Psychological Adaptation to cancer in adolescents and young adults (AYA): an investigation into the mechanisms of psychopathology and resilience

Cancer diagnosis and treatment often interfere with patient's normal routine, and cause increased levels of stress, which can negatively impact the psychological wellbeing of the young patient. Even though the majority of young cancer survivors lead fulfilling lives, almost 30% of this vulnerable population develops clinical levels of anxiety and depression. Identifying those at higher risk for developing psychopathology upon reaching remission is crucial to prevent the onset of mood disorders later on. Some of the known risk factors for poorer psychosocial outcomes in paediatric oncology are: being diagnosed in adolescence, poor family functioning, and pre-existing psychopathology. On the other hand, being diagnosed before adolescence and having a strong support system proved to be protective. No studies have yet directly measured cortisol levels and its association to stress-related
mental illness in young cancer survivors.
By analyzing data from Avon Longitudinal Study of Parents and Children (ALSPAC), a community-representative prospective study of women, and their children, this study aims to establish the prevalence of depression and anxiety in young cancer survivors in the sample, assess the relationship between abnormal cortisol levels and psychopathology, and propose ways in which current screening tools for psychopathology could be improved in light of presented findings. Compared to healthy controls, levels of mood disorders are expected to be significantly higher in those who had experienced childhood cancer, and have presented with significant cortisol abnormalities.
These results will expand on the existing literature on risk factors for mood disorders in young cancer patients and survivors, and provide a platform upon which advances in screening approaches for psychopathology could be made. While future studies should aim to identify more biomarkers for anxiety and depression in this population, in the meantime, regular attendance to psychological wellbeing of children and adolescents afflicted by cancer should become a norm.
With advances in modern medicine that allow for ever better screening and pharmacological interventions in oncology, the survival rates for paediatric cancer immensely improved. In some diagnoses such as acute lymphoblastic leukemia well over 90% of patients reach remission [10, 22]. Despite such high remission rates, cancer is still considered a chronic illness, and its effects on the psychological wellbeing of childhood cancer survivors should not be dismissed lightly.
Though researchers always noted and considered distress and depression in the aftermath of cancer, early epidemiological studies in the field of paediatric psycho-oncology present mixed findings. Some authors regarded depression as the most common psychiatric diagnosis in cancer patients and described it as a pathological response to the "loss of normalcy associated with treatment"[7, 26].
Other studies found no significant difference in depression levels among childhood cancer survivors and healthy controls [18], arguing that "children do not reach a sufficient cognitive level that enables them to understand their illness completely." In a more recent review by Dejong & Fombonne (2006), authors evaluated all the studies since 1980 that looked at depression outcomes in paediatric cancer and found only modest prevalence rates. The authors point at the need for future studies as the inconclusive findings may be attributable to weak methodology, small samples, lack of sufficient control groups, and reliance on self-report measures [13].
Along with depression, disorders such as anxiety, posttraumatic stress disorder or posttraumatic stress symptoms (PTSD or PTSS), and adjustment disorders also received some attention in paediatric psycho-oncology.