Mental Health Outcomes Among Long‐Term Survivors of Childhood, Adolescent and Young Adult Cancer: A Scottish Population‐Based Cohort Study

Background

Survivors of cancer face increased risks of long‐term morbidity compared to people without a cancer history.

Aims: To quantify the long‐term burden of mental health morbidity and to evaluate the healthcare settings in which these events are identified in long‐term Scottish cancer survivors diagnosed before 40 years of age.

Methods

Five‐year survivors of cancer diagnosed before 40 years of age in the Lothian region of Scotland between 1980 and 2018 ( n  = 8862) were matched (1:3) to individuals without cancer history by age, sex, and socioeconomic deprivation ( n  = 26,586). Mental‐health outcomes were identified from psychotropic drug prescribing, hospital admission and general‐practice records. Time to first mental health event was analysed using time‐stratified Cox proportional‐hazards models.

Results

During median follow‐up of 14.8 years for survivors and 16.7 years for comparators, 2983 survivors (33.7%) and 6774 comparators (25.5%) experienced a first mental health event. Around 90% of first events were identified in general practice or prescribing records, and fewer than 10% in hospital admissions. Survivors had a consistently higher incidence of first mental health events across follow‐up intervals when all data sources were considered, with hazard ratios ranging from 1.3 in the first year after study entry (95% CI 1.2–1.4) to 1.5 beyond 15 years (95% CI 1.4–1.6).

Conclusions

Integrating data sources provides a more comprehensive assessment of the mental health burden than hospital records alone. Mental health should be a core component of long‐term survivorship care, particularly within primary care, and cost‐effective strategies are needed to address the sustained excess burden.