress) and cognitive dysfunction was associated with having psychological distress (AOR 4.97, 95% CI 3.66-6.73).
Long-term survivors of AYA cancer have higher rates of cognitive dysfunction and psychological distress as compared to the general population. Additional services addressing psychosocial and neurocognitive issues should be integrated into standard AYA cancer survivorship care.
Cancer survivors should be aware of self-reported high rates of long-term cognitive dysfunction and psychologic distress and actively seek out formal evaluation and services such as mental health counseling.
被诊断为青少年和年轻成人（AYA）的癌症患者存在一系列长期心理社会后遗症的风险，而这些后遗症尚未得到充分研究。我们旨在描述长期 AYA 癌症幸存者认知功能障碍和心理困扰的患病率。
利用 2010 年至 2018 年期间全国健康访谈调查的数据，多变量逻辑回归分析定义了 AYA 癌症诊断与认知功能障碍和心理困扰（由 6 项 Kessler 心理困扰量表定义）之间的关联。在 AYA 癌症幸存者中，通过多变量逻辑回归评估心理困扰与认知功能障碍之间的关联。
在 230675 名参与者中，有 2646 名（1.1%）是在调查前 10 年被诊断为 AYA 癌症的幸存者。与没有癌症病史的个体相比，AYA 癌症的既往诊断与认知功能障碍的可能性更高（OR 1.61，95%CI 1.41-1.82；27.8%比 16.4%）和心理困扰（OR 1.60，95%CI 1.41-1.83；26.6%比 15.3%）。在报告癌症诊断的调查参与者中，较大的心理困扰与认知功能障碍的可能性更高相关（严重心理困扰的 OR 12.31，95%CI 7.51-20.18），而认知功能障碍与存在心理困扰相关（OR 4.97，95%CI 3.66-6.73）。
与一般人群相比，AYA 癌症的长期幸存者认知功能障碍和心理困扰的发生率更高。应将解决心理社会和神经认知问题的额外服务纳入 AYA 癌症生存者的标准护理中。
癌症幸存者应该意识到自我报告的长期认知功能障碍和心理困扰的高发生率，并积极寻求正式评估和服务，如心理健康咨询。
