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Overview of psychosocial issues in the adult cancer survivor

Karen L Syrjala, PhD
Jean Chiyon Yi, PhD
Section Editor
Patricia A Ganz, MD
Deputy Editor
Sadhna R Vora, MD


By 2026, over 20 million cancer survivors will be alive in the United States alone [1]. As more research is completed with large cohorts that permit subgroup analyses and with longitudinal follow-up [2], there is an increasing recognition that psychological issues are primary concerns for cancer survivors posttreatment, although the magnitude of difference between survivors and healthy controls is not clear [3-6]. For example, cohort studies show that compared with subjects with no histories of cancer, cancer survivors report higher rates of anxiety consistently; while some show higher rates of depression, this has not been consistently demonstrated [7-9].

Other psychological concerns such as fear of recurrence are specific to cancer survivors, and population norms are not relevant [5]. A population-based health registry cohort study from Sweden demonstrates convincingly that mental health diagnoses and psychiatric medications prescribed for cancer survivors are elevated compared with the general population from a year before cancer diagnosis until 10 years after diagnosis for all diseases except non-melanoma skin cancers, although rates do decline after treatment [10].

It is important to address these psychosocial issues not only to maintain quality of life, but also because these symptoms may impair health screening behaviors that are critical for survivors [11,12]. In addition, survivors who have clinical depression have a twofold risk of all-cause mortality [13]. Unfortunately, data suggest that we are not meeting these needs in cancer survivors as well as we should. For example, in a survey of hematopoietic cell transplantation (HCT) survivors, 50 percent of those who reported feeling distressed said they had not received any treatment for their emotional needs [14].

This section reviews psychosocial issues in cancer survivors, which increasingly are recognized as extending beyond anxiety and depression. Although the term "cancer survivor" may refer to anyone alive after a cancer diagnosis, in this section, we address psychosocial issues in disease-free survivors who have completed treatment.

Other aspects of general survivorship care are discussed elsewhere in the program. (See "Overview of cancer survivorship care for primary care and oncology providers" and "Assuring quality of care for cancer survivors: The survivorship care plan" and "Overview of cancer survivorship in adolescent and young adults" and "The roles of diet, physical activity, and body weight in cancer survivorship" and "Cognitive function after cancer and cancer-related treatment".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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  1. Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271.
  2. Lerro CC, Stein KD, Smith T, Virgo KS. A systematic review of large-scale surveys of cancer survivors conducted in North America, 2000-2011. J Cancer Surviv 2012; 6:115.
  3. National Research Council. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, Adler NE, Page AEK (Eds), The National Academies Press, Washington, D.C. 2007.
  4. Institute of Medicine, National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition, Hewitt M, Greenfield S, Stovall E. (Eds), The National Academies Press, Washington, D.C. 2006.
  5. Beckjord EB, Reynolds KA, van Londen GJ, et al. Population-level trends in posttreatment cancer survivors' concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys. J Psychosoc Oncol 2014; 32:125.
  6. Forsythe LP, Kent EE, Weaver KE, et al. Receipt of psychosocial care among cancer survivors in the United States. J Clin Oncol 2013; 31:1961.
  7. Greer JA, Solis JM, Temel JS, et al. Anxiety disorders in long-term survivors of adult cancers. Psychosomatics 2011; 52:417.
  8. Costanzo ES, Ryff CD, Singer BH. Psychosocial adjustment among cancer survivors: findings from a national survey of health and well-being. Health Psychol 2009; 28:147.
  9. Mitchell AJ, Ferguson DW, Gill J, et al. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol 2013; 14:721.
  10. Lu D, Andersson TM, Fall K, et al. Clinical Diagnosis of Mental Disorders Immediately Before and After Cancer Diagnosis: A Nationwide Matched Cohort Study in Sweden. JAMA Oncol 2016; 2:1188.
  11. Zhang JM, Wang P, Yao JX, et al. Music interventions for psychological and physical outcomes in cancer: a systematic review and meta-analysis. Support Care Cancer 2012; 20:3043.
  12. Katz ML, Donohue KA, Alfano CM, et al. Cancer surveillance behaviors and psychosocial factors among long-term survivors of breast cancer. Cancer and Leukemia Group B 79804. Cancer 2009; 115:480.
  13. Mols F, Husson O, Roukema JA, van de Poll-Franse LV. Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry. J Cancer Surviv 2013; 7:484.
  14. Mosher CE, DuHamel KN, Rini CM, et al. Barriers to mental health service use among hematopoietic SCT survivors. Bone Marrow Transplant 2010; 45:570.
  15. Boyes AW, Girgis A, D'Este C, Zucca AC. Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6months after diagnosis. J Affect Disord 2011; 135:184.
  16. Jarrett N, Scott I, Addington-Hall J, et al. Informing future research priorities into the psychological and social problems faced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 2013; 17:510.
  17. Boyes AW, Girgis A, D'Este CA, et al. Prevalence and predictors of the short-term trajectory of anxiety and depression in the first year after a cancer diagnosis: a population-based longitudinal study. J Clin Oncol 2013; 31:2724.
  18. Suzuki M, Deno M, Myers M, et al. Anxiety and depression in patients after surgery for head and neck cancer in Japan. Palliat Support Care 2016; 14:269.
  19. Vehling S, Mehnert A, Hartmann M, et al. Anxiety and depression in long-term testicular germ cell tumor survivors. Gen Hosp Psychiatry 2016; 38:21.
  20. Stanton AL. Psychosocial concerns and interventions for cancer survivors. J Clin Oncol 2006; 24:5132.
  21. Dunn J, Ng SK, Holland J, et al. Trajectories of psychological distress after colorectal cancer. Psychooncology 2013; 22:1759.
  22. Braamse AM, van Turenhout ST, Terhaar Sive Droste JS, et al. Factors associated with anxiety and depressive symptoms in colorectal cancer survivors. Eur J Gastroenterol Hepatol 2016; 28:831.
  23. Saboonchi F, Petersson LM, Wennman-Larsen A, et al. Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship. J Psychosoc Oncol 2015; 33:603.
  24. Park CL, Cho D, Blank TO, Wortmann JH. Cognitive and emotional aspects of fear of recurrence: predictors and relations with adjustment in young to middle-aged cancer survivors. Psychooncology 2013; 22:1630.
  25. Ozga M, Aghajanian C, Myers-Virtue S, et al. A systematic review of ovarian cancer and fear of recurrence. Palliat Support Care 2015; 13:1771.
  26. McGinty HL, Small BJ, Laronga C, Jacobsen PB. Predictors and patterns of fear of cancer recurrence in breast cancer survivors. Health Psychol 2016; 35:1.
  27. Liu Y, Pérez M, Schootman M, et al. Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 2011; 130:165.
  28. Mehnert A, Koch U, Sundermann C, Dinkel A. Predictors of fear of recurrence in patients one year after cancer rehabilitation: a prospective study. Acta Oncol 2013; 52:1102.
  29. Ghazali N, Cadwallader E, Lowe D, et al. Fear of recurrence among head and neck cancer survivors: longitudinal trends. Psychooncology 2013; 22:807.
  30. Lebel S, Tomei C, Feldstain A, et al. Does fear of cancer recurrence predict cancer survivors' health care use? Support Care Cancer 2013; 21:901.
  31. Kim Y, Carver CS, Spillers RL, et al. Dyadic effects of fear of recurrence on the quality of life of cancer survivors and their caregivers. Qual Life Res 2012; 21:517.
  32. Koch L, Bertram H, Eberle A, et al. Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship--a multi-regional population-based study. Psychooncology 2014; 23:547.
  33. Ziner KW, Sledge GW, Bell CJ, et al. Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis. Oncol Nurs Forum 2012; 39:287.
  34. Koch-Gallenkamp L, Bertram H, Eberle A, et al. Fear of recurrence in long-term cancer survivors-Do cancer type, sex, time since diagnosis, and social support matter? Health Psychol 2016; 35:1329.
  35. Lebel S, Beattie S, Arès I, Bielajew C. Young and worried: Age and fear of recurrence in breast cancer survivors. Health Psychol 2013; 32:695.
  36. Fisher A, Beeken RJ, Heinrich M, et al. Health behaviours and fear of cancer recurrence in 10 969 colorectal cancer (CRC) patients. Psychooncology 2016; 25:1434.
  37. Simonelli LE, Siegel SD, Duffy NM. Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology 2016.
  38. Smith SK, Zimmerman S, Williams CS, et al. Post-traumatic stress outcomes in non-Hodgkin's lymphoma survivors. J Clin Oncol 2008; 26:934.
  39. Mehnert A, Koch U. Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res 2008; 64:383.
  40. Abbey G, Thompson SB, Hickish T, Heathcote D. A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psychooncology 2015; 24:371.
  41. Swartzman S, Booth JN, Munro A, Sani F. Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis. Depress Anxiety 2017; 34:327.
  42. Stuber ML, Meeske KA, Krull KR, et al. Prevalence and predictors of posttraumatic stress disorder in adult survivors of childhood cancer. Pediatrics 2010; 125:e1124.
  43. Smith SK, Zimmerman S, Williams CS, et al. Post-traumatic stress symptoms in long-term non-Hodgkin's lymphoma survivors: does time heal? J Clin Oncol 2011; 29:4526.
  44. Syrjala KL, Yi JC, Langer SL. Psychometric properties of the Cancer and Treatment Distress (CTXD) measure in hematopoietic cell transplantation patients. Psychooncology 2016; 25:529.
  45. Syrjala KL, Sutton SK, Jim HS, et al. Cancer and treatment distress psychometric evaluation over time: A BMT CTN 0902 secondary analysis. Cancer 2017; 123:1416.
  46. Ploos van Amstel FK, van den Berg SW, van Laarhoven HW, et al. Distress screening remains important during follow-up after primary breast cancer treatment. Support Care Cancer 2013; 21:2107.
  47. Syrjala KL, Langer SL, Abrams JR, et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA 2004; 291:2335.
  48. Rusiewicz A, DuHamel KN, Burkhalter J, et al. Psychological distress in long-term survivors of hematopoietic stem cell transplantation. Psychooncology 2008; 17:329.
  49. Bradley S, Rose S, Lutgendorf S, et al. Quality of life and mental health in cervical and endometrial cancer survivors. Gynecol Oncol 2006; 100:479.
  50. Martin PJ, Storer BE, Rowley SD, et al. Evaluation of mycophenolate mofetil for initial treatment of chronic graft-versus-host disease. Blood 2009; 113:5074.
  51. Jansen L, Koch L, Brenner H, Arndt V. Quality of life among long-term (≥5 years) colorectal cancer survivors--systematic review. Eur J Cancer 2010; 46:2879.
  52. Epstein JB, Phillips N, Parry J, et al. Quality of life, taste, olfactory and oral function following high-dose chemotherapy and allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2002; 30:785.
  53. Banks E, Byles JE, Gibson RE, et al. Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study. Med J Aust 2010; 193:S62.
  54. Przezdziecki A, Sherman KA, Baillie A, et al. My changed body: breast cancer, body image, distress and self-compassion. Psychooncology 2013; 22:1872.
  55. Roland KB, Rodriguez JL, Patterson JR, Trivers KF. A literature review of the social and psychological needs of ovarian cancer survivors. Psychooncology 2013; 22:2408.
  56. Cohen M, Mabjish AA, Zidan J. Comparison of Arab breast cancer survivors and healthy controls for spousal relationship, body image, and emotional distress. Qual Life Res 2011; 20:191.
  57. Benedict C, Rodriguez VM, Carter J, et al. Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer. Support Care Cancer 2016; 24:1795.
  58. Schootman M, Deshpande AD, Pruitt SL, et al. National estimates of racial disparities in health status and behavioral risk factors among long-term cancer survivors and non-cancer controls. Cancer Causes Control 2010; 21:1387.
  59. Apenteng BA, Hansen AR, Opoku ST, Mase WA. Racial Disparities in Emotional Distress Among Cancer Survivors: Insights from the Health Information National Trends Survey (HINTS). J Cancer Educ 2016.
  60. Kelly KM, Shedlosky-Shoemaker R, Porter K, et al. Cancer recurrence worry, risk perception, and informational-coping styles among Appalachian cancer survivors. J Psychosoc Oncol 2011; 29:1.
  61. VanHoose L, Black LL, Doty K, et al. An analysis of the distress thermometer problem list and distress in patients with cancer. Support Care Cancer 2015; 23:1225.
  62. Kamen C, Mustian KM, Heckler C, et al. The association between partner support and psychological distress among prostate cancer survivors in a nationwide study. J Cancer Surviv 2015; 9:492.
  63. Belcher SM, Hausmann EA, Cohen SM, et al. Examining the relationship between multiple primary cancers and psychological distress: A review of current literature. Psychooncology 2016.
  64. Korszun A, Sarker SJ, Chowdhury K, et al. Psychosocial factors associated with impact of cancer in longterm haematological cancer survivors. Br J Haematol 2014; 164:790.
  65. Ashing-Giwa K, Rosales M, Lai L, Weitzel J. Depressive symptomatology among Latina breast cancer survivors. Psychooncology 2013; 22:845.
  66. Dupont A, Bower JE, Stanton AL, Ganz PA. Cancer-related intrusive thoughts predict behavioral symptoms following breast cancer treatment. Health Psychol 2014; 33:155.
  67. Andrykowski MA, Steffens RF, Bush HM, Tucker TC. Disparities in mental health outcomes among lung cancer survivors associated with ruralness of residence. Psychooncology 2014; 23:428.
  68. Begovic-Juhant A, Chmielewski A, Iwuagwu S, Chapman LA. Impact of body image on depression and quality of life among women with breast cancer. J Psychosoc Oncol 2012; 30:446.
  69. Bifulco G, De Rosa N, Tornesello ML, et al. Quality of life, lifestyle behavior and employment experience: a comparison between young and midlife survivors of gynecology early stage cancers. Gynecol Oncol 2012; 124:444.
  70. Sharp L, Carsin AE, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology 2013; 22:745.
  71. Stanton AL, Wiley JF, Krull JL, et al. Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer. Breast Cancer Res Treat 2015; 154:105.
  72. Thong MS, Mols F, Verhoeven RH, et al. Multiple primary cancer survivors have poorer health status and well-being than single primary cancer survivors: a study from the population-based PROFILES registry. Psychooncology 2013; 22:1834.
  73. Clark CJ, Fino NF, Liang JH, et al. Depressive symptoms in older long-term colorectal cancer survivors: a population-based analysis using the SEER-Medicare healthcare outcomes survey. Support Care Cancer 2016; 24:3907.
  74. Custers JA, Becker ES, Gielissen MF, et al. Selective attention and fear of cancer recurrence in breast cancer survivors. Ann Behav Med 2015; 49:66.
  75. Oancea SC, Cheruvu VK. Psychological distress among adult cancer survivors: importance of survivorship care plan. Support Care Cancer 2016; 24:4523.
  76. Rottmann N, Hansen DG, Hagedoorn M, et al. Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study. J Cancer Surviv 2016; 10:915.
  77. "I learned to live with it" is not good enough: Challenges reported by post-treatment cancer survivors in the LIVESTRONG surveys. A LIVESTRONG report, 2010. http://www.livestrong.org/pdfs/3-0/LSSurvivorSurveyReport_final (Accessed on July 23, 2014).
  78. Ganz PA, Desmond KA, Leedham B, et al. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 2002; 94:39.
  79. Ganz PA. Sexual functioning after breast cancer: a conceptual framework for future studies. Ann Oncol 1997; 8:105.
  80. Katz A, Dizon DS. Sexuality After Cancer: A Model for Male Survivors. J Sex Med 2016; 13:70.
  81. Syrjala KL, Kurland BF, Abrams JR, et al. Sexual function changes during the 5 years after high-dose treatment and hematopoietic cell transplantation for malignancy, with case-matched controls at 5 years. Blood 2008; 111:989.
  82. Green DM, Sklar CA, Boice JD Jr, et al. Ovarian failure and reproductive outcomes after childhood cancer treatment: results from the Childhood Cancer Survivor Study. J Clin Oncol 2009; 27:2374.
  83. Yi JC, Syrjala KL. Sexuality after hematopoietic stem cell transplantation. Cancer J 2009; 15:57.
  84. Christie KM, Meyerowitz BE, Maly RC. Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women. Psychooncology 2010; 19:1069.
  85. Sun V, Grant M, Wendel CS, et al. Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors. J Sex Med 2016; 13:1071.
  86. Boquiren VM, Esplen MJ, Wong J, et al. Sexual functioning in breast cancer survivors experiencing body image disturbance. Psychooncology 2016; 25:66.
  87. Marino JL, Saunders CM, Emery LI, et al. How does adjuvant chemotherapy affect menopausal symptoms, sexual function, and quality of life after breast cancer? Menopause 2016; 23:1000.
  88. Huffman LB, Hartenbach EM, Carter J, et al. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol 2016; 140:359.
  89. Bakker RM, Kenter GG, Creutzberg CL, et al. Sexual distress and associated factors among cervical cancer survivors: A cross-sectional multicenter observational study. Psychooncology 2016.
  90. Dyer G, Gilroy N, Bradford J, et al. A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia. Br J Haematol 2016; 172:592.
  91. Hammond C, Abrams JR, Syrjala KL. Fertility and risk factors for elevated infertility concern in 10-year hematopoietic cell transplant survivors and case-matched controls. J Clin Oncol 2007; 25:3511.
  92. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci 2003; 58:82.
  93. Grunfeld EA, Cooper AF. A longitudinal qualitative study of the experience of working following treatment for gynaecological cancer. Psychooncology 2012; 21:82.
  94. Tunceli K, Short PF, Moran JR, Tunceli O. Cancer survivorship, health insurance, and employment transitions among older workers. Inquiry 2009; 46:17.
  95. Bouknight RR, Bradley CJ, Luo Z. Correlates of return to work for breast cancer survivors. J Clin Oncol 2006; 24:345.
  96. Kirchhoff AC, Leisenring W, Syrjala KL. Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation. J Cancer Surviv 2010; 4:33.
  97. de Boer AG, Taskila T, Ojajärvi A, et al. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA 2009; 301:753.
  98. Chen L, Glimelius I, Neovius M, et al. Work Loss Duration and Predictors Following Rectal Cancer Treatment among Patients with and without Prediagnostic Work Loss. Cancer Epidemiol Biomarkers Prev 2016; 25:987.
  99. Drolet M, Maunsell E, Brisson J, et al. Not working 3 years after breast cancer: predictors in a population-based study. J Clin Oncol 2005; 23:8305.
  100. Torp S, Nielsen RA, Fosså SD, et al. Change in employment status of 5-year cancer survivors. Eur J Public Health 2013; 23:116.
  101. Boykoff N, Moieni M, Subramanian SK. Confronting chemobrain: an in-depth look at survivors' reports of impact on work, social networks, and health care response. J Cancer Surviv 2009; 3:223.
  102. Clarke TC, Christ SL, Soler-Vila H, et al. Working with cancer: health and employment among cancer survivors. Ann Epidemiol 2015; 25:832.
  103. Duijts SF, van Egmond MP, Spelten E, et al. Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review. Psychooncology 2014; 23:481.
  104. Sun Y, Shigaki CL, Armer JM. Return to work among breast cancer survivors: A literature review. Support Care Cancer 2017; 25:709.
  105. Cooper AF, Hankins M, Rixon L, et al. Distinct work-related, clinical and psychological factors predict return to work following treatment in four different cancer types. Psychooncology 2013; 22:659.
  106. Torp S, Syse J, Paraponaris A, Gudbergsson S. Return to work among self-employed cancer survivors. J Cancer Surviv 2017; 11:189.
  107. Stenberg U, Ruland CM, Miaskowski C. Review of the literature on the effects of caring for a patient with cancer. Psychooncology 2010; 19:1013.
  108. Kim Y, Given BA. Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer 2008; 112:2556.
  109. Langer SL, Yi JC, Storer BE, Syrjala KL. Marital adjustment, satisfaction and dissolution among hematopoietic stem cell transplant patients and spouses: a prospective, five-year longitudinal investigation. Psychooncology 2010; 19:190.
  110. Hagedoorn M, Sanderman R, Bolks HN, et al. Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull 2008; 134:1.
  111. Langer SL, Brown JD, Syrjala KL. Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer 2009; 115:4311.
  112. Dagan M, Sanderman R, Schokker MC, et al. Spousal support and changes in distress over time in couples coping with cancer: the role of personal control. J Fam Psychol 2011; 25:310.
  113. Kent EE, Rowland JH, Northouse L, et al. Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving. Cancer 2016; 122:1987.
  114. Sklenarova H, Krümpelmann A, Haun MW, et al. When do we need to care about the caregiver? Supportive care needs, anxiety, and depression among informal caregivers of patients with cancer and cancer survivors. Cancer 2015; 121:1513.
  115. Manne S, Badr H. Intimacy and relationship processes in couples' psychosocial adaptation to cancer. Cancer 2008; 112:2541.
  116. Hagedoorn M, Puterman E, Sanderman R, et al. Is self-disclosure in couples coping with cancer associated with improvement in depressive symptoms? Health Psychol 2011; 30:753.
  117. Weaver KE, Rowland JH, Alfano CM, McNeel TS. Parental cancer and the family: a population-based estimate of the number of US cancer survivors residing with their minor children. Cancer 2010; 116:4395.
  118. Osborn T. The psychosocial impact of parental cancer on children and adolescents: a systematic review. Psychooncology 2007; 16:101.
  119. Gazendam-Donofrio SM, Hoekstra HJ, van der Graaf WT, et al. Adolescents' emotional reactions to parental cancer: effect on emotional and behavioral problems. J Pediatr Psychol 2011; 36:346.
  120. Inbar C, Ety B, Ayala H, Tamer P. The mental health of breast cancer survivors and their adolescent daughters. Psychooncology 2013; 22:1236.
  121. Friedman LC, Barber CR, Chang J, et al. Self-blame, self-forgiveness, and spirituality in breast cancer survivors in a public sector setting. J Cancer Educ 2010; 25:343.
  122. Lebel S, Feldstain A, McCallum M, et al. Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers? Psychol Health 2013; 28:1066.
  123. Smith SK, Samsa G, Ganz PA, Zimmerman S. Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis? Psychooncology 2014; 23:315.
  124. Jeon M, Yoo IY, Kim S, Lee J. Post-traumatic growth in survivors of allogeneic hematopoietic stem cell transplantation. Psychooncology 2015; 24:871.
  125. Gesselman AN, Bigatti SM, Garcia JR, et al. Spirituality, emotional distress, and post-traumatic growth in breast cancer survivors and their partners: an actor-partner interdependence modeling approach. Psychooncology 2016.
  126. Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol 2003; 22:487.
  127. Tallman B, Shaw K, Schultz J, Altmaier E. Well-being and posttraumatic growth in unrelated donor marrow transplant survivors: a nine-year longitudinal study. Rehabil Psychol 2010; 55:204.
  128. Fava GA, Porcelli P, Rafanelli C, et al. The spectrum of anxiety disorders in the medically ill. J Clin Psychiatry 2010; 71:910.
  129. Denlinger CS, Carlson RW, Are M, et al. Survivorship: introduction and definition. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2014; 12:34.
  130. Mitchell AJ. Short screening tools for cancer-related distress: a review and diagnostic validity meta-analysis. J Natl Compr Canc Netw 2010; 8:487.
  131. Ryan DA, Gallagher P, Wright S, Cassidy EM. Sensitivity and specificity of the Distress Thermometer and a two-item depression screen (Patient Health Questionnaire-2) with a 'help' question for psychological distress and psychiatric morbidity in patients with advanced cancer. Psychooncology 2012; 21:1275.
  132. Ibbotson T, Maguire P, Selby P, et al. Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 1994; 30A:37.
  133. Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord 2010; 126:335.
  134. Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32:345.
  135. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166:1092.
  136. Löwe B, Decker O, Müller S, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008; 46:266.
  137. Recklitis CJ, Rodriguez P. Screening childhood cancer survivors with the brief symptom inventory-18: classification agreement with the symptom checklist-90-revised. Psychooncology 2007; 16:429.
  138. Hahn EE, Hays RD, Kahn KL, et al. Post-traumatic stress symptoms in cancer survivors: relationship to the impact of cancer scale and other associated risk factors. Psychooncology 2015; 24:643.
  139. Custers JA, van den Berg SW, van Laarhoven HW, et al. The Cancer Worry Scale: detecting fear of recurrence in breast cancer survivors. Cancer Nurs 2014; 37:E44.
  140. Custers JA, Gielissen MF, Janssen SH, et al. Fear of cancer recurrence in colorectal cancer survivors. Support Care Cancer 2016; 24:555.
  141. Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv 2015; 9:481.
  142. Rosenbaum JF. The drug treatment of anxiety. N Engl J Med 1982; 306:401.
  143. Reese JB, Sorice K, Beach MC, et al. Patient-provider communication about sexual concerns in cancer: a systematic review. J Cancer Surviv 2017; 11:175.
  144. Smith SL, Singh-Carlson S, Downie L, et al. Survivors of breast cancer: patient perspectives on survivorship care planning. J Cancer Surviv 2011; 5:337.
  145. Brotto LA, Erskine Y, Carey M, et al. A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol 2012; 125:320.
  146. Brotto LA, Yule M, Breckon E. Psychological interventions for the sexual sequelae of cancer: a review of the literature. J Cancer Surviv 2010; 4:346.
  147. Rowland JH, Meyerowitz BE, Crespi CM, et al. Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. Breast Cancer Res Treat 2009; 118:99.
  148. Schover LR, Yuan Y, Fellman BM, et al. Efficacy trial of an Internet-based intervention for cancer-related female sexual dysfunction. J Natl Compr Canc Netw 2013; 11:1389.
  149. Capuron L, Dantzer R. Cytokines and depression: the need for a new paradigm. Brain Behav Immun 2003; 17 Suppl 1:S119.
  150. Beatty LJ, Koczwara B, Rice J, Wade TD. A randomised controlled trial to evaluate the effects of a self-help workbook intervention on distress, coping and quality of life after breast cancer diagnosis. Med J Aust 2010; 193:S68.
  151. Badger TA, Segrin C, Figueredo AJ, et al. Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners. Qual Life Res 2011; 20:833.
  152. Marcus AC, Garrett KM, Cella D, et al. Can telephone counseling post-treatment improve psychosocial outcomes among early stage breast cancer survivors? Psychooncology 2010; 19:923.
  153. Otto AK, Szczesny EC, Soriano EC, et al. Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors. Health Psychol 2016; 35:1320.
  154. Duijts SF, Faber MM, Oldenburg HS, et al. Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors--a meta-analysis. Psychooncology 2011; 20:115.
  155. Traeger L, Penedo FJ, Benedict C, et al. Identifying how and for whom cognitive-behavioral stress management improves emotional well-being among recent prostate cancer survivors. Psychooncology 2013; 22:250.
  156. DuHamel KN, Mosher CE, Winkel G, et al. Randomized clinical trial of telephone-administered cognitive-behavioral therapy to reduce post-traumatic stress disorder and distress symptoms after hematopoietic stem-cell transplantation. J Clin Oncol 2010; 28:3754.
  157. Butow PN, Bell ML, Smith AB, et al. Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer 2013; 13:201.
  158. Butow PN, Turner J, Gilchrist J, et al. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol 2017; :JCO2017731257.
  159. de Boer AG, Taskila T, Tamminga SJ, et al. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2011; :CD007569.
  160. Scott DA, Mills M, Black A, et al. Multidimensional rehabilitation programmes for adult cancer survivors. Cochrane Database Syst Rev 2013; :CD007730.
  161. de Boer AG, Taskila TK, Tamminga SJ, et al. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2015; :CD007569.
  162. Buffart LM, van Uffelen JG, Riphagen II, et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 2012; 12:559.
  163. Cramer H, Lange S, Klose P, et al. Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer 2012; 12:412.
  164. Campo RA, Agarwal N, LaStayo PC, et al. Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of Qigong. J Cancer Surviv 2014; 8:60.
  165. Manne SL, Kissane DW, Nelson CJ, et al. Intimacy-enhancing psychological intervention for men diagnosed with prostate cancer and their partners: a pilot study. J Sex Med 2011; 8:1197.
  166. Ashing K, Rosales M. A telephonic-based trial to reduce depressive symptoms among Latina breast cancer survivors. Psychooncology 2014; 23:507.
  167. Badger T, Segrin C, Pasvogel A, Lopez AM. The effect of psychosocial interventions delivered by telephone and videophone on quality of life in early-stage breast cancer survivors and their supportive partners. J Telemed Telecare 2013; 19:260.
  168. Badger TA, Segrin C, Figueredo AJ, et al. Who benefits from a psychosocial counselling versus educational intervention to improve psychological quality of life in prostate cancer survivors? Psychol Health 2013; 28:336.
  169. Goode AD, Lawler SP, Brakenridge CL, et al. Telephone, print, and Web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv 2015; 9:660.
  170. Brebach R, Sharpe L, Costa DS, et al. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology 2016; 25:882.
  171. Wenzel L, Osann K, Hsieh S, et al. Psychosocial telephone counseling for survivors of cervical cancer: results of a randomized biobehavioral trial. J Clin Oncol 2015; 33:1171.
  172. Syrjala KL, Stover AC, Yi JC, et al. Development and implementation of an Internet-based survivorship care program for cancer survivors treated with hematopoietic stem cell transplantation. J Cancer Surviv 2011; 5:292.
  173. Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res 2013; 15:e37.
  174. Stanton AL, Thompson EH, Crespi CM, et al. Project connect online: randomized trial of an internet-based program to chronicle the cancer experience and facilitate communication. J Clin Oncol 2013; 31:3411.
  175. Short CE, Rebar A, James EL, et al. How do different delivery schedules of tailored web-based physical activity advice for breast cancer survivors influence intervention use and efficacy? J Cancer Surviv 2017; 11:80.
  176. Post KE, Flanagan J. Web based survivorship interventions for women with breast cancer: An integrative review. Eur J Oncol Nurs 2016; 25:90.
  177. Kim AR, Park HA. Web-based Self-management Support Interventions for Cancer Survivors: A Systematic Review and Meta-analyses. Stud Health Technol Inform 2015; 216:142.
  178. Kanera IM, Willems RA, Bolman CA, et al. Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial. J Med Internet Res 2016; 18:e229.
  179. Smith SK, O'Donnell JD, Abernethy AP, et al. Evaluation of Pillars4life: a virtual coping skills program for cancer survivors. Psychooncology 2015; 24:1407.
  180. van den Berg SW, Gielissen MF, Custers JA, et al. BREATH: Web-Based Self-Management for Psychological Adjustment After Primary Breast Cancer--Results of a Multicenter Randomized Controlled Trial. J Clin Oncol 2015; 33:2763.