Few differences were noted between survivors of childhood and AYA leukemia or brain cancer, but AYA patients with lymphoma or sarcoma appear to face lower risks of psychosocial and neurocognitive impacts in later adulthood.6 Patients with lymphoma or sarcoma diagnoses during AYA years reported lower levels of distress and neurocognitive issues than did children with those cancer types.6 However, the authors note that no such differences were apparent among survivors with CNS tumors or leukemia.6
Survivors diagnosed with cancers during AYA years were “significantly less likely than sibling controls to have attained post-high school education, to be working full time, to be married, or to be living independently, and social outcomes were related to neurocognitive symptoms,” the authors conclude.6
Self-reported task-inefficiency (eg, time required to complete a task), depression, and somatization (the expression of anxiety as physical symptoms) were each linked to unemployment risk in adult survivors of AYA cancers.6 These problems “have the potential to handicap young adults as they move toward the end of formal schooling, seek jobs or career opportunities, establish themselves as independent adults, and enter into intimate emotional and sexual relationships,” Zebrack says.
“A key finding is the association between unemployment with neurocognitive function and psychological distress, particularly depression,” Zebrack notes. “This is consistent with some of my own prior research.”
The youngest study participants included in the AYA analysis were 11 years old because that is the average age at which girls experience the onset of puberty.6 Onset of puberty among boys occurs, on average, by age 10 years.6
Cancer treatment for adolescents can be longer and more challenging than treatment for younger children with cancer.6 “Cancer treatment during this time has the potential to interfere with adolescents’ separation from caregivers, autonomy with regard to planning social and academic schedules, participation in social activities, and maintaining privacy, particularly of their bodies.”6
Key neuroanatomical and functional brain maturation processes continue into early adulthood.6 “Areas such as the prefrontal cortex, which coordinate executive functions, mature later than areas that are associated with sensory and motor tasks,” they report.
Patients with leukemia or brain tumors were more likely to have undergone chemoradiotherapy, the authors noted—a well established predictor of neurocognitive late effects.6 But AYA lymphoma and sarcoma survivors are not treated with chemoradiotherapy, allowing analysis of chemotherapeutic impacts on neurocognitive outcomes. Patients with lymphoma or sarcoma and who had undergone corticosteroid treatment, for example, had higher rates of somatization, anxiety, and problems with task efficiency and memory.6 Anxiety and memory problems were also associated with steroid treatment during younger adolescence (age 11 to 14 years).6