The Mental Health Effects in Adolescent/Young Adult (AYA) Patients Coping with Cardiotoxicity Related to Cancer Treatment: A proof-of-principle study

Abstract

Research Question: Are adolescent and young adult (AYA) cancer survivors with chemotherapy-induced cardiotoxicity at an increased risk of developing depression and anxiety than AYA cancer survivors with less severe chemotherapy-associated side effects?

Background, Significance, and Rationale for the Question: Less is known about the AYA cancer population than other cancer populations and this population has not seen the same positive trends in mortality over the last few decades when compared to cancers diagnosed in childhood or later in adulthood. As treatments continue to improve and cancer patients have longer survival periods, there has been an increased incidence of long-term chemotherapy-related side effects, of which cardiotoxic side effects are associated with the highest mortality rate. While there is research documenting the cardiotoxic side effects that may develop, less has been published regarding patient perceptions of this cardiovascular disease diagnosis and how it affects the mental and behavioral health of an AYA cancer survivor. The primary goal of this study is to provide proof-of-principle to support a larger, follow-up investigation designed to understand the psychosocial effect that a disease diagnosis with severe clinical effects by evaluating the impact that chemotherapy-induced cardiotoxic side effects may have on AYA cancer survivor cared for in an urban cancer survivorship clinic in Dallas, TX.

Materials and Methods: A prospective cohort study using semi-structured interviews in combination with surveys will be performed. Patients seen through the “After the Cancer Experience” (ACE) Survivorship program at the UT-Southwestern (UTSW) campus. A portion of these patients will have cardiotoxic side effects from chemotherapy and the remaining patients will have less severe side effects from chemotherapy. Secondary endpoint metrics will include anxiety and depression scales such as the PHQ-9 and GAD-7. All patients will be screened using these tools before and after each semi-structured interview and given the appropriate consent form. Survey data will be collected at the time of consent over telephone.

Results, Conclusions, and Impact: Recruitment posed as a major barrier to study completion as only three participants successfully enrolled and completed the study. Not enough data was collected to compare rates of anxiety and depression in cancer survivors suffering from chemotherapy-induced cardiotoxicity to less severe chemotherapy-related side effects. Initial data does suggest that survivors who underwent mental health counseling and addressed mental health concerns during cancer treatment were better equipped to cope with a late effect diagnosis later in life. This study highlighted the difficulty in recruiting cancer survivors into a research study, especially during the COVID pandemic. Future research should be done to fully assess whether certain late effect diagnoses that cancer patients develop may place them at a greater risk of developing anxiety and depression. In addition, many cancer patients may benefit from an effective mental health intervention to improve quality of life, patient satisfaction, and completeness of care that may improve long term mental health outcomes.