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Overview of psychosocial issues in the adult cancer survivor

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

INTRODUCTION

By 2024, over 18 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].

Despite these data, 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 [10,11]. In addition, survivors who have clinical depression have a twofold risk of all-cause mortality [12]. 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 [13].

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".)

ANXIETY

Approximately 18 to 20 percent of long-term cancer survivors report anxiety [9,14-16]. Patients may present with a complex mixture of physical and psychological symptoms, making recognition of anxiety symptoms requiring treatment quite challenging. Such symptoms may be expressed as:

                              

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