Psychological effects of cancer in young and middle adulthood

When Kate Middleton announcedopens in new window she had been diagnosed with cancer in early 2024, the Princess of Wales described the news as “a huge shock.” After all, she is just 42 years old, and the vast majority of cancers (about 80%) are diagnosed in people over age 50, the American Cancer Societyopens in new window reports. 

Middleton is not the only household name to face cancer at a surprisingly young age. Black Panther star Chadwick Boseman shook fans and colleagues when he, without public warning died from colorectal cancer at age 43 in 2020.

And in March, actress Olivia Munn, 43, revealedopens in new window she had been diagnosed with an aggressive, fast-moving breast cancer, and had undergone a double mastectomy and hysterectomyopens in new window. “Cancer doesn’t care who you are; it doesn’t care if you have a baby or if you don’t have time,” Munn told People magazineopens in new window in April. 

While increased awareness of the growing rates of cancer in younger populations is important, psychologists say the conversation needs to go beyond an emphasis on early detection. Understanding how the disease uniquely affects younger adults’ mental health, and learning how to treat this population’s specific psychological side effects, is critical too.

“Reports often do not adequately address the profound psychosocial impact of cancer on younger adults,” said epidemiologist Ola Abdelhadi, PhDopens in new window, a postdoctoral researcher at University of California, Berkeley’s School of Public Health who studies how health policies affect disparities in care, quality of health care services, and associated costs for younger cancer patients.

“This age group faces unique emotional and psychological challenges, including disruptions to their education, career, social relationships, and future planning,” continued Abdelhadi, who was diagnosed with cancer at age 19 and had a recurrence at age 30. “The emotional toll and the need for specialized mental health support are frequently underreported.”

That’s where psychologists are stepping in, said Julienne Bower, PhDopens in new window, a professor and chair of health psychology at the University of California, Los Angeles (UCLA). “We are getting to a place where we’re really being more mindful of the unique needs of this population, and so it’s really an exciting time for psychologists to be working in this area because there are a lot of opportunities for growth,” she said.

While a cancer diagnosis can be devastating at any age, it may affect younger adults’ mental health—and lives—more significantly and with more persistence over their lifetimes. One study, for instance, found that survivors who had been diagnosed between 15 and 39 years old had greater emotional distress than those who had been diagnosed at age 40 or older (Boakye, E. A., et al., Annals of Epidemiology, Vol. 72, 2022opens in new window).

“This is when they’re finishing their education, they’re working to build their careers, they’re initiating romantic relationships, getting married, thinking about having children. They’re not necessarily as financially stable as an older individual might be,” said Caroline Dorfman, PhDopens in new window, director of Research and Behavioral Medicine for the Teen and Young Adult Oncology Program at Duke. “And so when they are diagnosed with cancer, there are a lot of different things that they need to take into account.”

One of those things is getting an accurate and timely diagnosis to begin with. Because health care providers are not typically expecting to find cancer in their younger patients, the route to an answer is often “prolonged” and “convoluted,” authors of a study in the British Journal of Cancer found. And the longer it takes to get a diagnosis, the higher the risk of depression, anxiety, and impaired health-related quality of life, the research showed (Forster, A., et al., British Journal of Cancer, Vol. 126, 2022opens in new window).

Compounding that distress is the financial toll of cancer treatment on people who have not had much time to build up savings. Sadly, this puts fertility preservation out of reach for many. Egg freezing, for instance, is not always covered by insurance and costs around $10,000, according to Minnesota Oncologyopens in new window.

Because of such costs, 23% of adolescent and young adult cancer survivors said they lacked money for basic necessities, one study found. Nearly half took on credit card debt and put off major purchases. Even many years after treatment, younger cancer survivors have not “caught up” with their peers financially or in the workplace, said Cristina Pozo-Kaderman, PhDopens in new window, a senior psychologist at Dana-Farber Cancer Institute where she directs the Young Adult Program (Thom, B., et al., Journal of Cancer Survivorship: Research and Practice, Vol. 17, No. 6, 2023opens in new window).

Abdelhadi can relate. “There were times when I felt I was falling behind or missing out on life milestones,” she said. “However, this experience positively shifted my interest and passion toward cancer research.”

Despite the real mental and physical toll of developing cancer at younger ages, many patients find clarity through the process, experts say. Some say they are no longer going to work 60-hour weeks. Some become more adept at setting boundaries. Some are inspired to take better care of their health. 

“Patients in this age range are actually incredibly resilient,” Dorfman said. “When given the right tools and attention and the permission to not be OK, they actually do really well.”

Here are some of those tools.

1. Peer Support

Connecting with other cancer patients or survivors in the same life phase can ease a sense of isolation. Dana-Farber’s Young Adult Program, for one, offers programming for cancer patients from ages 18 into their early 40s, ranging from the educational (like sessions on how to advocate for oneself) to the purely fun (like Red Sox outings and book clubs). The program recently opened a lounge for this age group.

“The program provides many different ways for our young adults to connect, realizing that peer connection is critically important for them,” Pozo-Kaderman said.

2. Cognitive Behavioral Therapy

Dorfman and colleagues are testing a group-based interventionopens in new window, delivered via videoconferencing, that draws on cognitive behavioral therapy (CBT) and other approaches and is catered to the specific needs of young adult cancer survivors. While the project is ongoing, Abdelhadi says tailored interventions like it work.

“CBT that focuses on the unique concerns of young adults, such as body image issues, independence, and life planning, can be highly effective,” she said. “This therapy helps patients develop healthy coping strategies and manage distressing thoughts and emotions.”

3. Acceptance and Commitment Therapy

Researchopens in new window shows that younger cancer patients experience fear of recurrence more often than patients over 40 years old. This could be related to the fact that younger patients have both more time for the cancer to recur and more future life milestones those potential recurrences threaten to disrupt.

For this and other concerns, acceptance and commitment therapyopens in new window is a promising intervention that aims to help people accept reality (like that recurrence is possible) while living mindfully and in line with their values.

4. Mindfulness Interventions

At UCLA, Bower and colleagues have been testing the effectiveness of mindfulness-based interventions on breast cancer survivorsopens in new window under 50. They’re finding that programs, like a 6-week mindfulness group course that helps participants manage physical and emotional discomfort, might not only improve stress, depression, and other symptoms but may also lead to positive changes in the immune system and overall well-being. 

5. Meaning-Centered Therapy

Meaning-centered psychotherapyopens in new window, developed by psychiatrist William Breitbart, MD, at Memorial Sloan Kettering Cancer Center, which aims to enhance patients’ sense of meaning and purpose, has been shown to effectively reduce psychological and spiritual distressopens in new window among adult cancer patients.

There is reason to believe variations of it work well among younger adults with cancer. In one study in the Journal of Adolescent and Young Adult Oncology, cancer patients and survivors between ages 17 and 36 went through a 10-week program that prompted them to post photos on social media and answer related questions like “How has cancer changed who I am?” The researchers found participants had significantly lower depressive symptoms and a significantly better quality of life both at the end of the 10 weeks and 2 months later (Pailler, M. E., et al., Journal of Adolescent and Young Adult Oncology, Vol. 9, No. 4, 2020opens in new window).

These patients “do want to have meaning in their life. They do want to form relationships. They do have goals that they want to set for their life in their future,” Dorfman said. “And that’s where psychologists can really come in—to help them live their life in a way that is meaningful and in line with their values, even in the midst of a potentially life-limiting illness.”