Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
Cancer Med. 2023 Sep;12(17):18354-18367. doi: 10.1002/cam4.6435. Epub 2023 Aug 10.
Adolescent and young adult (AYA) cancer survivors (CS) face unique psychosocial challenges, which may affect their mental health. However, there are inconsistencies in AYA definitions and varying prevalence data on psychological distress, anxiety, and depression. We aimed to synthesize published literature on prevalence, risk, longitudinal changes, and predictors for these outcomes and estimate pooled prevalences.
We searched for observational studies published in English before June 1 2022, in PubMed, PsycINFO, Scopus, and Web of Science. Two researchers extracted independently information on study characteristics, prevalence, and risk. The pooled prevalence (PP) of psychological distress, anxiety, and depression was estimated using random-effects models. Geographical region, treatment status, and assessment instruments were considered in stratified meta-analyses.
Sixty-eight studies were included in the systematic review and 57 in the meta-analyses. We estimated an overall prevalence of 32% (n = 30; 4226/15,213 AYAs; 95% CI, 23%-42%; I = 99%) for psychological distress, 29% for anxiety (n = 24; 2828/8751 AYAs; 95% CI, 23%-36%; I = 98%), and 24% (n = 35; 3428/16,638 AYAs; 95% CI, 18%-31%; I = 98%) for depression. The range of PP of psychological distress varied across geographical regions, treatment status, and assessment instruments. The PP of anxiety varied significantly across continents, while no variations were seen for depression. Studies found higher risks for psychological distress, anxiety, and depression in AYAs compared to older cancer survivors or cancer-free peers.
Our research found that one in three AYA-CS experience psychological distress or anxiety and one in four are affected by depression, highlighting the need for specialized psychological services for AYA-CS in oncology settings and AYA-focused interventions.
青少年和年轻成人（AYA）癌症幸存者（CS）面临独特的心理社会挑战，这可能影响他们的心理健康。然而，AYA 的定义并不统一，心理困扰、焦虑和抑郁的流行数据也各不相同。我们旨在综合已发表的文献，以了解这些结果的流行率、风险、纵向变化和预测因素，并估计汇总流行率。
我们在 2022 年 6 月 1 日之前在 PubMed、PsycINFO、Scopus 和 Web of Science 中搜索了以英文发表的观察性研究。两名研究人员分别独立提取研究特征、流行率和风险信息。使用随机效应模型估计心理困扰、焦虑和抑郁的汇总流行率（PP）。在分层荟萃分析中考虑了地理位置、治疗状况和评估工具。
系统评价包括 68 项研究，荟萃分析包括 57 项研究。我们估计心理困扰的总体流行率为 32%（n=30；15213 名 AYA 中有 30 名；95%CI，23%-42%；I²=99%），焦虑为 29%（n=24；8751 名 AYA 中有 24 名；95%CI，23%-36%；I²=98%），抑郁为 24%（n=35；16638 名 AYA 中有 35 名；95%CI，18%-31%；I²=98%）。心理困扰的 PP 范围因地理位置、治疗状况和评估工具而异。焦虑的 PP 在各大洲之间差异显著，而抑郁则没有差异。研究发现，与老年癌症幸存者或无癌症同龄人相比，AYA-CS 发生心理困扰、焦虑和抑郁的风险更高。
我们的研究发现，三分之一的 AYA-CS 经历心理困扰或焦虑，四分之一的人患有抑郁，这突出表明需要在肿瘤学环境中为 AYA-CS 提供专门的心理服务，并开展针对 AYA 的干预措施。
