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Affiliation
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Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Chuo-ku, Tokyo, Japan. |
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Abstract
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Adolescents and young adults (AYA) with cancer are defined as individuals who receive their cancer diagnosis between 15 and 39 years of age based on the definition by the National Comprehensive Cancer Network (1). Cancer incidence in the AYA population has been increasing with more than 1.2 million AYAs estimated to be newly diagnosed with cancer in 2018 worldwide (2,3). AYAs with cancer have higher survival rates than older patients for most types of cancer in high-income countries (4). Even so, survival rates are less improved in AYAs than in children and older adults for certain types of cancer (4) and AYAs with cancer also have an increased risk of death from noncancer causes (5). The loss of healthy life-years by cancer is greater in AYAs than in older adults, leading to decreased productivity in society.
In recent decades, AYAs with cancer are increasingly recognized as a special subgroup distinguished from children and older adults with cancer in terms of psychosocial as well as biomedical aspects. Cancer spectrum and biology in AYAs differ from those in younger and older patients (6) and the AYA population is in a period of biological, psychosocial, and cognitive development. A growing body of literature has suggested that cancer experiences and psychosocial outcomes of AYAs differ from those of the adult population (7,8). Understanding psychological outcomes following cancer diagnosis unique to the AYA population will allow improved psychosocial support for this special age group.
Previous research has consistently reported a higher suicide risk among cancer patients compared with the general population (9). However, the existing literature has investigated suicide risk mainly among adults or all-age cancer patients, with only a few studies focused specifically on the AYA population.
To address this issue, Zhou et al. conducted a retrospective, population-based study in the United States to compare suicide risk between an AYA group (age 15–39 years) and all-age group (10). Using a cohort of 5,261,459 all-age patients including 312,313 AYA diagnosed with 20 types of solid malignancies between 1973 and 2015 and registered in the Surveillance, Epidemiology, and End Results (SEER) database, the authors found a slightly lower suicide mortality rate in the AYA group than in the all-age group (0.14% vs. 0.15%, respectively). Male sex, white race, unmarried status, localized stage of cancer, and longer survival time within 5 years of cancer diagnosis increased the risk of suicide for both the AYA and all-age groups, although the effect of gender and surgery on the AYA group was not as obvious as that on the all-age group, and localized cancer stage more strongly impacted the AYA group than the all-age group. The authors concluded that AYAs need not be separated as a special group for identifying a higher risk group of suicide among cancer patients. The findings of Zhou et al. are important because they highlight the psychological burden experienced by this understudied population. However, there remain unaddressed limitations and weaknesses in their study ...
Language: en |