Sex-specific risk of mood and anxiety disorders following cancer diagnosis in adolescents and young adults: A Canadian population-based study.

Abstract

e24120 Background: Adolescents and young adults (AYAs) with cancer have unique medical and psychosocial needs. Despite improvements in survival outcomes, AYAs remain at elevated risk for psychological morbidity. Sex-based differences in the development of mood and anxiety disorders are not well characterized. This study examined factors associated with the development of mood and anxiety disorders among AYAs within five years of cancer diagnosis stratified by sex and tumor type. Methods: This retrospective cohort study used population-based data from the Manitoba Cancer Registry to identify individuals aged 15–39 years diagnosed with invasive cancer between 1989 and 2019. Mood and anxiety disorders were determined using validated administrative algorithms. Associations between demographic, clinical, and treatment-related factors including age at diagnosis, comorbidities, income quintile, residence, year of diagnosis, sex and tumor type (sex-specific, non-sex-specific solid, and non-solid), and receipt of chemotherapy, surgery, and radiation were evaluated using competing risks regression. Sex-specific cancers included breast, ovarian, uterine, and cervical cancers in females, and prostate and testicular cancers in males. Results: Among 3,818 AYAs with cancer, 56% were female, and 21% were aged 15-25. Most individuals had solid tumors (83%), of whom 34% had a sex-specific tumor. In competing risks regression, compared to males with a sex-specific cancer, females with sex-specific cancers [sub-Hazard Ratio (sHR) 2.28, 95% Confidence Interval (CI) 1.36–3.82], females with non–sex-specific solid tumors (sHR 2.22, 95% CI 1.33–3.70), females with non-solid tumors (sHR 2.98, 95%CI 1.55–5.71), and males with non-solid tumors (sHR 1.97, 95% CI 1.03–3.78) had a higher risk of developing mood or anxiety disorder. Additionally, younger age at diagnosis (Table 1), presence of one or more comorbidities (sHR 1.34, 95% CI 1.05-1.71), a more recent year of cancer diagnosis (sHR 1.03 per year, 95% CI 1.01-1.04), receipt of chemotherapy (sHR 1.38, 95% CI 1.03-1.84) and surgery (sHR 1.93, 95% CI 1.38-2.69) were associated with an increased risk of mood and anxiety disorders. Conclusions: Among AYAs with cancer, the risk of mood and anxiety disorders was highest among females, those with non-solid tumors, a younger age at diagnosis, presence of a comorbidity, a more recent diagnosis year, and receipt of chemotherapy or surgery. These findings underscore the need for targeted mental health screening and psychosocial support for AYA populations at a higher risk of a mood or anxiety disorder. 5-year adjusted cumulative incidence of mood and anxiety disorders post cancer diagnosis. Age at diagnosis (years) 5-year adjusted cumulative incidence (%) 15 14.0 20 10.2 25 7.9 30 7.0 35 7.2 39 7.6