Illness Perceptions and Emotional Health in Adolescent Cancer Survivors: Exploratory Associations With Mindfulness

Adolescent cancer survivors report greater levels of anxiety, depression, and poorer quality of life compared to healthy controls. Survivors' illness perceptions and cognitive coping strategies may be modifiable risk factors to mitigate poor emotional health in this population. This study examined the roles of illness perceptions and mindfulness in emotional health among survivors transitioning off active cancer therapy.

Adolescent survivors (n = 48; mean age = 14.42; standard deviation [SD] = 1.89; 75% White; 94% non-Hispanic; 35% hematologic tumor; 33% central nervous system [CNS] tumor; 31% solid tumor) completed measures of illness perceptions, mindfulness, anxiety, depression, and quality of life. Multivariable models examined associations between illness perceptions and anxiety, depression, and quality of life in survivors, adjusting for relevant covariates. Exploratory indirect effects between illness perceptions and emotional health outcomes via mindfulness were also examined.

Negative illness perceptions were significantly associated with greater anxiety (b = 0.35, β = 0.37, 95% confidence interval [CI] [0.08, 0.62], p = 0.01), greater depression (b = 0.53, β = 0.54, 95% CI [0.27, 0.79], p < 0.01), and lower quality of life (b = -0.72, β = -0.50, 95% CI [-1.09, -0.34], p < 0.01). Indirect effects through mindfulness completely explained the relationship between illness perceptions and anxiety (β = 0.26, 95% CI [0.05, 0.45]) and partially explained the relationship between illness perceptions and depression (β = 0.23, 95% CI [0.06, 0.40]), as well as the relationship between illness perceptions and quality of life (β = -0.15, 95% CI [-0.33, -0.02]).

Illness perceptions are a promising modifiable target for adolescent survivors struggling with poor emotional health at the end of treatment. Mindfulness emerged as a possible mechanism through which illness perceptions are associated with emotional health outcomes, and highlights the potential value of incorporating mindfulness-based strategies into survivorship care.