This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
A study of more than 800 young people with cancer found that those whose diagnosis took longer were at increased risk of anxiety, depression and reduced quality of life.
Thinking you have cancer symptoms, or being told by a GP that you may have cancer (before a confirmed diagnosis), can be frightening. In adults, a long wait before receiving a cancer diagnosis is thought to harm mental health. There is little research in teenagers and young adults on the impact of the time it takes to get a cancer diagnosis.
The BRIGHTLIGHT study included 830 young people aged 12 – 24 years, and was carried out in England between 2012 and 2014. Researchers found that a wait of 2 months or more to see a specialist (from first noticing symptoms) was linked to reduced quality of life and depression. Having 3 or more GP appointments before being referred to a specialist was linked to reduced quality of life and anxiety. Delays in seeking help (the period between the first symptoms and seeing a GP for the first time) was linked with depression.
Speeding up the diagnostic process for teenagers and young people with cancer could reduce the impact on their mental health, the researchers say. However, this could be difficult to achieve in practice. Providing emotional support to this group while they wait, or shortly after diagnosis, may help.
The data from this study are almost 10 years old, so the speed of diagnosis and the experiences of young people may have changed since.
More information on cancer in teenagers and young adults is available on the NHS website.
What’s the issue?
Cancer remains rare in young people. However, according to the UK Health Security Agency more than 2,000 people aged 15 – 24 years receive a cancer diagnosis each year. The numbers surviving 5 years after being diagnosed has increased in all age groups. However, improvements among young people have been less than in other groups.
Young people often have many consultations and investigations before receiving a diagnosis. This is due to the rarity of cancer in this age group and the fact that the cancers young people typically present with, such as lymphomas, bone and soft tissue sarcomas, and brain tumours, are also rare. Common cancers, such as breast or colorectal, are not seen often in this group.
A cancer diagnosis interrupts young people’s social and psychological development, education and employment. Coping with cancer can be especially difficult when they are going through life changes, such as studying at university. Longer times to diagnosis adds to this disruption and worry. Improved diagnostic experiences (including the time to diagnosis) is a priority for young people.
Before this study, there was little research among young people on the relationship between time to a cancer diagnosis, mental health and quality of life. This analysis was part of the BRIGHTLIGHT study, which had the original aim of determining whether specialist cancer care for teenagers and young adults influences quality of life.
What’s new?
The BRIGHTLIGHT study was carried out at 97 hospitals in England. Young people who received a new cancer diagnosis between 2012 and 2014 were asked about their experiences of cancer care a few months after their diagnosis, then several more times over the next 3 years.
This analysis looked at the association between time to diagnosis and quality of life, depression, and anxiety. It took into account age, ethnicity, deprivation and other relevant factors. In all, 830 participants (aged 12 – 24 years) completed interviews; their average age was 20. More than half (55%) were male, and most were White (88%).
The researchers found that young people were twice as likely to have a lower quality of life if they:
- waited 2 months or more between first symptom and first appointment with a cancer specialist (compared to seeing a cancer specialist within 2 months); this also doubled their risk of depression
- had 3 or more GP appointments prior to referral (compared with fewer than 3 consultations); this also doubled their risk of anxiety.
Young people who waited a month or more between first symptom and seeing their GP also had twice the risk of depression (compared to those who sought help within a month).
Why is this important?
Longer times to cancer diagnoses were associated with lower quality of life, anxiety, and depression. The researchers say this was the first large study of the psychological and quality of life experiences of times to diagnosis among young people.
Young people experience longer times to cancer diagnosis than children or adults, the researchers say. In this study, more than one in 3 (35%) had 3 or more GP consultations before they were referred.
This study highlights the need to speed up the diagnostic process. However, this is challenging as cancer is uncommon in young people. We do not know enough about how symptoms develop, or how to help professionals identify potential symptoms and refer them for further tests. A multi-pronged approach will be needed, involving patients, healthcare professionals, biological scientists and healthcare systems.
What’s next?
Developing interventions to speed up cancer diagnoses is challenging. However, this study suggests that interventions such as psychological support could improve the mental health of young people who have longer times to diagnosis.
The time taken for cancer to be diagnosed and the experiences of young people may have changed in the 10 years since the data were collected. More GP consultations are now carried out online, for example. Whether this has had an impact on cancer diagnoses for young people is not yet known. The BRIGHTLIGHT team is planning to explore whether times to diagnosis have changed for young people since 2012 – 2014.
You may be interested to read
This Alert is based on: Forster A, and others. Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: cross-sectional analysis of the BRIGHTLIGHT cohort. British Journal of Cancer 2022; 126: 1725–1734.
Times to cancer diagnosis in young people: Herbert A, and others. Diagnostic timeliness in adolescents and young adults with cancer: a cross-sectional analysis of the BRIGHTLIGHT cohort. Lancet Child and Adolescent Health 2018; 2: 180–190.
Presenting symptoms in young people with cancer: Koo MM and others. Association of Self-reported Presenting Symptoms With Timeliness of Help-Seeking Among Adolescents and Young Adults With Cancer in the BRIGHTLIGHT Study. Journal of the American Medical Association Network Open 2020; 1; 1–11.
A study examining cancer diagnosis in young people: Dommett RM, and others. Achieving a timely diagnosis for teenagers and young adults with cancer: the ACE “too young to get cancer?” study. BMC Cancer 2019; 19: 616.
Cancer information for young people and their families from The Teenage Cancer Trust, including advice and resources to help with mental health, nutrition, exercise, staying creative and keeping busy.
Funding: This study was funded by Teenage Cancer Trust, Cancer Research UK and an NIHR Programme Grant for Applied Research.
Conflicts of Interest: None declared.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
