A new study by UNSW Sydney medical researchers has shown that young cancer survivors struggle to imagine their future lives in detailed ways—one of the factors putting them at increased risk for mental health disorders later in life.

The study in 77 young cancer survivors and 62 young people who had never had cancer was published this week in the journal Psycho-Oncology. It examined whether aspects of autobiographical thinking (eg, memories, imagining the future) were linked with young people’s current distress and quality of life.

“How people think about themselves and their lives—their sense of self in the context of their life story—is strongly linked with people’s vulnerability to several mental health disorders, including clinical depression, post-traumatic stress disorder, and complicated grief,” study lead Dr. Ursula Sansom-Daly from UNSW says.

“In particular, people who are less able to remember their personal past in clear, detailed ways, and can’t imagine personal future events in similarly detailed, vivid ways, are more at risk for these disorders.”

Given how crucial identity development is for young people, the research team hypothesized that these same psychological processes may be crucial to how vulnerable young people may be for later distress.

“We found that compared with their peers who had never had cancer, young cancer survivors remembered their pasts in more negative, illness-focused, and vivid ways,” Dr. Ursula Sansom-Daly says.

“Cancer survivors’ imagined future lives were still more illness-focused than their cancer-free peers, but survivors were less able to imagine their futures with this same degree of specificity and detail.”

“This inability to imagine future events in specific or detailed ways is likely to place young people at risk for poor mental health down the track, as the ability to imagine personal future events with a great degree of detail is a skill that is vital to effective problem-solving, for instance,” Dr. Sansom-Daly explains.

The team’s analysis also indicated that survivors who were female identified more with the label of ‘cancer survivor,’ currently had worse depression, and finished cancer treatment more recently, were also more likely to show these problematic autobiographical thinking processes.

“It is possible that young cancer survivors who have recently experienced life-threatening illness may avoid thinking about their futures in great detail because this is anxiety-provoking to them,” Dr. Sansom-Daly says.

“Our findings suggest that helping young cancer survivors to learn to imagine their future lives in detail-rich ways may be protective against future distress.”

Adolescents and young adults with cancer are a unique group. Their adult coping skills are still in development, their identities are ‘under construction,’ and as a group, they are the most vulnerable to mental health disorders relative to older adults.

Going through a cancer experience on top of this can leave them more at risk for negative mental health impacts in the aftermath of their cancer experience.

“It is important to try and understand which young people may be most ‘at risk’ for severe distress following cancer, so that intervention efforts can be most effectively targeted at those most in need,” Dr. Sansom-Daly says.

“To date, research aimed at understanding this has often focused on medical factors, such as the type of cancer or treatment a young person experienced. This leaves a big gap in knowledge—these medical factors don’t always account for the distress young people experience.”

“We also need to understand more about psychological factors that predict why some young people experience worse mental health than others in survivorship, as these types of factors are modifiable—meaning we can treat them with evidence-based psychological therapies,” Dr. Sansom-Daly concludes.