UC Irvine

Given significant advancements in cancer treatment, close to 85% of children and adolescents diagnosed with cancer have long-term survival. In the United States, there are approximately 500,000 childhood cancer survivors looking forward to many years ahead. Yet, the aftermath of cancer poses substantial challenges, including cancer-related late effects, psychosocial struggles, and financial burdens. The objective of this dissertation is to further our understanding of life milestones (e.g., employment, educational attainment, living arrangement, relationship status) and cancer-related late effects among Young Adult Childhood Cancer Survivors (YACCS) using a population-based sample from the Los Angeles Cancer Surveillance Program, the Surveillance, Epidemiology, and End Results (SEER) Cancer Registry covering Los Angeles County.Study 1 aimed to examine the prevalence of life milestones among YACCS and non-cancer population-based cohort controls. The study conducted a matched-cohort case control to compare YACCS and a non-cancer comparison group from the California Health Interview Survey (CHIS) (matched by age, sex, year of survey, and race/ethnicity) on the prevalence of life milestones (e.g., full-time employment, educational attainment, living independently, relationship status). The results showed that YACCS were less likely to have a college degree, have a full-time employment, and married/partnered compared to their peers without a cancer history. In contrast, they were more likely to be unemployed, have a part-time employment, and live with a parent. The objective of study 2 was to assess the relationship between delays in achieving life milestones and depressive symptoms over time in YACCS. The study used linear regression model with depressive symptoms as the outcome variable and delay in life milestone as the exposure variable. Delays in educational attainment was a significant predictor of depressive symptoms, even when demographic factors and baseline depressive symptoms were controlled. The aim of study 3 was to identify the subgroups of YACCS based on their cancer-related late effects and how each subgroup is associated with life milestone achievement. The study used latent class analysis and logistic regression models. The latent class analysis revealed multimorbidity group and resilient group based on cancer-related late effects reported by the survivors. The multimorbidity group were less likely to have a college degree and be employed full-time compared with the resilient group after adjusting for demographic factors, years since diagnosis, and treatment intensity. This research is a population-based study that utilizes a diverse sample of recently treated YACCS in Los Angeles County. It offers valuable insights into their post-cancer experiences during a period marked by medical and treatment advancements in childhood cancers. The significance of this research lies in its potential to positively impact cancer survivorship research by enhancing our understanding of the risk and protective factors that affect the achievement of life milestones among YACCS. It also offers a window into the long-term effects of childhood cancer on the social determinants of health and wellbeing. The findings from this study not only contribute to the existing body of knowledge but also lay the groundwork for future research aimed at developing targeted interventions. These interventions will be tailored to the age-specific needs of survivors, focusing on promoting social integration and independence, which are pivotal in securing a high-quality survivorship experience.