Exploring the Intersection of Sex and Age at Diagnosis: Implications for Psychosocial Well-Being in Childhood and Adolescent Cancer Survivors

Background and Purpose: Understanding the impact of cancer from the perspectives of childhood and adolescent cancer survivors is considered a critical predictor of psychosocial well-being and quality of life. While research on developmental age at cancer diagnosis has primarily focused on the distinct biomedical and psychosocial differences between childhood and adolescent survivors, studies on the influence of sex and developmental age at diagnosis are sparse. This study explores how being biologically female and diagnosed with cancer during adolescence interact to predict both positive (e.g., health literacy, socializing) and negative impacts of cancer (e.g., life challenges, financial problems) compared to other survivor groups.

Methods: Using secondary data from a childhood and adolescent survivorship clinic in the U.S. Pacific Northwest collected from 2009-2019, reports from 470 participants diagnosed and treated between ages 0-19 were analyzed. Hierarchical OLS regression assessed the predictive power of demographic and environmental factors, including interaction effects, on negative and positive impacts of cancer measured by the Impact of Cancer – Childhood Survivors Scale (IOC-CS). Designed to assess the wide-ranging effects of cancer on survivors diagnosed in childhood, the IOC-CS notably incorporated survivor, healthcare professional, and researcher perspectives in its development. The IOC-CS consists of 45 items in which participants endorsed their experiences and perceptions of the impact of cancer on a 5-point Likert scale (1 = No impact at all, to 5 = Great impact). The negative impact of cancer (NIOC) includes 20 items organized by three subscales: life challenges, thinking and memory problems, and financial problems; the positive impact of cancer (PIOC) consists of 25 items grouped with five subscales: health literacy, socializing, body and health, talking with parents, and personal growth. This approach ensures the IOC-CS accurately reflects the unique challenges and multidimensional experiences of childhood cancer survivors, covering physical, emotional, social, and existential/spiritual impacts.

Results: Participant ages ranged from 14 to 55 (mean = 26.7, SD = 7.3); 79% were childhood, and 21% were adolescent cancer survivors. Just under half of participants were identified as female (49%, n = 230). There were 344 (73%) non-Hispanic White/Caucasian cancer survivors (vs. n = 100, 21% non-white). Hematological cancers accounted for 60% (n=283), CNS/brain tumors accounted for 11% (n=52), while solid and soft tissue tumors and other cancers accounted for 29% (n=135). Hierarchical OLS regression models revealed that the interaction effect of being a female survivor and diagnosed during adolescence significantly predicted a decreased PIOC (β = -0.21, p < 0.00) indicated by decreased health literacy, socializing, body and health, talking with parents, and personal growth after controlling for years since diagnosis and other demographic and environmental factors.

Conclusions: Findings highlight distinct experiences for female survivors diagnosed during adolescence and an opportunity for social workers and healthcare professionals to integrate these identities into psychosocial responses in support of this group. Furthermore, it is essential for social workers and healthcare professionals to develop and/or strengthen assessment tools like the IOC-CS to consider gender and developmental life course while also considering intersecting influences of socioeconomic status, culture, and family dynamics.