As patients develop cancer at younger ages, psycho-oncologists are studying the mental health impact

While a cancer diagnosis can be devastating at any age, it may affect younger adults’ mental health—and lives—more significantly and with more persistence over their lifetimes. One study, for instance, found that survivors who had been diagnosed between 15 and 39 years old had greater emotional distress than those who had been diagnosed at age 40 or older (Boakye, E. A., et al., Annals of Epidemiology, Vol. 72, 2022).

“This is when they’re finishing their education; they’re working to build their careers; they’re initiating romantic relationships, getting married, thinking about having children. They’re not necessarily as financially stable as an older individual might be,” said Caroline Dorfman, PhD, director of research and behavioral medicine for the Teen and Young Adult Oncology Program at Duke University. “And so when they are diagnosed with cancer, there are a lot of different things that they need to take into account.”

One of those things is getting an accurate and timely diagnosis to begin with. Because health care providers are not typically expecting to find cancer in their younger patients, the route to an answer is often prolonged and convoluted, the authors of a study in the British Journal of Cancer found (Forster, A., et al., Vol. 126, 2022). And the research showed that the longer it takes to get a diagnosis, the higher the risk of depression, anxiety, and impaired health-related quality of life.

Adolescent and young adult (AYA) patients may think, “Is my team really going to be able to help me since it took them so long to find this cancer?” or “What if they had found it earlier?” said Dorfman, also an assistant professor in Duke’s Department of Psychiatry and Behavioral Sciences. “So they may be coming into their diagnosis with an added layer of distress.”

Compounding that distress is the financial toll of cancer treatment on people who have not had much time to build up savings. Sadly, this puts fertility preservation out of reach for many. Egg freezing, for instance, is not always covered by insurance and costs around $10,000, according to Minnesota Oncology.

Because of such costs, 23% of adolescent and young adult cancer survivors said they lacked money for basic necessities, one study found. Nearly half took on credit card debt and put off major purchases. Even many years after treatment, younger cancer survivors have not caught up with their peers financially or in the workplace, Pozo-Kaderman said (Thom, B., et al., Journal of Cancer Survivorship: Research and Practice, Vol. 17, No. 6, 2023).

Abdelhadi can relate. “There were times when I felt I was falling behind or missing out on life milestones,” she said. “However, this experience positively shifted my interest and passion toward cancer research.”

A cancer diagnosis can also affect the home lives of 20-, 30-, and 40-somethings in significant ways. A young parent with cancer might need new forms of childcare and struggle to find the best way to talk to their kids about treatments. A recent college grad may need to move back in with her parents, challenging her sense of independence and identity. Newlyweds planning to close on a house or try for kids may need to abandon those plans indefinitely.

Couples can also struggle with intimacy issues. Cancer treatments often induce early menopause in women, leading to hot flashes, vaginal dryness, and a lack of desire. If the person with cancer is single, they can face added stress in their sex life—or lack thereof, Pozo-Kaderman said. “If they’re really young, sometimes they have very limited experiences,” she said. “If they’re a little older and they’re single, it’s like, When do I tell [a new partner about how cancer has changed my body?] How do I tell? Will anybody want me?”

These patients “do want to have meaning in their life. They do want to form relationships. They do have goals that they want to set for their life in their future,” Dorfman said. “And that’s where psychologists can really come in—to help them live their life in a way that is meaningful and in line with their values, even in the midst of a potentially life-limiting illness.”