Occupied with Cancer: Trajectories of Employment/Education and Psychological Distress among Socioculturally Diverse Adolescent and Young Adult Cancer Patients

Author(s): Cheung, Christabel Kar-Yin | Advisor(s): Schilling, Robert; Zebrack, Bradley J | Abstract: The primary question that this dissertation research investigates is how trajectories of employment/education and psychological distress are characterized across two years following a cancer diagnosis among socioculturally diverse adolescent and young adult (AYA) patients, and whether and how change in occupational status is associated with psychological distress over time. Within this overarching question, the researcher examines the following specific aims: (1) To identify longitudinal trajectories of psychological distress (Bonanno, 2004) among AYA cancer patients across two years following initial cancer diagnosis, and depict the association between psychological distress and treatment status, health status, and sociocultural factors; (2) To examine the relationship between theoretical trajectories of occupational status and psychological distress across two years after initial cancer diagnosis among AYA cancer patients, including examination of treatment status, health status related to readiness to work, and sociocultural factors. The study used the HopeLab longitudinal dataset (Zebrack et al., 2013), a prospective longitudinal study of 215 AYA cancer patients ages 14-39 years across two-years following a cancer diagnosis, from three institutions: University of Southern California/Children’s Hospital Los Angeles, University of Texas Health Science Center at San Antonio, and Oregon Health and Science University. The methodology included descriptive results to define and characterize trajectories of occupational status and trajectories of psychological distress, bivariate results to test hypothesized associations with psychological distress trajectory, and linear mixed modeling for multivariate analyses of change in psychological distress over time.The overall trend in psychological distress among AYA cancer patients across the two-year observation period formed a U-shaped curve that bottomed out at 6-month follow-up, then climbed to its highest level at 24-month follow-up. On average, psychological distress at 24-months following cancer diagnosis was worse than at baseline. Furthermore, theoretical trajectories of occupational status among AYA cancer patients are identified and named. Multivariate results indicated that being male and being Non-White were each significantly associated with increased psychological distress among AYA participants, while being on treatment and having fatigue were associated with decreased psychological distress. Consistent with the building body of knowledge on mental health among AYA cancer patients, this dissertation research contributes longitudinal findings that expand the limited available evidence on occupational status change and psychological distress among socioculturally diverse AYA cancer patients. Future research should investigate ways to support the mental health of cancer patients who must maintain education/employment roles following a cancer diagnosis, with more specificity related to various occupational and sociocultural contexts.