Supportive Care in Cancer

, Volume 21, Issue 9, pp 2403–2408 | Cite as

Distress among young adult cancer survivors: a cohort study

  • Betina YanezEmail author
  • Sofia F. Garcia
  • David Victorson
  • John M. Salsman
Original Article



Being diagnosed with cancer as a young adult can lead to significant psychological distress and impaired quality of life. Compared to children and older adults diagnosed with cancer, fewer studies have addressed psychological distress among young adult cancer survivors. This study sought to identify the prevalence of, and factors associated with, distress among young adult cancer survivors (ages 18–39).


Young adult cancer survivors (N = 335, mean age = 31.8, women = 68.4 %) were recruited from an online research panel and stratified by cohort (time postactive treatment: 0–12, 13–24, and 25–60 months). Participants completed measures assessing demographic and clinical characteristics, global impact of cancer, cancer-related education and work interruption, and cancer-specific distress using the impact of event scale (IES).


The mean score on the IES (M = 31.0, range = 0–75) was above the cut point of 20, suggesting clinically elevated distress. Analysis of covariance revealed significant main effects for cohort, global impact and cancer-related education/work interruption, and an interaction between cohort and cancer-related education/work interruption on distress. Although there was no significant effect of education/work interruption on distress for those in the 0–12 month cohort (p = .88), survivors in the 13–24 and 25–60 month cohorts reporting education/work interruption were significantly more distressed than those not reporting education/work interruption in the respective cohorts (p < .05).


Young adult cancer survivors face unique challenges. These data underscore the importance of attending to cancer-related distress beyond the completion of treatment and may help inform targeted interventions to prevent or reduce significant distress and related sequelae in this population.


Young adults Survivorship Cancer Distress Psychosocial 



The contents of this work were developed under a training grant from the Department of Education, NIDRR grant (H133P080006). This work was also supported by a Psychosocial and Behavioral Research Grant (PSB-08-15) funded by the American Cancer Society-Illinois Division and by a career development award (51K07CA158008-01A1) funded by the National Cancer Institute.




  1. 1.
    Bleyer A, Albritton K (2003) Special considerations for the young adult and adolescent. In: Kufe DW, Pollock RE, Weichselbaum R Blast R, Gansler T, Holland J, Frei E (eds) Cancer Medicine. BC Decker, Hamilton (ON), pp 2414–2422Google Scholar
  2. 2.
    Stanton AL (2012) What happens now? Psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol 30:1215–1220CrossRefGoogle Scholar
  3. 3.
    Jim HS, Andrykowski MA, Munster PN, Jacobsen P (2007) Physical symptoms/side effects during breast cancer treatment predict posttreatment distress. Ann Behav Med 34:200–208CrossRefGoogle Scholar
  4. 4.
    Kazak AE, Derosa BW, Schwartz LA et al (2010) Psychological outcomes and health beliefs in adolescent and young adult survivors of childhood cancer and controls. J Clin Oncol 28:2002–2007CrossRefGoogle Scholar
  5. 5.
    Howard-Anderson J, Ganz P, Bower JE, Stanton AL (2011) Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst 104(5):386–405CrossRefGoogle Scholar
  6. 6.
    Greenfield DM, Walters SJ, Coleman RE et al (2010) Quality of life, self-esteem, fatigue, and sexual function in younger men after cancer: a controlled cross-sectional study. Cancer 116:1592–6101CrossRefGoogle Scholar
  7. 7.
    Zebrack B (2009) Information and service needs for young adult cancer survivors. Support Care Cancer 17:349–357CrossRefGoogle Scholar
  8. 8.
    Bellizzi KM, Smith A, Schmidt S, Keegan THM et al (2012) Positive and negative psychosocial impact of being diagnosed with cancer as an adolescent or young adult. Cancer 20:5155–5162CrossRefGoogle Scholar
  9. 9.
    Gorman JR, Malcarne V, Roesch SC, Madlensky L, Pierce JP (2010) Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat 123:477–485CrossRefGoogle Scholar
  10. 10.
    Erikson EH. (1980) Identity and the life cycle. (Vol. 1). New York: NortonGoogle Scholar
  11. 11.
    Carstensen LL, Isaacowitz DM, Charles ST (1999) Taking time seriously. A theory of socioemotional selectivity. Am Psychol 54:165–181CrossRefGoogle Scholar
  12. 12.
    Roster CA, Rogers RD, Bloebaum G, Klein D (2004) A comparison of response characteristics from web and telephone surveys. Int J Mark Res 46:359–374CrossRefGoogle Scholar
  13. 13.
    Liu H, Cella D, Gershon R, Shen J, Morales LS, Riley W et al (2010) Representativeness of the PROMIS Internet Panel. J Clin Epidemiol 63:1169–1178CrossRefGoogle Scholar
  14. 14.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655CrossRefGoogle Scholar
  15. 15.
    Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 413:209–218CrossRefGoogle Scholar
  16. 16.
    Garcia SF, Cella D, Clauser SB, Flynn KE et al (2007) Standardizing patient-reported outcomes assessment in cancer clinical trials: a PROMIS initiative. J Clin Oncol 25:5106–5112CrossRefGoogle Scholar
  17. 17.
    Lai JS, Garcia SF, Salsman JM et al (2012) The psychosocial impact of cancer: evidence in support of independent general positive and negative components. Qual Life Res 21:195–207CrossRefGoogle Scholar
  18. 18.
    Joseph S (2000) Psychometric evaluation of Horowitz’s impact of event scale: a review. J Trauma Stress 13:101–113CrossRefGoogle Scholar
  19. 19.
    Coffey SF, Berglind G (2006) Screening for PTSD in motor vehicle accident survivors using PSS-SR and IES. J Trauma Stress 19:119–128CrossRefGoogle Scholar
  20. 20.
    Andersen BL, Shapiro CL, Farrar WB et al (2005) A controlled prospective study of psychological responses to cancer recurrence. Cancer 104:1540–1547CrossRefGoogle Scholar
  21. 21.
    Santacroce SJ, Zebrack BJ (2010) Adolescent and young adult patients. In: Holland JC, Breitbart WS, Jacobsen PB, Lederberg MS, Loscalzo MJ, McCorkle R (eds) Psycho-Oncology 2nd edn. Oxford, New York, pp 497–502CrossRefGoogle Scholar
  22. 22.
    Zebrack BJ (2011) Psychological, social, and behavioral issues for young adults with cancer. Cancer 117:2289–2294CrossRefGoogle Scholar
  23. 23.
    Hewitt M, Greenfield S, Stovall E (2006) From cancer patient to cancer survivor: lost in transition. Institute of Medicine, National Academies Press, WashingtonGoogle Scholar
  24. 24.
    Harlan LC, Lynch CF, Keegan THM, Hamilton AS et al (2011) Recruitment and follow-up of adolescent and young adult cancer survivors: the AYA hope study. J Cancer Survivorship 5:305–314CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Betina Yanez
    • 1
    • 2
    Email author
  • Sofia F. Garcia
    • 2
    • 3
    • 4
  • David Victorson
    • 2
    • 3
  • John M. Salsman
    • 2
    • 3
  1. 1.Center for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityChicagoUSA
  4. 4.Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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