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National Cancer Institute

Psychological Late Effects of Cancer Diagnosis and Treatment

Michael Andrykowski, Ph.D.
University of Kentucky College of Medicine
Lexington, KY

  • Psychological late effects present after the conclusion of primary treatment for cancer and can include stress, anxiety, depression, and social isolation. Positive late effects also are observed in some patients; this is termed "posttraumatic growth" and includes enhanced self-esteem, a greater sense of peace, and enhanced relationships. Positive and negative late effects can coexist in the same person.
  • Challenges to measuring the prevalence of distress in survivors include how to define and measure "distress;" a lack of large, population-based studies; lack of appropriate control groups; differences in the point in the cancer trajectory at which stress is assessed; and difficulties in assessing psychological disorders in the milieu of comorbid conditions.
  • A patient's risk for distress is a dynamic balance between stress and the burden of the cancer experience itself (encompassing physical, emotional, financial, and interpersonal aspects) and access to resources for coping. These resources include the intrapersonal (sense of optimism, resiliency), interpersonal (social support), informational (awareness of late effects and sources for assistance), and tangible (financial, access to mental health services). Positive late effects similarly reflect the balance between stress and challenges of cancer and available coping resources.
  • The National Comprehensive Cancer Network (NCCN) has developed guidelines for monitoring and managing distress. The group recommends that all survivors be screened periodically for distress using the "distress thermometer"-a rating of 5 or more indicates moderate to severe distress and should trigger a referral for further evaluation and possible treatment.

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