A related article on this topic can be read here. The following interview was edited for clarity.

Research suggests that pediatric and adolescent and young adult (AYA) cancer survivors have an increased risk of psychological disorders, and cancer treatment may have the greatest impact on psychological functioning in these patients.1-4

To discuss this phenomenon and address the unique risks and needs of these patients, we interviewed Robert Casey, PhD, a pediatric psychologist and director of the Wellness Program at the Center for Cancer & Blood Disorders at Children’s Hospital Colorado and an associate professor at the University of Colorado School of Medicine Anschutz Medical Campus in Aurora.

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What does the literature suggest about the risk of psychological disorders in pediatric and AYA cancer survivors?

Pediatric cancer survivors are at greater risk for a range of clinically relevant psychological late effects when compared with sibling comparison groups or matched controls who have no history of cancer.1,2 The most common psychological diagnoses include anxiety, post-traumatic stress disorder, and depression.

The literature is inconsistent when reporting elevated levels of anxiety, depression, or interpersonal problems in young cancer survivors. Several studies indicate that young cancer survivors are remarkably resilient and experience few long-term emotional side effects.2 One potential explanation is that children diagnosed at younger ages may have few memories of their treatment and thus may be less susceptible to treatment-related post-traumatic stress symptoms.

But the literature also suggests that there are subgroups of survivors who are more vulnerable and at increased risk for emotional distress.1-4 There has been extensive research examining the impact of cancer treatment on the psychological functioning of AYA patients, who are more likely to remember the details of their treatment and to experience their treatment as extremely disruptive to their developmental trajectory.4,5  

Why do pediatric and AYA cancer survivors have a higher risk of psychological disorders?

The literature suggests that the long-term physical and cognitive effects of cancer treatment are likely to have the greatest impact on the psychological functioning of pediatric cancer survivors.2

For example, chemotherapy and radiation treatment can increase the risk for secondary cancers, cardiac problems, infertility, and learning disabilities. The occurrence of these secondary effects — or even the fear that any of these side effects might occur — can increase levels of anxiety and depression, as cancer survivors may feel that they have not escaped their pediatric cancer diagnosis despite completing treatment years before. 

Cognitive deficits can result from cranial radiation, and more significant cognitive impairment can be found in brain tumor survivors whose lesions may have irreparably damaged brain tissue, causing problems with emotional regulation, memory, or executive functioning.

Physical impairments such as avascular necrosis and amputation may also seriously impact psychological functioning. Fear of relapse of their initial cancer diagnosis can also be a source of increased depression and anxiety.