Modifiable risk behaviors in adolescents and young adults (AYA) with cancer


Background: A cancer diagnosis in adolescents and young adults (AYA) comes at a complex developmental interval that often coincides with risky behaviors, such as substance use. Modifiable risk behaviors are an important area of research to minimize morbidity for AYA. Our goal was to examine substance use, affect, and other health indicators in a diverse AYA cancer patient sample. Methods: We identified patients between the ages of 18-39 years and 6 or more months from date of cancer diagnosis. Measures included demographic, general health and substance use variables, the Center for Epidemiologic Studies Depression Scale (CES-D), and the State-Trait Anxiety Inventory (STAI-T). Linear trend analyses were performed to examine group differences. Backward-selection ordinal regression analyses identified specific factors associated with risky health behaviors. Results: Participants (60% male; Mage = 27; 70% White; 14% Black) included 100 patients with primary diagnoses of lymphoma (N = 45); leukemia (N = 37); sarcoma (N = 10); other (N = 8). Median time from cancer diagnosis was 2 years (range 6 months - 20 years). Past year alcohol, cigarette, and marijuana use was reported in 80% ,15%, and 33% of participants, respectively. We classified three subgroups based on past year alcohol and smoking, including non-smoker/non-drinker (n = 20), non-smoker/drinker (n = 65), and smoker/drinker (n = 15). Linear trend analyses indicated that the groups did not differ on time since diagnosis, but the smoker/drinker group initiated drinking younger (p< 0.01), were more likely to use marijuana in the past year (p< 0.01), and had increased depressive symptoms (CES-D; p< 0.01), anxiety (STAI-T; p< 0.05), body pain (p< 0.05), and poorer sleep quality (p< 0.05). Backward model selection treating outcome categories as ordinal indicated that frequent marijuana use and poor sleep quality were associated with being a past year smoker/drinker. Conclusions: A sizable portion of AYA cancer patients engage in drinking and smoking, which is associated with negative affect and poorer self-reported health. Targeted interventions should be considered to reduce risky behaviors in this population.


Smith, L.J., King, A.C., Lin, X., Hedeker, D., & Henderson, T.O. (2017). Modifiable risk behaviors in adolescents and young adults (AYA) with cancer.  Journal of Clinical Oncology 35S, Abstract e18095.