The Effect of Pediatric Cancer on Identity in Young Adult Survivors: Results from Project REACH

Living through cancer can have a profound effect on identity. Among those treated for adult-onset cancer, identifying as a cancer survivor is common and has been linked to positive mental and physical health outcomes. Although childhood is a critical period for identity formation, comparatively less is known about identity development after pediatric cancers. One hundred seventy young adults previously treated for pediatric cancer enrolled in Project REACH, a prospective cohort study, and completed self-report measures on effect of cancer on identity (e.g., cancer victim and survivor identity), frequency of thoughts of cancer, health outcomes (i.e., anxiety, depression, and health-related quality of life), and health behaviors (i.e., smoking, sun protection, exercise, and binge drinking). The majority of participants identified as a survivor (n = 146, 85.9%), and survivor identity was linked to significantly higher anxiety (p = 0.01) and worse overall mental health (p = 0.04), but no other health outcomes or behaviors. Only 14 participants (8.2%) endorsed the victim identity, and they were significantly more likely to report binge drinking (p = 0.03) and worse overall mental health (p = 0.02) than nonvictims. Frequency of thoughts of cancer and effect of cancer on identity were also significantly associated with health outcomes (e.g., more frequent thoughts associated with higher anxiety). Our findings suggest that what is known about the relationship between identity and health outcomes after adult-onset cancer cannot be generalized to pediatric cancers, and that clinicians should not assume survivor identity is associated with better health outcomes in this group.