Mental Health Burden in Long-Term Survivors of Childhood and Young Adult Cancer

Key Takeaways

• First mental health events were more common in five-year survivors of cancer diagnosed before age 40 than in matched comparators without a cancer history.
• Higher incidence in survivors was observed across follow-up intervals, with hazard ratios ranging from 1.3 in the first year after study entry to 1.5 beyond 15 years.
• Most first events were identified through general practice or prescribing records rather than hospital admissions, pointing to a broader view of survivorship burden.

Five-year survivors of cancer diagnosed before age 40 in the Lothian region of Scotland had a higher long-term burden of first mental health events than matched people without a cancer history, with events in 33.7% versus 25.5% in a population-based cohort study.

The study included 8,862 survivors and 26,586 comparators matched 1:3 by age, sex, and socioeconomic deprivation. Survivors were diagnosed with cancer between 1980 and 2018, and all had lived at least five years after diagnosis. Mental health outcomes were identified through psychotropic drug prescribing, hospital admission, and general-practice records. Median follow-up was 14.8 years for survivors and 16.7 years for comparators.

A first mental health event occurred in 2,983 survivors and 6,774 comparators. The analysis used time-stratified Cox proportional-hazards models to compare incidence across follow-up intervals. Survivors showed a consistently higher incidence throughout follow-up, with hazard ratios ranging from 1.3 in the first year after study entry to 1.5 beyond 15 years.

The authors described mental health as a core component of long-term survivorship care, particularly within primary care, and noted a need for cost-effective approaches to the sustained excess burden.