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Results From a National Survey

Karen E. Hoffman, MD, MHSc; Ellen P. McCarthy, PhD, MPH; Christopher J. Recklitis, PhD, MPH; Andrea K. Ng, MD, MPH

Arch Intern Med. 2009;169(14):1274-1281.

Background  As advances in cancer screening and treatment increase the number of long-term cancer survivors, it is important to understand the long-term psychological sequelae of the cancer experience.

Methods  The 4636 respondents who identified themselves as survivors of adult-onset cancer of 5 years or more and 122 220 respondents who were never diagnosed as having cancer were identified in the 2002 to 2006 National Health Interview Survey. The primary outcome in this population-based study was serious psychological distress (SPD) defined as a K6 scale (a validated screening tool for mental illness) score of 13 or more.

Results  Among survivors, the median age at diagnosis was 50 years, the age at interview was 66 years, and the time since diagnosis was 12 years. The prevalence of SPD was significantly higher among long-term cancer survivors than among respondents who were never diagnosed as having cancer (5.6% vs 3.0%; P < .001). After adjustment for clinical and sociodemographic variables (age, sex, race, relationship status, educational attainment, insurance status, comorbidities, smoking history, and ability to perform instrumental activities of daily living), survivors remained significantly more likely to experience SPD (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.7). After adjustment for other clinical and sociodemographic variables, long-term survivors who were younger, were unmarried, had less than a high school education, were uninsured, had more comorbidities, or had difficulty performing instrumental activities of daily living were more likely to experience SPD.

Conclusions  Long-term survivors of adult-onset cancer are at increased risk for psychological distress. This study identifies several clinical and sociodemographic factors associated with SPD that may help target high-risk survivors for psychological screening and support.

Author Affiliations: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute (Drs Hoffman and Ng), Harvard Radiation Oncology Program (Dr Hoffman), Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (Dr McCarthy), and Perini Family Survivors' Center, Dana-Farber Cancer Institute, and Department of Pediatrics (Dr Recklitis), Harvard Medical School (Drs McCarthy, Recklitis, and Ng), Boston, Massachusetts.

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