Cancer survivors' psychosocial outcomes: a population-based investigation of anxiety, depression and unmet needs at six to twelve months post-diagnosis

This thesis comprises five papers exploring important issues concerning the psychosocial wellbeing of survivors in the late treatment to early survivorship phase of the cancer continuum. A population-based longitudinal survey of the psychosocial wellbeing of 1360 adult cancer survivors diagnosed with one of the eight most incident cancers in Australia was undertaken. The cohort was recruited from two state-based cancer registries, and surveyed at six and twelve months post-diagnosis. Outcome measures assessed survivors’ self-reported anxiety, depression and unmet supportive care needs. The individual, disease, treatment, health behaviour, psychological and social factors associated with these outcomes were assessed by self-report and linkage with registry records. In the aftermath of diagnosis and treatment, cancer survivors demonstrated an extraordinary ability to cope with and adjust to the psychosocial issues they were confronted with. Surprisingly few survivors reported psychosocial morbidity. Rather, survivors defied expectations and demonstrated considerable resilience in the face of adversity. Cancer survivorship is a rapidly growing field of research and service delivery. That the present circumstances enabled most survivors to recover well should not be underestimated or disregarded in the debate about the optimal allocation of scarce resources to survivorship care relative to the other phases of the cancer control continuum. The survivors who participated in this research generously documented their wellbeing and shared their cancer journeys. One of the challenges is to harness and make use of the goodwill of the growing population of cancer survivors to reduce the burden imposed by cancer.